Lsu Health Sciences Center New Orleans Request

Download a blank fillable Lsu Health Sciences Center New Orleans Request in PDF format just by clicking the "DOWNLOAD PDF" button.

Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.

Complete Lsu Health Sciences Center New Orleans Request with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.

Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.

ADVERTISEMENT

LSU HEALTH SCIENCES CENTER-NEW ORLEANS
REQUEST FOR DUPLICATE W2/1042/Paycheck
PLEASE PRINT
Date of Request:______________________________
MAIL TO: LSUHSC-PAYROLL DEPARTMENT
FAX NO: (504) 568-2366
433 Bolivar Street
New Orleans, LA 70112
EMAIL:
lsunopayroll@lsuhsc.edu
Please provide a duplicate copy of the following form(s) for the following employee:
EMPLOYEE NAME:________________________________
EMPID:__________
SOCIAL SECURITY NO.:________________________________________________
Form W-2
Year(s) _______________________________________
Form 1042-S
Year(s) _______________________________________
Paycheck
Pay Period(s) __________________________________
I would like to receive my form by (please check one):
MAIL
EMPLOYEE CURRENT MAILING ADDRESS:
Street Address:______________________________________________
City:_______________________ State: _______Zip Code: __________
PICKUP
Phone Number: ____________________________________________
The duplicate copy is requested for the following reason:
Never Received
Misplaced or Destroyed
Social Security Number or Name Incorrect
Mailing Address with HR or Registrar’s Office is incorrect
Other(Explain)_______________________________________
__________________________________
(Employee’s Signature)

ADVERTISEMENT

00 votes

Related Articles

Related forms

Related Categories

Parent category: Business
Go