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Get and Sign 19132a Form 2014
Reimbursement of the indicated expenses under my Health Spending Account. Spouse s family coverage - I wish to use my Health to cover the expenses that are not reimbursed under my group insurance. I recognize that I am responsible for paying any taxes that may result form the reimbursement of these expenses and that for tax or administrative purposes my plan administrator may have access to a statement of expenses for which I claimed a reimbursement under my Health Spending Account. C. P. 3950...
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