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My signature below authorizes Carpenter Contractors of America Inc. to deduct insurance premiums on a pre-tax basis. I choose to waive medical coverage for myself and my dependents Dental Coverage Dental PPO Delta Dental Vision Coverage the 2017 plan year Vision Dependent Information Name Birth Date Relationship Medical Dental Authorization and Signature Every employee is required to complete this form in its entirety either electing specific coverage or waiving coverage completely. Your next...
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