Request For Duplicate W-2

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MAIL TO:
Orange County Public Schools
Date of Request: _________________
445 W. Amelia Street
Orlando, FL 32801
ATTN:
Payroll Services
407.317.3260
Please reissue a year ___________ Form W-2 Wage and Tax Statement for the following employee:
Employee Name:
Personnel Number:
Phone Number:
Work Location Name:
Disbursement: Mail
Pick Up
OCPS WILL NOT RELEASE THE W-2 TO ANYONE OTHER THAN THE EMPLOYEE
Address of Residence:
Mailing Address:
(Note: if different from Address of
Residence please specify below)
Address:
Address:
City/State:
City/State:
Zip:
Zip:
The Form W-2 is requested for the following reason:
_____Never Received
_____Misplaced or Destroyed
_____Social Security Number or Name Incorrect
_____Address Change (new address above)
_____Other (Explain) ____________________________________________________
________________________________________
Signature of employee
________________________________________________________________________________________
FOR PAYROLL DEPARTMENT USE ONLY:
Date request received: _________________
Original W-2 remailed: _____________________
Processed by: ________________________
Duplicate W-2 reissued: ____________________
Work Location #: _____________________
Screen Print Attached: ______________________
03/05/10

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