| Payment ID | 7975 |
|---|---|
| Date Created | 09/12/22 4:37 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 | $158.00 |
| Receipt Date | 09/12/2022 |
| Comments | extended stay at Super 8 departure date is 9/14/2022 |
| Receipt | 7975-Abernathy.pdf |
| Staff Name | Gloria Jimenez |
| Case Manager | AL |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 09/12/2022 |
