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Get 2011 Flexible Spending Account - St Jude

Home phone: Spouse s SSN Spouse s date of birth I want to participate in our Flexible Spending Account (FSA). Reduce my future compensation by the total annual election shown below. This amount will be contributed on my behalf to our FSA. I understand this reduces my wages for social security purposes, and may reduce my social security disability and retirement benefits. I understand I will not earn interest on my contribution. I also understand that once I have made this election,.

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