Form W-2/k-2 - Kentucky Wage And Tax Statements Order Form - 2012

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42D003
COMMONWEALTH OF KENTUCKY
DEPARTMENT OF REVENUE
7-12
FINANCE AND ADMINISTRATION CABINET
FRANKFORT, KY
40620
TO:
Employers
DATE:
September 17, 2012
SUBJECT:
2012 Kentucky Wage and Tax Statements (W-2/K-2) Order Form
Employers are required to furnish each employee with a wage and tax statement on or before January 31, 2013. This applies to
all employees from whose wages tax has been withheld or would have been withheld if no more than one exemption had been
claimed.
The Kentucky Department of Revenue maintains a record of the receipt of the wage and tax statements by utilizing the Kentucky
Withholding Account Number. It is extremely important that the correct account number as assigned by the Kentucky Department
of Revenue be entered in the applicable block on the wage statements. Failure to enter the correct account number contributes to
delays in processing and possible mishandling of the statements.
The Department of Revenue is providing combination federal and Kentucky wage and tax statements based on the rate schedule
below. Orders for up to 100 forms will be filled at no charge. The forms consist of all required copies of federal Form W-2 and
Revenue Form K-2. Employers must use these official forms or approved commercially printed forms. Federal W-2 forms may
be used if the Kentucky tax withheld is clearly identified. Any questions regarding commercially printed forms or magnetic
media should be addressed to the Division of Individual Income Tax, Withholding Tax Branch, Station 57, P.O. Box 1274, Frankfort,
KY 40602-1274, (502) 564-7287.
Please type or clearly print your name, address, including ZIP code, and number of forms requested on the order form below and
return with payment.
DO NOT INCLUDE WITHHOLDING TAX PAYMENTS OR RETURNS
WITH THIS ORDER FORM OR THERE WILL BE A DELAY IN PROCESSING.
Form Rates
Make check payable to: Kentucky State Treasurer
1–100
No Charge
Return bottom portion with payment to: Kentucky Department of Revenue,
Operations and Support Services Branches, P.O. Box 518,
101 or more
$17.50
Frankfort, KY 40602-0518
Plus $ .07 for each additional form over 101
AN EQUAL OPPORTUNITY EMPLOYER M/F/D
DETACH HERE
Please Fill Out This Side With Name and Address
Information. This is Our Label.
W-2/K-2 Quantity __________________
FROM: Department of Revenue
Name _________________________________________________
Frankfort, KY 40620
(
)
Telephone ______________________________________________
Unit
Total
Wage and Tax Statements
Quantity
Price
Cost
TO:
Name ____________________________________
Up to 100 Form W-2/K-2
NC
NC
____________________________________
101 (flat rate)
Form W-2/K-2
101
$ 17.50
$
Over 101
(per Form W-2/K-2)
x $.07
$
Street ____________________________________
City, State
Sales Tax (6%) ...................................................................
$
and ZIP Code _____________________________
Total ..........................................................................
$

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