State of indiana form 28808 2008-2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the Vendor Name in Section 1, followed by your Tax Identification Number in Section 2. Ensure these details are accurate for processing.
3. In Section 3, input your unique Invoice Number. If you do not use invoice numbers, leave this blank.
4. Fill out your Address in Section 4, ensuring it matches the W-9/DD form on file.
5. Indicate the Page Number in Section 5 and specify the Claim period in Section 6 by entering the start and end dates.
6. Calculate and enter the Amount of Claim in Section 7 based on your Total Cost from later sections.
7. Complete Sections 8 through 18 with relevant IDs, names, service dates, units, rates, and total costs for each child supported.
8. Finally, sign the form in Section 19, provide your email address in Section 20, and date it in Section 21 before submitting.

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