Request Duplicate Tax Form printable pdf download

Request for Blackhawk Technical College Duplicate

Tax Form(s) to be Mailed or Faxed

First Name: ________________________________ Last Name: ____________________________

Select which tax form(s) you need a duplicate copy and fill in the year(s) you need. Example: If you need a duplicate of your

1098‐T tax form for 2011, check the box next to "1098‐T" and write "2011" in the corresponding "Year" field.

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W‐2 ‐ Wage Statement ($5.00/each)

Year(s):__________________

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1098‐T – Tuition Statement ($15.00/each)

Year(s):__________________

Select Delivery Method of Mail or Fax:

1) Mail form(s) to address:

Street: ___________________________________________

City: _____________________________________________

State: ____________________________________________

Country: __________________________________________

Zip Code (9 digit code):______________________________

2) Fax form(s) to fax number:

(______) ________________________________________

By providing the information above, I expressly authorize Blackhawk Technical College to release my Social Security

Number, Student Financial Records, or other records maintained by the College, only to the address or fax number

indicated.

Signature: (Required) __________________________________________

Contact Phone Number: (Required) (______) ___________________________

Social Security Number: (Required) ___________________________

College ID: (9 digits; Required) _______________________________

Submit this form along with a copy of a government issued picture ID (e.g. driver’s license or state ID card) via facsimile to

608.757.7740 or mail to Blackhawk Technical College, attn: Payroll Department, 6004 S County Road G, P.O. Box 5009,

Janesville, WI 53547‐5009.

Payment: Forms of acceptable payment are check and money order. If paying via check or money order, make payable to

"Blackhawk Technical College" and mail to the address listed above. The fee must be paid prior to the statement(s) being

released.

Disclaimer: Blackhawk Technical College will do its best to provide the requested tax form(s) however, in some cases the

information may no longer be available or the information being requested was not required to be provided. In addition,

Blackhawk Technical College reserves the right to not approve and provide tax information if any of the information

contained on this form appears to be invalid, inaccurate, or illegible.

Request Duplicate Tax Form