MAIL TO: Meredith College
Human Resources
3800 Hillsborough Street
Raleigh, NC 27607
________________
Date of Request
REQUEST FOR DUPLICATE FORM W-2
PLEASE PRINT
Please reissue a WAGE AND TAX STATEMENT (Form W-2) for the following employee
for the tax year ending __________. There is a $5.00 charge for each W-2
requested. This fee must be paid at the time of the request.
EMPLOYEE NAME: ______________________________________________
SOCIAL SECURITY NO.: __________________________________________
PHONE NUMBER: __(_______)_____________________________________
Area Code Number
EMPLOYEE CURRENT MAILING ADDRESS:
_______________________________________________________________
Street Address
_______________________________________________________________
City State Zip Code
The FORM W-2 is requested for the following reason:
________ Never received Pick Up_________
________ Misplaced or Destroyed Mail ____________
________ Social Security Number or Name Incorrect
________ Other (Explain)
__________________________
Signature of Employee
====================================================================================================
FOR DEPARTMENT USE ONLY:
Reissued on: __________________ Mailed on: _________________________
Processed by: _____________________________________
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