Final Paycheck Demand and Wage Claim — Indiana
Final Paycheck Demand and Wage Claim — Indiana
Before you use this: Complete Part A to send a demand to the former employer. Part B is a signed attachment that records the facts for a wage claim; submit it with the Indiana Department of Labor's current official online claim form if using that process. Check its current filing instructions for the type of pay claimed.
Part A — Demand to former employer
Date: [__/__/____]
To: [EMPLOYER LEGAL NAME], [EMPLOYER MAILING ADDRESS]
From: [EMPLOYEE NAME], [EMPLOYEE MAILING ADDRESS], [PHONE], [EMAIL]
Re: Unpaid final wages for employment ending [__/__/____]
Dear [EMPLOYER CONTACT]:
I worked for [EMPLOYER LEGAL NAME] as [JOB TITLE] from [__/__/____] through [__/__/____]. My regular payday was [DAY AND FREQUENCY]. I request payment of the amounts itemized below.
Separation and due date — complete the applicable line:
☐ I voluntarily left employment on [__/__/____]. Under Ind. Code § 22-2-5-1(b), payment of an amount due may be deferred until the next usual and regular payday, which was [__/__/____]. My mailing address is stated above.
☐ The employer separated me from its payroll on [__/__/____]. Under Ind. Code § 22-2-9-2(a), unpaid wages or compensation became due at the regular payday for the pay period in which separation occurred, which was [__/__/____].
| Pay item | Dates or calculation | Amount claimed |
|---|---|---|
| Regular wages | [HOURS × RATE / SALARY PERIOD] | $[________] |
| Overtime, if covered by 29 U.S.C. § 207(a)(1) | [WORKWEEKS, HOURS, REGULAR RATE, AMOUNT PAID] | $[________] |
| Earned commissions, if due under plan | [PLAN TERM AND CALCULATION] | $[________] |
| Other claimed wages | [BASIS AND CALCULATION] | $[________] |
| Wage subtotal | $[________] | |
| Separate contract or policy amount, if any | [BASIS; NOT INCLUDED IN WAGE SUBTOTAL] | $[________] |
I ask that you pay the wage subtotal of $[________] and address any separate amount listed above. Please send payment or a written explanation of any disputed item by [__/__/____] to the address above. This requested response date is part of this demand; it does not replace any statutory due date.
If an action under Ind. Code § 22-2-5-2 applies, the court must order a reasonable fee for the plaintiff's attorney and court costs. It must order liquidated damages equal to two times the unpaid wages only if it finds the employer's failure to pay under § 22-2-5-1 was not in good faith. I reserve any applicable remedies without claiming that those additional amounts are already due.
Please preserve payroll records, time records, commission terms, wage statements, and separation communications relevant to these amounts.
Sincerely,
Employee signature: [________________________________] Date: [__/__/____]
Part B — Wage claim attachment
Use the agency's current official form to file. This attachment supplies a calculation and supporting facts; it is not a substitute for the agency form.
| Required claim information | Entry |
|---|---|
| Employee name, mailing address, phone | [________________________________] |
| Employer legal name, Indiana location, mailing address, phone | [________________________________] |
| Employment start and end dates | [__/__/____] to [__/__/____] |
| Type of claim and gross amount | [________________________________] / $[________] |
| Regular rate and pay schedule | [________________________________] |
| Dates and hours worked for unpaid-wage claim | [ATTACH ITEMIZED SCHEDULE] |
| Payments received and remaining balance | [________________________________] |
Explanation of claim: [____________________________________________________________]
Attached records: ☐ Pay stubs ☐ Time records ☐ Employment terms ☐ Commission plan ☐ Demand and delivery proof ☐ Other: [________]
I certify that the facts and calculations I submit are accurate to the best of my knowledge.
Employee signature: [________________________________] Date: [__/__/____]
The commissioner may investigate wage claims under Ind. Code § 22-2-9-4. Section 22-2-9-5(a) limits the commissioner's authority to take assignments for collection to wage claims under $6,000; it does not state a general cap on submitting information to the agency. Use the current Indiana DOL instructions for filing eligibility and process updates.
About this template
- Last updated
- October 18, 2026
- Citations checked
- October 18, 2026
- Jurisdiction
- Indiana
- Category
- Employment & HR
Legal authority
- Ind. Code § 22-2-5-1
- Ind. Code § 22-2-5-2
- Ind. Code § 22-2-9-2
- Ind. Code § 22-2-9-4
- Ind. Code § 22-2-9-5
- 29 U.S.C. § 207(a)(1)
Employment documents govern the relationship between a company and its workers, from offer letters and employment agreements through handbooks, performance reviews, and separations. Done right, they set clear expectations, protect against wrongful termination and discrimination claims, and give both sides a record to rely on. Done poorly, they invite lawsuits, agency complaints, and costly disputes.
Not legal advice
This template is provided for informational purposes. We recommend having an attorney review any legal document before signing, especially for high-value or complex matters.
Checked against the law it cites
A reviewer verified this template's legal citations against the official source on October 18, 2026.
Ind. Code § 22-2-5-1(b) (checked October 18, 2026): "if an employee voluntarily leaves employment, either permanently or temporarily, the employer shall not be required to pay the employee an amount due the employee until the next usual and regular day for payment of wages, as established by the employer."
Ind. Code § 22-2-5-2 (checked October 18, 2026): "The court shall order as costs in the case a reasonable fee for the plaintiff's attorney and court costs. In addition, if the court in any such suit determines that the person, firm, corporation, limited liability company, or association that failed to pay the employee as provided in section 1 of this chapter was not acting in good faith, the court shall order, as liquidated damages for the failure to pay wages, that the employee be paid an amount equal to two (2) times the amount of wages due the employee."
Ind. Code § 22-2-9-2(a) (checked October 18, 2026): "Whenever any employer separates any employee from the pay-roll, the unpaid wages or compensation of such employee shall become due and payable at regular pay day for pay period in which separation occurred"
Ind. Code § 22-2-9-4(a) (checked October 18, 2026): "It shall be the duty of the commissioner of labor to enforce and to insure compliance with the provisions of this chapter, to investigate any violations of any of the provisions of this chapter"
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