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REQUEST FOR ENROLLMENT IN THE
VOLUNTARY EXCLUSION PROGRAM (VIP)
State Form 51803 (R / 714)
INDIANA GAMING COMMISSIONSummary of Rules for the Voluntary Exclusion Program
Pursuant to 68 IAC 631 and
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How to fill out sf 51803 rev 6
01
To fill out SF 51803 rev 6, follow these steps:
02
Start by entering the date in the 'Date' field at the top of the form.
03
In the 'Name of Claimant' section, write the full name of the person who is claiming the benefit.
04
Provide the claimant's contact information, including address, phone number, and email address.
05
Indicate the claimant's Social Security Number in the designated field.
06
Next, fill out the 'Claimant Certification' section by checking the appropriate boxes to acknowledge understanding and compliance with the provided statements.
07
If the claimant is not the employee, provide the employee's information in the 'Name of Person Employed' section.
08
Complete the 'Employment Information' section by entering the employer's name, address, and phone number.
09
Specify the period for which the claim is being made by indicating the 'From' and 'To' dates in the corresponding fields.
10
In the 'Amount Claimed' section, enter the total amount being claimed for reimbursement.
11
Finally, both the claimant and the employer must sign and date the form to acknowledge its accuracy and agreement.
12
Make sure to review the completed form for any errors or omissions before submitting it.
Who needs sf 51803 rev 6?
01
SF 51803 rev 6 is needed by individuals who are making a claim for reimbursement of their expenses. This form is typically required by employers or government agencies to process and verify claims for benefits or reimbursements.
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What is sf 51803 rev 6?
SF 51803 rev 6 is a form used for reporting certain information related to tax filings.
Who is required to file sf 51803 rev 6?
Individuals or businesses meeting certain criteria may be required to file SF 51803 rev 6.
How to fill out sf 51803 rev 6?
SF 51803 rev 6 can be filled out by providing the required information in the designated fields on the form.
What is the purpose of sf 51803 rev 6?
The purpose of SF 51803 rev 6 is to gather specific information for tax reporting purposes.
What information must be reported on sf 51803 rev 6?
SF 51803 rev 6 requires the reporting of certain financial information as outlined on the form.
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