Fillable As387 (Louisiana State University)

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As387 (Louisiana State University)

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Rev 12/11
Office of Accounting Services
Payroll
204 Thomas Boyd Hall
REQUEST FOR DUPLICATE TAX INFORMATION FORMS AS387
* There is a $10 fee for each duplicate W-2 requested
Method of Distribution
Department will pick up. Call __________________________________at ________________ when ready.
Name Ext
Mailing Address ____________________________________________________________
____________________________________________________________
Recipient will pick up. Call ________________________________ at ________________ when ready.
(Picture ID required)
Name Ext
The Mailing Address listed above is new and my Payroll records should be updated. Yes No
Remarks / Special Instructions _______________________________________________________________________________
________________________________________________________________________________________________________
Fee Payment (if applicable)
Cash Check
Electronic Draft ___________________________ ___________________________
Bank Routing # Account #
Checking Savings
I hereby authorize LSU to initiate a debit entry in the amount of _____________ to the account at the indicated financial institution,
and I hereby authorize the indicated financial institution to accept and to post such entry to my account.
____________________________________________ _________________________
Signature Date
--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
FOR ACCOUNTING SERVICES USE ONLY
Disposition of Duplicate
Form picked up by Dept representative, ______________________________________, on ___________________
Form picked up by Recipient, _______________________________________, on ______________________
Recipient’s Signature ____________________________________________________________
Form mailed by ____________________________________, Payroll representative, on ______________________
Original re-mailed by ________________________________, Payroll representative, on ______________________
Name (Last, First, MI)
LSU ID Phone
Type of Employee
Academic (9 mos) Salary / Academic / GA (12 mos)
Wage / Contingent Student Non-employee
Desired Tax Document W-2 * W-2C 1042-S 1099-MISC Tax Year
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As387 (Louisiana State University)

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Completed 21 July 2020

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