TAX CLEARANCE - Download as Excel by mgq48337

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									PURDUE UNIVERSITY
                                                                                                         Interoffice Memorandum
To:                     Tamara Carpenter / Tax Group Disbursements
From:
Date:

Subject:                Tax Clearance Request

Please provide the current year’s earnings information on Form W-2 and/or Form 1042S in order for the following
individual to obtain a Tax Clearance from the Internal Revenue Service.

NAME:

SOCIAL SECURITY NUMBER:                                                    DEPARTMENT NAME:

FINAL PAY AMOUNT:                                                          FINAL PAY DATE:

DATE LEAVING COUNTRY:                                                      DATE FORM NEEDED:

ARRANGEMENTS FOR DELIVERY / PICKUP:
                   Mail the forms to department                  Will pick up the forms in Freehafer Hall



The Form W-2 and/or Form 1042S will be available for pick up in Freehafer Hall at 1:00 p.m. on the date
indicated above.
Therefore, if the individual plans to go to the IRS on a Monday morning to obtain their tax clearance,
you should indicate the forms are needed no later than the prior Friday.

OTHER INFORMATION (IF NECESSARY):




                            THIS SECTION TO BE COMPLETED BY PAYROLL
                                                  Marital Status            Federal Exemptions           State Exemptions



                                                  Year-To-Date                  Final Pay                 Tax Clearance
                              Gross
                          Pre-Tax Items
                         Adjusted Gross
                           Federal Tax
                            State Tax
                           County Tax
                            SS/OASDI
                              SS/HI



                                              Tax Clearance                     Form W-2                 Form 1042S
                         Adjusted Gross



taxclearancerequest.xls (Rev 10-2002)

								
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