If you are in business, you know that tracking your expenses is important. Whether you are self-employed or run a company, it is essential to keep accurate records of all money spent. This includes mileage reimbursement. When travelling for work, you can deduct the cost of getting from one place to another from your taxable income. To do this, you need to submit a mileage reimbursement form. Let's take a look at what this document entails and how to complete it correctly.
Below is the information in regards to the PDF you were seeking to fill out. It can tell you how long it will require to finish mileage reimbursement form, what fields you will need to fill in, etc.
| Question | Answer |
|---|---|
| Form Name | Mileage Reimbursement Form |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | workmans comp mileage sheet, worker compensation mileage reimbursement fl, forida workers compensation mileage reimbursement form, mtm florida mileage reimbursement form |
MILEAGE REIMBURSEMENT FORM
CLAIMANT NAME
SOCIAL SECURITY NUMBER
CLAIMANT ADDRESS
DATE OF ACCIDENT
DATE OF TRAVEL
NAME OF MEDICAL FACILITY
(excluding Pharmacies)
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 employer or employee, insurance company, or
Claimant’s Signature
Today’s Date