| Payment ID | 6257 |
|---|---|
| Date Created | 08/22/22 1:13 pm |
| Created By | Gloria Jimenez |
| Service Request | |
| Application ID | 2995 |
| Authorization Number | |
| Applicant Information | |
| Name | John Robert |
| 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 | 16170300289 |
| Payment Type | Short-Term Hotel/Motel Stays |
| Payment Details | |
| Receipt Amount | $250.00 |
| Receipt Date | 08/10/2022 |
| Comments | extended stay at Sandman hotel departure date is 8/22/2022 |
| Receipt | 6257-Robert.pdf |
| Staff Name | Gloria Jimenez |
| Case Manager | AL |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 08/22/2022 |
