W-2 Copy Request
Please complete and send to:
Southeast Missouri State University
One University Plaza, MS 3175
Cape Girardeau, MO 63701
Fax: 573-651-2108
Identification
Date of Request: _______________________________________________________________________
Social Security Number: ________________________________________________________________
Name: ________________________________________________________________________________
Last
First
Phone Number: _____________________
MI
Total number of copies: ____________________
Year(s) Requested
Circle the year(s) for which you are requesting a copy:
2000
2001
2002
2003
2004
2005
Delivery Options
Pick up in Payroll Department, Academic Hall Room 220 (8 am to 5 pm)
Mail copy to
______________________________________________________________
_______________________________________________________________
_______________________________________________________________
Note: Allow 5 working days for processing.