<p>Mail to: Charles County Public Schools P.O. Box 2770 Date of Request La Plata, Maryland 20646 Attn: Payroll Department Fax No: 301-934-7497</p><p>REQUEST FOR W-2 FORM PLEASE PRINT</p><p>Please reissue a WAGE AND TAX STATEMENT (Form W-2) to the following employee, for tax years:</p><p>EMPLOYEE NAME: </p><p>SOCIAL SECURITY NO.: </p><p>EMPLOYEE CURRENT MAILING ADDRESS:</p><p>Street Address </p><p>City State Zip Code </p><p>Work location: </p><p>The W-2 Form is requested for the following reason:</p><p>Never Received Misplaced or Destroyed Other (Explain): </p><p>Signature of Employee Date Please Select: Mail duplicate W-2 Pony to School Call for pick-up in Payroll Phone Number:</p><p>Employees Signature when picked up Date picked up</p><p>FOR PAYROLL DEPARTMENT USE ONLY: Date request rec'd: Processed by: Date Processed:</p>