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Get FL Mileage Reimbursement Form

CE I hereby certify and affirm that the above mileage was incurred by me as necessary traveling expenses related ot those medical facility visits pursuant to my workers’ compensation case. An injured employee or any other party making a claim under Florida Statute 440.105(7) shall provide his or her personal signature attesting that he or she has reviewed, understands, and acknowledges the following statement: “Any person who, knowingly and with intent to injure, defraud, or deceive any emp.

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