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525 Attach to original or amended Form 540, 540 2EZ, or 540NR. 1 Your first name, middle initial, and last name 2 Your SSN or ITIN 3 Address (number and street, apt., suite, PO box, or PMB no., city, state, and ZIP code) 4 ENTER THE YEAR IN THE SPACE PROVIDED AT THE END OF THIS STATEMENT: I notified the Internal Revenue Service that I have been unable to obtain or have received an incorrect federal Form W-2, Wage and Tax Statement, or Form 1099-R, Distributions From Pensions, Annuities, Reti.

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