Annual Tax Form Print Request

Annual Tax Form Print Request
Instructions: Complete this form to request a printed or electronic copy of your annual tax form (e.g., 1095-C). Provide your contact information, select the tax year you need, and choose how you want to receive your form. Upload a copy of your government-issued ID and sign before submitting. Please allow up to five business days for processing.
Full Name*

First NameLast Name
Are you a current or former Orange County employee?*

Current employeeFormer employee
Employee ID Number*
If you are unable to locate or recall your Employee ID Number, kindly reach out to Benefits@ocfl.net. This information is required to process your request.
Phone Number*
Please enter a valid phone number.
1095-C Request Year*
Email*
example@example.com
Former Address If Updating Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
New or Current Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Distribution Options*

Pick Up (ID must be shown to validate identity)US Mail (Mailed to address on driver's license or ID)E-mail (Will be sent securely)
Pick Up Location: 450 E South St, Orlando, FL 32801
Please scan or click the QR code below to upload your driver's license or Government issued Identification card reflecting your current address
By signing below, you are hereby giving authorization for the Human Resources Department to process the requested information above. Please allow up to five (5) business days for your request to be processed.
Signature*

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Date*

MonthDayYear
Date
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