Request for Duplicate 1099-R Solicitud De Copia Del 1099-R
SOUTHERN NEVADA CULINARY AND BARTENDERS PENSION PLAN
P O Box 43449 Las Vegas, Nevada 89116
Telephone: (702) 369-0000
Fax: (702) 369-2198
Request for Duplicate 1099-R
Solicitud De Copia Del 1099-R
Print or type all information.
Imprima o escriba toda la informacion.
DATE:
(FECHA)
Please provide me with a copy of my 1099-R form(s) for the years (s) of:_____________________
Favor de proporcionarme una copia de la forma 1099-R por los a?os de:
NAME:
NOMBRE
ADDRESS:
DIRECCION
CITY:
STATE:
ZIP CODE:
CUIDAD
ESTADO
ZONA POSTAL
SOCIAL SECURITY NO:
TELEPHONE:
NUMERO DE SEGURO SOCIAL
TELEFONO
SIGNATURE:
FIRMA
Send completed request form to: / Enviar solicitud completa a:
Pension Office
P O Box 43449
Las Vegas, NV 89116
Or fax to: / O por fax a:
(702) 369-2198
Any questions, please call: / Cualquier tipo de pregunta, por favor llame a:
(702) 369-0000
For Pension Office use only / Para la Oficina de Pensi¨®n solamente:
Reference #
Request Duplicate 1099r
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