Sample W2 Form Completed

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Sample W2 Form Completed Powered By Docstoc
					                              Request for Replacement of IRS Form W2

To request a replacement copy of your Wage and Tax Statement (Form W2), please provide the
information below. Please print neatly, and make sure you sign and date the form at the bottom of the
page. Note: This service is available to current/former employees. A charge of $ _______ will be required
for Company replacement for tax year more than _________ years old.


    Tax Year Needed
    Your Legal Name
    Your Social Security Number


Please indicate below how you would like to receive your replacement W2:
□           I will pick it up at the Company Payroll Office. Please notify me when it is ready.
□           Please mail it to me at the address below.


Please provide your current mailing address AND a phone number or email address where you can be
reached during the day. Due to confidentiality issues, W2s will not be faxed.


    Street Address
    City
    State                                            Zip Code
    Daytime Telephone                                Email Address
    Your signature
    Date
Please forward the completed form to:
[Company]




For Office Use Only
□     Original W2 Resent                                              Date: ___________________________
□     Duplicated W2 Reprinted and Reissued                            Date: ___________________________




                                                                                                  HFPAY015

				
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Description: Sample W2 Form Completed document sample