| Location: | Home  FLEX AND DEPENDENT CARE Change Form 2012 FLEX AND DEPENDENT CARE Change Form Properties |
| Location: | Home FLEX AND DEPENDENT CARE Change Form 2012 FLEX AND DEPENDENT CARE Change Form Properties |
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| 2012 FLEX AND DEPENDENT CARE Change Form | |
| Handle: | Version-79975 |
| Owner: | Fuller, Tina (User-7387, tfuller:DocuShare)DS |
| Monday, March 19, 2012 09:35:07 AM EDT | |
| Wednesday, October 23, 2013 09:11:31 AM EDT | |
| Modified By: | |
| - The employer maintains a Plan Document; if anything in this document conflicts with the Plan Document, then the Plan Document controls. - Dependent Care FSA $ ______________ $ ______________ C. - MID-YEAR CHANGE INFORMATION Please check applicable event. - I authorize any election amount(s) above to be deducted from payroll as indicated. - Furthermore, I understand that if my Beniversal Card is used for expenses other than eligible medical expenses or if I violate the terms of the agreement, my account may be suspended and I will reimburse the ... | |
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| Appears In: | FLEX AND DEPENDENT CARE Change Form |
