EMPLOYEE’S REQUEST FOR DUPLICATE W-2


     
    Employee Name      
    Social Security Number
         
         
         
    Daytime Phone Number (
         
    )      


    Employee’s Current Mailing Address:

     
    Street Address      
    City       State       Zip      


     
    Employee’s Signature   
    Date of Request
         
    /
         
    /
         
    Year(s) Requesting      


    The FORM W-2 is requested for the following reason:

     
     Never Received
     Misplaced or Destroyed
     Social Security Number or Name Incorrect
     Other (Explain)      


    How would you like to receive your duplicate W-2 form?

     
     Mail to my home.
     I will pick up in Payroll Office. ID required.
     Other (Explain)      
     


    For Business Office Use Only


     
    Date Request Received  /  /  Date Processed  /  /   
    Processed By  Mailed On  /  /   

    Back to top




    Rev. 05/11  5.06a