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Affidavit of Health Care Expenses Mn  Form

Affidavit of Health Care Expenses Mn Form

Use a Affidavit Of Health Care Expenses Mn template to make your document workflow more streamlined.

Information, and belief the following is a list of the joint child(ren)’s unreimbursed or uninsured health care expenses for which the other parent has not paid his/her full share: Name of Joint Child Who Received the Care Date Care Was Provided (Limited to costs within the past 2 years) Name of Provider (doctor, dentist, clinic, hospital) If you need more space, add additional sheets of paper. FAM403 State ENG 5/11 Description of Medical/Dental...
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