| Payment ID | 3353 |
|---|---|
| Date Created | 06/30/22 11:45 am |
| Created By | Gloria Jimenez |
| Service Request | |
| Application ID | 570 |
| Authorization Number | |
| Applicant Information | |
| Name | Dwayne Martin |
| Agency Name | Homeless Coalition |
| Agency Code | 220213 |
| Agency | Homeless Coalition |
| Agency Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16170100081 |
| Payment Type | Short-Term Hotel/Motel Stays |
| Payment Details | |
| Receipt Amount | $553.00 |
| Receipt Date | 06/15/2022 |
| Comments | extended stay at Super 8. |
| Staff Name | Gloria Jimenez |
| Case Manager | YS |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 06/15/2022 |
