Request For Duplicate W2 Form printable pdf download

Request For Duplicate W2 Form

REQUEST FOR DUPLICATE FORM W-2 FOR TAX YEAR: _________ / __________

FEE: $15 per duplicate

(year)

(Increase effective 2-15-06)

Please return this form to: Anne Arundel County Public Schools

Human Resources/Payroll

2644 Riva Road

Annapolis, MD 21401

Fax: (410) 222-5610

Please issue a duplicate copy of the Wage and Tax Statement (Form W-2) for the following

employee:

Employee Name: _________________________Soc. Sec. #: __________________________

Work Location: ______________________________________________________________

Distribution of W-2 (circle one):

Pick-Up From Payroll

Mail

If mail, send W-2 to: _____________________________________________________

(street)

______________________________________________________

(city)

(state)

(zip code)

Former employee:

Submit $15 fee by check or money order payable to AACPS. HR/Payroll cannot accept cash.

Current employee:

I authorize the fee of $15 to be automatically deducted from my next check.

Signature: ____________________________________________

If picking up the duplicate W-2 in person, please bring in picture ID such as driver’s license or ID badge.

Allow 5 business days to process your request.

For HR/Payroll Department Use Only:

Date request received: _____________ Date W-2 mailed to employee: ___________

W-2 picked up by employee:_______________________________________________

(employee signature and date)

Revised 2-1-06

Request For Duplicate W2 Form