REQUEST FOR DUPLICATE W-2 FOR TAX YEAR: ______
Please issue a duplicate copy of the Wage and Tax Statement (Form W‐2) for the following employee:
*If a request is made after April 15 or for a previous year, a $6.00 fee will be charged. Please submit
$6.00 in check or money order only.
Employee name: _______________________________________ NSU ID: N___________________
Distribution of Form:
☐ Pick Up from Payroll Office: PAYROLL IS LOCATED ON THE EAST CAMPUS AT
3100 SW 9TH AVE. (NEAR FT LAUDERDALE AIRPORT)
☐ Mail Form: __________________________________________________________
Street Address
__________________________________________________________
City State Zip Code
Reason for Request: ☐ Never Received ☐ Lost/Misplaced/Destroyed
Signature of Employee: _______________________________________________
Contact Number/Extension: ______________________________________________
*If requesting that the form be mailed, please provide a copy of picture identification, such as a driver’s
license (former employees) or ID badge (current employees), along with this request form. If picking up
the duplicate form W‐2 in person, please be prepared to show picture ID such as a driver’s license or your
ID badge. Allow five business days to process your request.
Please return this form to the Payroll Department:
EMAIL: PAYROLL@nova.edu FAX: (954) 262‐3997 MAIL: Nova Southeastern University
Payroll Department
3100 SW 9TH AVE
Ft Lauderdale, FL. 33315
For Payroll Department Use Only:
Date request received: ______________________ Date form mailed to employee: ___________________
Or Date picked up by employee: ______________
Signature of employee if picked up in person: ________________________________________________
Revised 09/20/2018
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