REQUEST FOR IRS FORM W-2
Please reissue a Wage and Tax Statement (Form W-2) for the following employee, for the tax year ending __________________.
Employee Name _______________________________________
LU ID # (if applicable) _______________________________________
Employee Current Mailing Address:
Street Address __________________________________________
City _________________________ State ______ Zip _________
The Form W-2 is requested for the following reason:
_______________ Never Received
_______________ Misplaced or Destroyed
_______________ Social Security number or name incorrect
_______________ Other (explain) ____________________________
______________________________
Signature of Employee
___________________
Date Signed
Mail to:
Attn: Payroll
PAYROLL USE ONLY:
Date Request Received _________________ Processed by _____________
Duplicate W-2 reissued __________________