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Get Texas Dir Form Dwc 053

Cal mileage expense form Forma de gastos por distancia recorrida por visitas medica If you have to travel to get treatment for your work injury, you are entitled to re-payment of your travel costs. The mileage rate is 56.5 cents ($.565) per mile. Mileage for reasonable travel to the pharmacy, parking, bridge tolls, public transportation and other travel-related costs are also included. Complete this form. Attach receipts. Send the original to the insurance company and keep a copy. Do not send th.

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