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HomeMy WebLinkAbout314068 7/26/2017 ,+us CggMf �• CITY OF CARMEL, INDIANA VENDOR: 00353016 ONE CIVIC SQUARE BOB PELZER CHECK AMOUNT: S`"" '"300.00" ,? r4 CARMEL, INDIANA 46032 14350 WEEPING WILLOW COURT CHECK NUMBER: 314068 v CARMEL IN 46033 CHECK DATE: 07/26/17 ''JITON DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 301 5023990 07 .24 .17 300.00 OTHER EXPENSES 0 n ca < « k0 O / E k ? L:k ° # 2 0 -0 0 n \ 0 $ N ® m / n 2 m m o m O A / z / § � C / a o o Q n , m --% Q c k ƒ ƒ -n [ A � k { a k k n - o -Ti 0 O E D k \ \ E \ § § -UX / 8 > D CL 2 ? 2 $ > - O $ / 0 O [ § E m CD o z = o w _ J % 3 V # Er 10 ( k ( � 0 Er i { E 2 0 m H ° / \ / k E CD m 2 / E E 2 } ® 2 § $ ® ( f k - / a) 2 % 7 a Z J % � a m Q / o a G - q k o i ƒ f cu o ® q J J & F § - I ƒ Z § 3 a � ƒ � - -4 0 a ƒ 7 \_I w m o z s CA a o a A ` ° rr m - S k CDk cr i Dcn {/ ) / n ( o -n < a 0 /} § \ § ƒ � k QE w # % \ Z f mg m 4 ; § / %E k k \ �0 fƒ { }_$ (D \ k D §\ A0 @ « § 0 \ / 9.0 U / � � O ? a * z E ] % 3 ƒ C \ CD /_ 7 CD \ q B k R 2 CD _ _L M f 8 m ] CD \ z k / § - K co CD { C,) 0 . ƒ k C) k 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: Robert Pelzer 14350 Weeping Willow Court Carmel, IN 46033 Amount: $300.00 Fund: Medical Escrow Fund (301) Date: July 24,2017 Submit.-ted To JUL 2 5 2017 Clerk Treasurer