﻿Department of the Treasury-Internal Revenue Service

Form 886-L
(Rev. December 2014)
Supporting Documents

Name of Taxpayer ----
Tax Identification Number ----
Tax Year ----

Please provide a photocopy of the document or documents requested below. Return the photocopies with this form in the envelope provided. 

Wages and Withholding: 
• Periodic pay statements or check stubs clearly identifying the date, amount of gross income received and withholding taken out, or 
• A letter from your employer on company letterhead or stationary indicating dates of employment and gross amount of wages paid and withholdings deducted. The letter must include a contact person and telephone number. 

Form 886-L (Rev. 12-2014)
Catalog Number 73202A
www.irs.gov
Department of the Treasury - Internal Revenue Service 