FORM W-2 (Wage & Tax Statement) Reissue Request
Please provide all requested information and return the completed, signed form to your local payroll office, or mail/fax to:
Kentucky State University ATTN: Payroll 400 East Main St. ASB 428 Frankfort, KY 40601 Fax: 502-597-6450
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.
Part 1: Employee/Former Employee Information
Employee ID___ Last Four Digits of SSN ___
Employee Name ___
Current Mailing Address___
City___State___Zip Code___
Active employees, seeking to make a change to their current contact information, please use employee self-service: https://workforcenow.adp.com/workforcenow/login.html
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.
Part 2: W-2 Information
Tax year to be reissued:_____
Reason for Reissue (check one): Lost __Destroyed
Other (please specify) _
——
___ Never Received
Part 3: Authorized Signature
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.
_____
___
Signature Date
OR PAYROLL DEPARTMENT USE ONLY:
Date Received Processed By Date Processed