Request Form For W-2

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REQUEST FORM FOR W-2
IF YOU HAVE LOST OR MISPLACED YOUR W-2 FORM PLEASE FILL OUT THIS FORM
AND FORWARD TO NETRA THOMA IN PAYROLL.
DATE REQUESTED_____________________________________________________
EMPLOYEE NAME______________________________________________________
FOR WHICH TAX YEAR? ________________________________________________
SOCIAL SECURITY #____________________________________________________
SCHOOL TO SEND FORM TO OR ADDRESS: _______________________________
_______________________________________________________________________
REASON FOR REQUESTING A DUPLICATE FORM__________________________
_______________________________________________________________________
EMPLOYEE SIGNATURE_________________________________________________
Duplicate forms will not be sent without this form.
FOR PAYROLL DEPT USE ONLY
Date request received___________________________________
Original W-2 reissued and processed_______________________
Date duplicate W-2 reissued and processed____________________

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