W2 Replacement Request

Please provide the information listed below when requesting a replacement W2:

· Full name
· If married during W2 processing year include your maiden name
· Social Security Number
· Current Address
· Signature

Please send your request to the address below and allow 7 to 10 business days to receive your replacement.

Attn: Larry Thompson
JDK Management
1388 State Route #487
Bloomsburg, PA 17815

This is a Replacement Request. That is only to be used if you did not receive your original W2 issued to you no later than January 31st.