Salary Reduction Agreement. I hereby request the Treasurer to reduce my salary, on a pre-tax basis, by any Health Savings Account (HSA) contributions, Highmark FSA contributions and administrative fees, spousal costs*, and Pastor’s contributions** as applicable. (Please sign below even if no dollars are reduced from salary. Signature indicates you have read and understand this Election Sheet)
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Samples: Reduction Agreement, www.pen-del.org, www.pen-del.org