314046 7/26/2017 a, �:` CITY OF CARMEL, INDIANA VENDOR: 00350028 *
ONE CIVIC SQUARE FRED GLASER CHECK AMOUNT: $-*kw,,,,300.00
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CARMEL, INDIANA 46032 10538CARMEL AKESHOR DR E CHECK NUMBER: 314046
".oN CHECK DATE: 07/26/17
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
301 5023990 07.24 .17 300.00 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:
Fredrick Glaser
10538 Lakeshore Drive East
Carmel, IN 46033
Amount: $300.00
Fund: Medical Escrow Fund (301)
Date: July 24,2017
Subm tied To
JUL 2 5 2017
Clerk Treasurer