| Payment ID | 3933 |
|---|---|
| Date Created | 07/12/22 2:18 pm |
| Created By | Gloria Jimenez |
| Service Request | |
| Application ID | 2756 |
| Authorization Number | |
| Applicant Information | |
| Name | Byron Allen |
| Agency Name | Homeless Coalition |
| Agency Code | 220213 |
| Agency | Homeless Coalition |
| Agency Email Address | Email hidden; Javascript is required. |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16171100260 |
| Payment Type | Short-Term Hotel/Motel Stays |
| Payment Details | |
| Receipt Amount | $1,425.00 |
| Receipt Date | 07/06/2022 |
| Comments | hotel stay at Delta Inn for 30 days beginning 7/6/22 |
| Receipt | 06-07-2022Allen0.00.pdf |
| Staff Name | Gloria Jimenez |
| Case Manager | BP |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 07/12/2022 |
