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
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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:
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