Request For Irs Form W-2 And/or Form 1042s
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1Mail To:
Temple University
ATTN: Payroll/Information Management Department
TASB (083-39)
Phone: 215-926-2244
1852 N. 10th Street
Fax:
215-926-2262
Philadelphia, PA 19122
REQUEST FOR IRS FORM W-2 and/or FORM 1042S
Please reissue a Wage and Tax Statement (Form W-2) and/or a Nonresident Alien Tax Form (1042-S) for
the following employee, for the tax year ending ________.
Please Specify Which Form Is Needed: _______ W-2
_________ 1042-S
(PLEASE PRINT)
EMPLOYEE NAME: _________________________________________________________
SOCIAL SECURITY NUMBER: ** ____________________________________________
CURRENT MAILING ADDRESS:
Street Address:
___________________________________________________
City:
_______________________ State: __________ Zip Code: _____________
Daytime Phone Number: (
) ___ ________________________
The Form W-2 and/or 1042S is/are requested for the following reason:
_________Never Received
_________Name Incorrect (copy of SS card required)
_________Misplaced or Destroyed
_________Address Incorrect
_________Social Security Number Incorrect (copy of SS card required)
_________Other, please explain _______________________________________________________
_________________
______________________________________________
Date
Signature of Employee
All checks and/or money orders must be made payable to "Temple University"
For Department Use Only:
Date Request Received:___________
Original Form Remailed:__________
Processed by:___________
Duplicate Form Reissued:__________
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Processing Fees: (Check One)
MONEY ORDER/CHECK _______
PAYROLL DEDUCTION (FEE) ________
Employee & Student($35)________
Account: 7600 104603000
* Year 2010 to Present
** Temple University requests your Social Security number (SSN) because federal, state, and local law requires the University to report the
name, address, and SSN for certain purposes. Temple University will not disclose your SSN without consent unless it is required to do so by
).
law, or as permitted by the University’s Social Security Number Usage Policy
(
Revised 10/08/2013
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