| Payment ID | 5055 |
|---|---|
| Date Created | 08/02/22 4:46 pm |
| Created By | Gloria Jimenez |
| Service Request | |
| Application ID | 925 |
| Authorization Number | |
| Applicant Information | |
| Name | Danielle Dominguez |
| 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 | 16170400112 |
| Payment Type | Short-Term Hotel/Motel Stays |
| Payment Details | |
| Receipt Amount | $300.00 |
| Receipt Date | 07/27/2022 |
| Comments | extended in Super 8 |
| Staff Name | Gloria Jimenez |
| Case Manager | DG |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 08/02/2022 |
