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LCTCSPR22 Ed 01.29.03
Louisiana Community & Technical College System
Centralized Payroll (PeopleSoft)
Request for Duplicate W-2
To be Completed by Employee
Date _____/___/___
Indicate Year
______________ W-2 ____________W-2c
Reason for request:
________Lost _________Never Received
________Other (explain) _________________________________________________________
Name ________________________________________________ Social Security No. _______________
(Last) (First) (MI)
Current Mailing Address
Requested by ______________________________
(Signature of Employee)
To be Completed by Human Resources
EMPLID ___________________ Bus Unit/Location SOWELA__________________
Agency Contact _______________ Telephone 337/421-6910 Email ____________________________
(Name)
Has mailing address been updated in Banner (if applicable)? Circle: Y/N/NA Date ____/___/____
Remarks/special instructions: ______________________________________________________________
To be completed by Centralized Payroll
Disposition of duplicate
Request Received _____/____/_____ by _________________________
Printed ____/____/______ by _________________________
Mailed ____/____/______ by _________________________
Request for Duplicate W2
