Request for Duplicate or Corrected W-2 Tax Form
(Pace University Employees/Former Employees Only)
SECTION I (Required)
PLEASE TYPE OR PRINT CLEARLY
1. Name (Last,First, MI)
2. Social Security( last 4 digits) or UID# Number
3. Address
4. City, State, Zip Code
6. Phone (Please include area code)
5. Email
(
)
SECTION II (Required)
7. Requested Year(s)
TO REQUEST DUPLICATE FORM,COMPLETE Section III, Line 8,THEN SKIP TO Section V, Lines 10-11
SECTION III
8. A Duplicate form is requested for the following reason(s):
__ Never Received
__ Misplaced Form(s)
__ Forms Destroyed
TO REQUEST CORRECTED FORM, COMPLETE Section IV & V, Lines 9 - 11
SECTION IV
9. A Corrected form is requested for the following reason(s): (Please check all that apply)
__ Incorrect SSN or ITIN (Enclose copy of your SS/ITIN card-Required)
__ Incorrect or misspelled name (Enclose copy of your SS/ITIN card-Required)
__ Incorrect amount- (Please include box number or line number and attach an explanation)
__ Other- (Please attach an explanation)
SECTION V
10.
__ Send Form to Address Below
_Email Form to
Mailing Address
I confirm that this email is secure.
Please update my home address on file to reflect the above
11.
Signature (Required): ________________________________________Date Requested: ________________
Send Request To:
Pace University
Payroll Dept.
6XPPLW/DNH'ULYH- UG)ORRU
9DOKDOOD, New York 105
Fax:
914-989-8135
Contact Us:
[email protected]
Email:
Payroll Departmental Use Only:
Date Received: _____________________
Date corrected form mailed to individual: ____________
914-923-2898