IRS issues standard mileage rates for 2019Internal Revenue ... 2025

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering your name in the 'EMPLOYEE' field at the top of the form. This identifies you as the individual submitting the travel expenses.
3. Fill in the 'INJURY/ILLNESS' section with relevant details regarding your workers' compensation claim.
4. In the 'EMPLOYER' field, input the name of your employer, which is essential for processing your claim.
5. Record the date of submission in the 'DATE' field to ensure accurate tracking of your expenses.
6. For each trip, provide details such as 'TRIP DATE', 'PHYSICIAN/HOSPITAL/THERAPIST', and 'CITY'. Make sure to list all relevant trips related to your injury.
7. Calculate and enter your total mileage in the 'TOTAL MILEAGE' section, ensuring accuracy for reimbursement purposes.
8. Finally, sign and date at the bottom of the form to certify that all information provided is true and accurate.

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