42A808 (1-19)
Commonwealth of Kentucky
DEPARTMENT OF REVENUE        Authorization to Submit Employees Annual
                                W-2 Information in EFW2 Format via
                             Kentucky Department of Revenue Web Site

 1.  Check appropriate box:

    Initial request for PIN (personal identification number).
    Misplaced PIN.
    Request to change PIN due to security issue, i.e., new employee responsible for submitting W-2 information or 
       PIN security has been compromised.
    Update contact information.
    FEIN changed, new PIN required.

   Name,addressandfederalemployeridentificationnumberofperson,organizationorfirmrequesting
   Webfiling:

   Business Name ______________________________________ FEIN* ___________________________

   Street Address ________________________________         City/State/ZIP _______________________________
 
  3.  Name, title and telephone number of contact person:

   Contact Name _________________________________________   Phone Number _____________________

   Title __________________________________           E-mail Address** ___________________________________

   Estimatednumberofwageandtaxstatementstobereported:          ___________________________________

       Signature of Person Completing Authorization                      Date

Please submit the request to:
   Kentucky Department of Revenue
   Withholding Tax Branch
   P.O. Box 181, Station 57
   Frankfort, KY 40602-0181
   www.revenue.ky.gov

   *If more than one FEIN is involved, please use the FEIN of the submitting/transmitting entity.

   **This gives Kentucky Department of Revenue permission to confirm the status to the employer using the
   confidential e-mail address provided on the form.

PIN NOTrequiredtosubmitK-5.

PleaseNote:Itisimportanttogetyoursystem/networkadministratorinvolvedimmediatelytoensurethatyouhave
the proper capabilities. Kentucky Department of Revenue provides a secure Web site, but there are often limitations 
inyoursystemornetwork.Pleaseworkwithyoursystem/networkadministratorearlytoensureyoursuccess!