| Payment ID | 8408 |
|---|---|
| Date Created | 09/20/22 11:09 am |
| Created By | Gloria Jimenez |
| Service Request | |
| Application ID | 5298 |
| Authorization Number | |
| Applicant Information | |
| Name | Michael Brandt |
| 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 | 16171100487 |
| Payment Type | Short-Term Hotel/Motel Stays |
| Payment Details | |
| Receipt Amount | $1,268.63 |
| Receipt Date | 09/15/2022 |
| Comments | extended stay at woodspring paid on 9/15/22 departure date is 10/03/22 |
| Receipt | 8408-Brandt.pdf |
| Staff Name | Gloria Jimenez |
| Case Manager | BJ |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 09/20/2022 |
