Form 886-L (Rev. 12-2014)
Catalog Number 73202A Department of the Treasury - Internal Revenue Service
Form 886-L
(Rev. December 2014)
Supporting Documents
Please provide a photocopy of the document or documents requested below. Return
the photocopies with this form in the envelope provided.
Name of Taxpayer Tax Identification Number Tax Year
Periodic pay statements or check stubs clearly identifying the date, amount of
gross income received and withholding taken out, or
A letter from your employer on company letterhead or stationary indicating
dates of employment and gross amount of wages paid and withholdings
deducted. The letter must include a contact person and telephone number.
Department of the Treasury–Internal Revenue Service
Wages and Withholding:
dd mmm yyyy
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