| Payment ID | 9586 |
|---|---|
| Date Created | 10/12/22 5:33 pm |
| 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 | $974.52 |
| Receipt Date | 10/11/2022 |
| Comments | hotel stay at Woodspring extended departure date 10/24/2022 |
| Receipt | 9586-Brandt.pdf |
| Staff Name | Gloria Jimenez |
| Case Manager | BJ |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 10/12/2022 |
