Form # 335 |
I mplement ed 12/ 09 |
EMPLOYEE’S REQUEST FOR DUPLICATE W-2 FORM OR
ADDRESS CHANGE FOR FORMER EMPLOYEES
I am/was employed by: |
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Bob Evans Farms |
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Mimi’s Café |
To protect your privacy, a duplicate W-2 form will be issued only through completion of this form. All information must be complete.
PLEASE PRINT CLEARLY
Please release a duplicate W-2 form for the calendar year______.
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We do not Fax duplicate W-2’s |
Mailing Address: |
Please check box if this is a new address |
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Street |
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Day Time
Phone Number
Reason for request (please check the appropriate box):
Never received
Lost/Misplaced/Destroyed
Other: ___________________
Note:
1.To ensure confidentiality, a duplicate W-2 form will not be faxed or e-mailed regardless of location or time constraints. Please allow approximately five (5) business days processing time after receipt of request by the payroll department.
2.An employee is the only person allowed to request additional copies of his/her W-2 form(s)
I hereby authorize Bob Evans Farms, Inc. to release a copy of my W-2 form to the mailing address indicated above:
Mail this request form to: Payroll Department |
Fax: 614-409-2173 |
Bob Evans Farms, Inc. |
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3776 S. High Street |
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Columbus, OH 43207 |
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For Payroll Use Only |
Date request received: ______________________ |
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Processed by: _____________________________ |
Date: ____________________ |
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