314084 07/26/17 9�,c,1N'4
*� CITY OF CARMEL, INDIANA VENDOR: 370846
D ONE CIVIC SQUARE JAMES TONEY CHECK AMOUNT: $ .....300.00'
CARMEL, INDIANA 46032 6950 46TH AVENUE NORTH#5 CHECK NUMBER: 314084
9yiroN�, ST.PETERSBURG FL 33709 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:
James Toney
6950 46th Avenue North #5 USE THIS STREET ADDRESS
St. Petersburg, FL 33709
Amount: $300.00
Fund: Medical Escrow Fund (301)
Date: July 24,2017
Submitted To
JUL 2 5 2017
Clerk Treasurer