For your convenience, all benefit forms are now available online. Each form comes in an easy to read and use pdf format.

The forms maybe completed in one of two ways:

  1. Print the form and complete by hand, OR;
  2. Complete the form on your computer, then print and sign.

Send completed forms via interoffice mail, postal service, or in person, to the County’s benefits staff representative listed in the Contact information of this website. FORMS MAY NOT BE ELECTRONICALLY TRANSMITTED

Flexible Spending


Must be completed each year in order to pre-tax your premiums

Flex Change Form

Take Care

Watch this video to understand the substantial benefits a flexible spending account offers.

Watch Video

Flexible Benefits

To change your benefit election, you must notify your benefit coordinator within 30 days of the qualifying event.

Claim Form

Reimbursement Claim Form

Download Form

Dependent Claim

Dependent Care Claim Form

Download Form

TakeCare Debit Card

Authorization to receive "Take Care™" Debit Card

Download Form

For Cafeteria Plan Information please contact:

Lockard & Williams

Kenny Anderson 850-516-7043