HomeMy WebLinkAbout314075 7/26/2017 +W Coq*
>^ '� CITY OF CARMEL, INDIANA VENDOR: 00351588 CHECK AMOUNT: $*****"*400.00*
D ONE CIVIC SQUARE RICHARD DUFEK
CARMEL, INDIANA 46032 1772 FALCON WAV CHECK NUMBER: 314075
BROWNSBURG IN 46112 CHECK DATE: 07/26/17
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
301 5023990 07 .24 .17 400.00 OTHER EXPENSES
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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:
Richard Dufek
1772 Falcon Way
Brownsburg,IN 46112
Amount: $400.00
Fund: Medical Escrow Fund (301)
Date: July 24,2017
Submitted To
JUL 2 5 2017
Clerk Treasurer