| Location: | Home  FLEX AND DEPENDENT CARE Enrollment Form 2012 FLEX AND DEPENDENT CARE Enrollment Form Properties |
| Location: | Home FLEX AND DEPENDENT CARE Enrollment Form 2012 FLEX AND DEPENDENT CARE Enrollment Form Properties |
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| 2012 FLEX AND DEPENDENT CARE Enrollment Form | |
| Handle: | Version-79980 |
| Owner: | Fuller, Tina (User-7387, tfuller:DocuShare)DS |
| Monday, March 19, 2012 09:34:21 AM EDT | |
| Wednesday, October 23, 2013 09:11:31 AM EDT | |
| Modified By: | Dickenson, Rhonda (User-8396, rhonda.dickenson:gvwfl)DS |
| - The employer maintains a Plan Document; if anything in this document conflicts with the Plan Document, then the Plan Document controls. - B. - FLEXIBLE SPENDING ACCOUNTS (FSAs) Please enter your FSA election(s) below. - Any choices above may be modified only as defined in the plan. - If a Beniversal® Prepaid MasterCard® is associated with my Flexible Spending Account: I authorize the issuance of a Beniversal Card by a bank chosen by Benefit Resource. - Signature: ________________________________________________________________________________ Date: _____ / _____ / _____ D. PAYROLL DEDUCTION I... | |
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| Appears In: | FLEX AND DEPENDENT CARE Enrollment Form |
