LCTCSPR22 Ed 110707
Louisiana Community & Technical College System
Centralized Payroll (PeopleSoft)
Request for Duplicate W-2
Date _____/___/___
To be Com
p
leted b
y
Em
p
lo
y
ee
Indicate Year
______________ W-2 ____________W-2c
Reason for request:
________Lost _________Never Received
________Other (explain) _________________________________________________________
Name _______________________________________________________________________________
(Last) (First) (MI)
Current Mailing Address
__________________________________________________________________________
Requested by ______________________________
(Signature of Employee)
To be Completed by Human Resources
EMPLID ___________________ Bus Unit/Location _____________/__________________
Agency Contact _________________ Telephone __________________ Email ___________________
(Name)
Has mailing address been updated in PeopleSoft (if applicable)? Circle: Y/N/NA Date ____/___/____
Remarks/special instructions: ______________________________________________________________
______________________________________________________________________________________
To be com
p
leted b
y
Centralized Pa
y
roll
Disposition of duplicate
Request Received _____/____/_____ by _________________________
Printed ____/____/______ by _________________________
Mailed ____/____/______ by _________________________
Request for Duplicate W2
Print Form
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