| Payment ID | 8758 |
|---|---|
| Date Created | 09/26/22 2:46 pm |
| Created By | Gloria Jimenez |
| Service Request | |
| Application ID | 5378 |
| Authorization Number | |
| Applicant Information | |
| Name | Christopher Cline |
| 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 | 16171100496 |
| Payment Type | Short-Term Hotel/Motel Stays |
| Payment Details | |
| Receipt Amount | $1,450.26 |
| Receipt Date | 09/26/2022 |
| Comments | hotel stay at Super 8 arrival date is 9/26/22 departure 10/10/22 |
| Receipt | 8758-Cline.pdf |
| Staff Name | Gloria Jimenez |
| Case Manager | LRE |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 09/26/2022 |
