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Get Flexible Benefits State Of Tennessee Form

State of Tennessee Treasury Department 502 Deaderick Street Nashville TN 37243-0228 615- 741-3131 or 615-401-6815 fax www. tn.gov/treasury/flex FLEXIBLE BENEFITS PLAN YEAR REIMBURSEMENT REQUEST FOR MEDICAL EXPENSES AND DEPENDENT CARE EXPENSES Be sure to read the instructions on the back of this form before completing.

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