| Payment ID | 4551 |
|---|---|
| Date Created | 07/26/22 1:53 pm |
| Created By | Gloria Jimenez |
| Service Request | |
| Application ID | 3159 |
| Authorization Number | |
| Applicant Information | |
| Name | Timothy Abernathy |
| 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 | 01868900300 |
| Payment Type | Short-Term Hotel/Motel Stays |
| Payment Details | |
| Receipt Amount | $2,370.00 |
| Receipt Date | 07/25/2022 |
| Comments | hotel stay at Super 8 arrival date 7/23/22 thru 8/22/2022 |
| Receipt | 25-07-2022Abernathy0.00.pdf |
| Staff Name | Gloria Jimenez |
| Case Manager | AL |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 07/26/2022 |
