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[DOC File]Exhibit 5-3: Acceptable Forms of Verification
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Notarized statement or signed affidavit attesting to amounts paid. The owner must determine if this expense is to be considered medical or disability assistance. Child care expenses (including verification that a family member who has been relieved of child care is …

[DOC File]FLR 13.1 - Ontario Court Forms
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Necessary childcare expenses; . Medical insurance premiums and certain health-related expenses for the child that cost more than $100 annually; . Extraordinary expenses for the child’s education; . Post-secondary school expenses; and, . Extraordinary expenses for extracurricular activities. FLR 13.1 (November 1, 2018) Page 1 of 10

[DOC File]Section I All Provider Manuals - Arkansas
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A. Medical assistance to families with dependent children, the aged, the blind, the permanently and totally disabled, the medically needy and children under 18 whose income and resources are insufficient to meet the costs of necessary medical services ... (5%) of the provider’s total operating expenses during the 12-month period immediately ...

FA-4151V: Marital Settlement Agreement without Minor …
We warrant to each other that there has been an accurate, complete, and current disclosure of all income, assets, debts, and liabilities. We understand and agree that deliberate failure to provide complete disclosure constitutes perjury under §767.127, Wis. Stats. and a fraud upon the court.

[DOC File]ADJUSTED GROSS INCOME WORKSHEET - HUD
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MEDICAL EXPENSES AND/OR ASSISTANCE FOR ANY ELDERLY OR . DISABLED FAMILY MEMBER. If deductions are taken on this line for medical expenses, the deduction on line 14 must also be taken. (ONLY EXPENSES NOT REIMBURSED FROM ANY . OTHER SOURCES ARE ALLOWED.) b. ENTER TOTAL non-reimbursed expenses for this category $ _____

Contract for Unit 8 & 10 - January 2017 - December 2019
A medical statement provided pursuant to this Article shall list the address and telephone number of the attending physician or medical provider. Failure to produce such evidence within ten (10) days of its request may result, at the discretion of the Appointing Authority, in denial of sick leave for the period of …

Sample Employee Handbook.doc - HR 360, Inc.
However, all medical expenses incurred in connection with an on-the-job injury or illness and partial salary payments are paid in accordance with applicable state law. If you are injured or become ill on the job, you must immediately report the injury or illness to …

Assistance for medical expenses