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I also certify that the medication received was not for an on-the-job injury. I recognize that reimbursement will be paid directly to me and that assignment of these benefits to a pharmacy or any other party is void. X Signature of Enrollee AL0792 475-3921 02/11 CF51795 Instructions Read carefully before completing this form 1. California For your protection California law requires the following to appear on this form Any person who knowingly presents false or fraudulent claim for the payment...
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What is cf51795 form?
The cf51795 form is a specific tax form used for reporting financial information.
Who is required to file cf51795 form?
Anyone who meets the criteria set by the tax authorities must file the cf51795 form.
How to fill out cf51795 form?
To fill out the cf51795 form, you need to provide accurate and complete financial information as per the instructions provided.
What is the purpose of cf51795 form?
The cf51795 form is used to gather financial data and ensure compliance with tax regulations.
What information must be reported on cf51795 form?
The specific information required to be reported on the cf51795 form may vary, but generally includes income, expenses, assets, liabilities, and other financial details.
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