{ "document_id": 14668, "filename": "w2-reissue-request.pdf", "engine": "paddleocr_vl", "source_run_id": 14778, "generated_at": "2026-11-04T03:43:03+00:00", "page_count": 1, "counts_by_type": { "figure": 1, "heading": 4, "list": 2, "list_item": 6, "text": 13, "title": 1 }, "timings": { "total_ms": 225, "structure_ms": 128, "text_layer_ms": 9, "build_ms": 6 }, "pages": [ { "document_id": 14668, "page": 1, "width": 612, "height": 792, "rotation": 0, "pipeline_version": "paddleocr-vl-1.6+paul-48", "width_pt": 612, "height_pt": 792, "engine": "paddleocr_vl", "source_run_id": 14778, "item_count": 27, "counts_by_type": { "figure": 1, "heading": 4, "list": 2, "list_item": 6, "text": 13, "title": 1 }, "build_ms": 6, "items": [ { "id": "p1.1", "order": 1, "type": "figure", "bbox": { "l": 16.32, "t": 761.52, "r": 84.24, "b": 691.68 }, "text": "", "attrs": { "role": "page_header", "block_label": "header_image" }, "reading_order": 0 }, { "id": "p1.2", "order": 2, "type": "title", "bbox": { "l": 144.72, "t": 670.08, "r": 466.08, "b": 628.32 }, "text": "FORM W-2\n(Wage & Tax Statement) Reissue Request", "attrs": { "block_label": "doc_title" }, "level": 2, "reading_order": 1 }, { "id": "p1.3", "order": 3, "type": "text", "bbox": { "l": 45.6, "t": 618.24, "r": 276.72, "b": 574.56 }, "text": "Please provide all requested information and return the completed, signed form to your local payroll office, or mail/fax to:", "reading_order": 2 }, { "id": "p1.4", "order": 4, "type": "text", "bbox": { "l": 69.36, "t": 563.52, "r": 210, "b": 492.48 }, "text": "Kentucky State University\nATTN: Payroll\n400 East Main St. ASB 428\nFrankfort, KY 40601\nFax: 502-597-6450", "reading_order": 3 }, { "id": "p1.5", "order": 5, "type": "text", "bbox": { "l": 364.08, "t": 606.96, "r": 522.24, "b": 489.6 }, "text": "All W-2 Reissue requests will be processed by Kentucky State University Payroll Staff. Please allow up to three business days for form processing. Requests for most recent year tax forms will not be processed prior to February 8.", "reading_order": 4 }, { "id": "p1.6", "order": 6, "type": "heading", "bbox": { "l": 45.6, "t": 466.32, "r": 300.48, "b": 451.44 }, "text": "Part 1: Employee/Former Employee Information", "attrs": { "block_label": "paragraph_title" }, "level": 3, "reading_order": 5 }, { "id": "p1.7", "order": 7, "type": "list", "bbox": { "l": 45.84, "t": 443.52, "r": 559.68, "b": 357.6 }, "text": "", "attrs": { "item_count": 4 }, "children": [ { "id": "p1.7.1", "order": 8, "type": "list_item", "bbox": { "l": 45.84, "t": 443.52, "r": 553.68, "b": 427.92 }, "text": "Employee ID___ Last Four Digits of SSN ___", "reading_order": 0 }, { "id": "p1.7.2", "order": 9, "type": "list_item", "bbox": { "l": 46.56, "t": 419.04, "r": 559.2, "b": 403.2 }, "text": "Employee Name ___", "reading_order": 1 }, { "id": "p1.7.3", "order": 10, "type": "list_item", "bbox": { "l": 45.84, "t": 396.48, "r": 559.2, "b": 381.36 }, "text": "Current Mailing Address___", "reading_order": 2 }, { "id": "p1.7.4", "order": 11, "type": "list_item", "bbox": { "l": 46.56, "t": 373.44, "r": 559.68, "b": 357.6 }, "text": "City___State___Zip Code___", "reading_order": 3 } ], "reading_order": 6 }, { "id": "p1.8", "order": 12, "type": "list", "bbox": { "l": 60.48, "t": 353.28, "r": 538.08, "b": 298.8 }, "text": "", "attrs": { "item_count": 2 }, "children": [ { "id": "p1.8.1", "order": 13, "type": "list_item", "bbox": { "l": 62.64, "t": 353.28, "r": 534, "b": 328.32 }, "text": "Active employees, seeking to make a change to their current contact information, please use employee self-service: https://workforcenow.adp.com/workforcenow/login.html", "marker": "•", "reading_order": 0 }, { "id": "p1.8.2", "order": 14, "type": "list_item", "bbox": { "l": 60.48, "t": 324, "r": 538.08, "b": 298.8 }, "text": "W-2 forms contain confidential, personal information. Due to security reasons, reissued W-2's cannot be transmitted via fax or e-mail. All forms will be mailed to the address listed above.", "marker": "-", "reading_order": 1 } ], "reading_order": 7 }, { "id": "p1.9", "order": 15, "type": "heading", "bbox": { "l": 49.44, "t": 269.76, "r": 178.8, "b": 256.56 }, "text": "Part 2: W-2 Information", "attrs": { "block_label": "paragraph_title" }, "level": 3, "reading_order": 8 }, { "id": "p1.10", "order": 16, "type": "text", "bbox": { "l": 49.2, "t": 252.48, "r": 245.04, "b": 238.56 }, "text": "Tax year to be reissued:_____", "reading_order": 9 }, { "id": "p1.11", "order": 17, "type": "text", "bbox": { "l": 49.68, "t": 235.68, "r": 379.92, "b": 220.56 }, "text": "$$ R e a s o n~f o r~R e i s s u e~(c h e c k~o n e):\\quadL o s t\\quad\\_\\_\\_D e s t r o y e d $$", "reading_order": 10 }, { "id": "p1.12", "order": 18, "type": "text", "bbox": { "l": 51.6, "t": 218.88, "r": 169.92, "b": 204 }, "text": "Other (please specify) _", "reading_order": 11 }, { "id": "p1.13", "order": 19, "type": "text", "bbox": { "l": 405.6, "t": 252.72, "r": 422.16, "b": 244.32 }, "text": "——", "reading_order": 12 }, { "id": "p1.14", "order": 20, "type": "text", "bbox": { "l": 402, "t": 236.4, "r": 509.28, "b": 220.8 }, "text": "___ Never Received", "reading_order": 13 }, { "id": "p1.15", "order": 21, "type": "heading", "bbox": { "l": 46.08, "t": 179.04, "r": 199.2, "b": 164.88 }, "text": "Part 3: Authorized Signature", "attrs": { "block_label": "paragraph_title" }, "level": 3, "reading_order": 14 }, { "id": "p1.16", "order": 22, "type": "text", "bbox": { "l": 46.08, "t": 153.12, "r": 558.96, "b": 109.44 }, "text": "Please reissue IRS Form W-2, Wage and Tax Statement for the single tax year requested. I certify I am the individual listed above. I acknowledge KYSU is not responsible for reprint requests that are lost, incomplete, misdirected, stolen, mutilated, illegible, postage due, or any combination thereof.", "reading_order": 15 }, { "id": "p1.17", "order": 23, "type": "text", "bbox": { "l": 46.56, "t": 96.48, "r": 560.16, "b": 82.08 }, "text": "_____", "reading_order": 16 }, { "id": "p1.18", "order": 24, "type": "text", "bbox": { "l": 395.28, "t": 95.28, "r": 559.2, "b": 83.04 }, "text": "___", "reading_order": 17 }, { "id": "p1.19", "order": 25, "type": "text", "bbox": { "l": 48.96, "t": 79.68, "r": 564.24, "b": 64.32 }, "text": "Signature Date", "reading_order": 18 }, { "id": "p1.20", "order": 26, "type": "heading", "bbox": { "l": 47.04, "t": 48.72, "r": 286.08, "b": 35.04 }, "text": "OR PAYROLL DEPARTMENT USE ONLY:", "attrs": { "block_label": "paragraph_title" }, "level": 3, "reading_order": 19 }, { "id": "p1.21", "order": 27, "type": "text", "bbox": { "l": 48, "t": 29.04, "r": 574.8, "b": 14.88 }, "text": "Date Received Processed By Date Processed", "reading_order": 20 } ] } ] }