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CLEAR FORM

Mail to:

Auburn University Payroll & Employee Benefits 212 Ingram Hall Auburn University, AL 36830 334-844-1799 [email protected]

_______________________ Date of Request

Fax: Email:

REQUEST FOR REISSUED IRS FORM W-2

PLEASE PRINT or Fill in Online Please reissue my WAGE AND TAX STATEMENT (Form W-2) for the tax year ___________. EMPLOYEE NAME: ___________________________________________________________ SOCIAL SECURITY NO. OR BANNER ID:_________________________________________ CURRENT MAILING ADDRESS: ________________________________________________

CITY:________________________________________________ STATE/ZIP: _______ / _________________________________ DAYTIME PHONE NUMBER: ________________________________________________ Active Separated

Current employment status with Auburn University:

Mail to above address

Call for pickup (picture ID required)

Email to: _______________________________

_________________________________ Signature of Employee

For Payroll & Employee Benefits use only: W-2 reissued: ____________________ Mailed: ____________________ Date Date Processed by: _______________________________________________________________

Picked up: ______________________________________ Signature

_______________________ Date

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Microsoft Word - w2-req.docx

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Microsoft Word - w2-req.docx