Date:								
								
Name:								
								
SS #:								
								
								


I have received a duplicate W-2 for the year of					from Orange County Community College 			
Payroll Office.								


								
_________________________________________________________________________________								
PRINT NAME                                                                                  SIGNATURE								
								
								
								
**PLEASE RETURN BY MAIL OR FAX**								
								
								
	          MAIL					             FAX		
								
								
ORANGE COUNTY COMMUNITY COLLEGE								
115 SOUTH STREET					                         845-341-4670			
"MIDDLETOWN, NEW YORK 10940"								
								
ATTENTION: PAYROLL DEPARTMENT