Form C 4267 PDF Details

The State of New Jersey’s Department of the Treasury Division of Taxation provides a crucial document, the C 4267 form, designed for employees who face difficulties in acquiring their Form W-2, Wage and Tax Statement, from their employers. As a substitute wage and tax statement, it encompasses a declaration space for employees to report their estimated gross wages, tips, and other compensation alongside the New Jersey Gross Income Tax that was withheld by the employer during the tax year. The form requires employees to detail the attempts made to obtain their original W-2 form, including any communication with the Internal Revenue Service about the issue, and to explain how they calculated the reported wages and taxes. It emphasizes the importance of accuracy and honesty, with a stern reminder that submitting the form comes under penalties of perjury for false declarations. The form serves as an affidavit by the employee on their best knowledge and belief regarding their wage and tax details in situations where obtaining an official W-2 form proves impossible, thereby ensuring that they can comply with tax reporting requirements despite the lack of formal documentation. This measure not only aids in maintaining an individual's tax compliance but also triggers a verification process by the Division of Taxation, which may contact the employer to investigate the reasons behind their failure to issue a W-2 statement.

QuestionAnswer
Form NameForm C 4267
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other names4267 irs w2 c4267 form

Form Preview Example

State of New Jersey

DEPARTMENT OF THE TREASURY

DIVISION OF TAXATION

EMPLOYEE’S SUBSTITUTE WAGE AND TAX STATEMENT

Name

Social Security Number

Address (Number, Street, City, State, Zip Code)

I have been unable to obtain a form W-2, Wage and Tax Statement, from my employer, named below, and have so notified the Internal Revenue Service. The amounts shown below are my best estimates of the gross wages paid to me and the New Jersey Gross Income Tax withheld by this employer during __________

Name and Address of Employer

Gross Wages, Tips, and Other Compensation

New Jersey Gross Income Tax Withheld

How did you estimate the above gross wages and New Jersey Gross Income Tax?

Give reason Form W-2 was not furnished by employer, if known, and explain your efforts to obtain it.

Under penalties of perjury, I declare that I have made reasonable attempts to obtain the Wage and Tax Statement or copy thereof and that I have examined this statement and, to the best of my knowledge and belief, it is true, correct, and complete.

Your Signature

Date

The Division of Taxation will contact your employer for verification of the information reported on this form and to determine the reason no Wage and Tax Statement was issued.

THIS FORM IS TO BE USED ONLY IF A WAGE AND TAX STATEMENT

CAN NOT BE SECURED FROM YOUR EMPLOYER

C-4267 (10-99, R6)

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A way to fill out Form C 4267 part 1

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Form C 4267 conclusion process described (portion 2)

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