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Get MA Form M-4852 2013

E. Your information 1 Last name First name Middle initial 2 Social Security no. 3 Street address City/Town State Zip Form W-2 not received I have been unable to obtain (or have received an incorrect) Form W-2, Wage and Tax Statement, from the employer or payer named below. The amounts shown are my best estimates of all wages or payments paid to me and the Massachusetts taxes withheld by this employer or payer. 4 Year 5 Employer or payer s name Employer or payer s address Identifi.

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