| Payment ID | 6273 |
|---|---|
| Date Created | 08/22/22 2:04 pm |
| Created By | Gloria Jimenez |
| Service Request | |
| Application ID | 1202 |
| Authorization Number | |
| Applicant Information | |
| Name | Curtis Harris |
| 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 | 16170700142 |
| Payment Type | Short-Term Hotel/Motel Stays |
| Payment Details | |
| Receipt Amount | $553.00 |
| Receipt Date | 08/11/2022 |
| Comments | extended stay at Super 8 departure date is 8/21/2022 |
| Receipt | 6273-Harris.pdf |
| Staff Name | Gloria Jimenez |
| Case Manager | AL |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 08/22/2022 |
