Loading
Form preview picture

Get LA LUBA Workers Compensation Mileage Claim Form

___ Employer:_____________________ List trip(s) taken such as home to doctor, home to hospital, identify doctor, pharmacy, hospital by name and address and return home Beginning Location Address Ending Location Address Round Trip Mileage Total Mileage Please complete and mail to: LUBA Workers’ Comp PO Box 98082 Baton Rouge, LA 70898-9082 I certify that the above information furnished by me is true and correct and based on such information hereby claim payment for the mileage indicated. S.

How It Works

louisiana workers comp mileage form rating
4Satisfied
22 votes

Tips on how to fill out, edit and sign Simple mileage reimbursement form online

How to fill out and sign LA LUBA Workers Compensation Mileage Claim Form online?

Get your online template and fill it in using progressive features. Enjoy smart fillable fields and interactivity. Follow the simple instructions below:

The days of terrifying complex legal and tax documents have ended. With US Legal Forms the entire process of filling out official documents is anxiety-free. A powerhouse editor is already close at hand offering you multiple useful tools for filling out a LA LUBA Workers Compensation Mileage Claim Form. These guidelines, combined with the editor will help you through the complete process.

  1. Click the orange Get Form option to begin modifying.
  2. Activate the Wizard mode on the top toolbar to get more tips.
  3. Fill out every fillable area.
  4. Be sure the info you add to the LA LUBA Workers Compensation Mileage Claim Form is up-to-date and accurate.
  5. Indicate the date to the document with the Date function.
  6. Click on the Sign icon and make an electronic signature. You will find 3 options; typing, drawing, or uploading one.
  7. Make sure that each and every area has been filled in properly.
  8. Select Done in the top right corne to save and send or download the document. There are many choices for getting the doc. An attachment in an email or through the mail as a hard copy, as an instant download.

We make completing any LA LUBA Workers Compensation Mileage Claim Form simpler. Use it now!

Get form

Experience a faster way to fill out and sign forms on the web. Access the most extensive library of templates available.

Video instructions and help with filling out and completing mileage request form

Get all you need for filling in, editing and e-signing your Form in a single place. Our quick and simple video guidelines take you from beginning to end.

Mileage reimbursement form template FAQ

Get This Form Now!

Use professional pre-built templates to fill in and sign documents online faster. Get access to thousands of forms.

If you believe that this page should be taken down, please follow our DMCA take down processhere.
Ensure the security of your data and transactions

USLegal fulfills industry-leading security and compliance standards.

  • 
                            VeriSign logo picture

    VeriSign secured

    #1 Internet-trusted security seal. Ensures that a website is free of malware attacks.

  • Accredited Business

    Guarantees that a business meets BBB accreditation standards in the US and Canada.

  • 
                            TopTenReviews logo picture

    TopTen Reviews

    Highest customer reviews on one of the most highly-trusted product review platforms.