HomeMy WebLinkAbout314063 7/26/2017 CITYOF CARMEL, INDIANA VENDOR: 371523 .......
CHECK AMOUNT: $ 300.00'
ONE CIVIC SQUARE MARLENE MILLER
: ao CARMEL, INDIANA 46032 13718 ROSWELL DRIVE CHECK NUMBER: 314063
,M CARMEL IN 46032 CHECK DATE: 07/26/17
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
301 5023990 07 .24 . 17 300.00 OTHER EXPENSES
0 n K < «
0 _0 0 0 ¢ / ¢ k C
# 2 I = r o
n
\ r- 3 Z ^ X
I n 2 2 q m
K0 z
o � o � E a O
% / § b b ® / \ q
\ 2 \
0 0 -0 0
E > E E X
O D
k \ \ k \ m §
� -0k
g # # a CL
k z
°
z
> z
m / 0 O
/ § E m |
/
8
%
3 , g L - 2 >
%
T. o k p I ? 0
k i n [ / \ § K
c § D ° ƒCA \
CD 2 { m # 2
E ƒ a ƒ , k
9 $ C f k -
§ 2
% / Z
/ en k a
% k
\ 7 k } _
® CL % k 0 k
I ƒ §
% & l
o /
@ � w0 « 7
m 4 m i - •
\CD ° , A 2
7 w k
, ; » CT
2 § k $
�® 0 0
\ E
22 0 -n < m m
}} \ o ¥ 0 k
gym ƒ C R
RE � -4 \ Z >
mn m 4 q §
§
:E =r
\ i /
�0
eo E }
}/ ( \
)/ 0) o D 0 a «
D
dCD0
/ 0 0 E / c *
CD M \ ] } CD
( C
CD CD$ /}
¥ 0) � _0 } g 2: \
kCL
0 / 7 \ X \
\
13 CD CD
z
k / �
- CD c
0 .
C Z ° \
City of Carmel Employee Health Benefit Plan
Health Savings Account Incentive
The retired plan participant listed below has elected Plan A for 2017 and is eligible for a bi-
annual contribution to his or her HSA account, as authorized by Resolution BPW-10-03-12-02.
Payroll: Please return check to Human Resources for distribution
Plan Participant/Payee:
Marlene Miller
13718 Roswell Drive
Carmel,IN 46032
Amount: $300.00
Fund: Medical Escrow Fund (301)
Date: July 24,2017
Subrnl`ted To
JUL 2 5 2017
Clerk Treasurer