Complete the following:

Name
UID #
Birthdate
Department
Phone	format: nnn-nnn-nnnn
Email	format: name@provider.net

I would like to request a duplicate 1042S form for the following calendar year:

Enter Year

1042S Distribution - Please send the duplicate 1042S form to:

Don't mail it, I will pick it up*
Mail to this campus address (include campus Mail Code): 
Mail to this off campus address: 
Fax to: 

Comments:

*Note:  Duplicate 1042S forms can be picked up at the Payroll Services window at 10920 Wilshire Blvd, Suite 620.  The request will take about a week to process.   We will contact you when the duplicate 1042S form is ready for pickup at the Payroll Services window.  You will be required to show a photo ID to pick up the 1042S form.

Once you click on the Send Email form button below, a confirmation form will appear.  We suggest that you print it for your records.  If you do not see a confirmation form in your web browser or receive an error message, please call (310) 825-1089 to request a duplicate by phone.