Resident Income Tax Return
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4IT-201
Department of Taxation and Finance
Resident Income Tax Return
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New York State
New York City
Yonkers
MCTMT
1 6
For the full year January 1, 2016, through December 31, 2016, or fiscal year beginning ...
and ending ...
For help completing your return, see the instructions, Form IT-201-I.
Your first name
MI
Your last name
(for a joint return, enter spouse’s name on line below)
Your social security number
Your date of birth (mmddyyyy)
Spouse’s first name
MI
Spouse’s last name
Spouse’s social security number
Spouse’s date of birth (mmddyyyy)
Mailing address
Apartment number
New York State county of residence
(see instructions, page 13) (number and street or PO box)
City, village, or post office
State
ZIP code
Country
School district name
(if not United States)
Taxpayer’s permanent home address
Apartment number
(see instructions, page 13) (number and street or rural route)
School district
code number ...............
Taxpayer’s date of death
Spouse’s date of death
City, village, or post office
State
ZIP code
(mmddyyyy)
(mmddyyyy)
Decedent
NY
information
D1
Did you have a financial account
A Filing
Single
located in a foreign country?
.......... Yes
No
(see page 14)
status
Married filing joint return
(mark an
D2
Yonkers residents and Yonkers part-year residents only:
(enter spouse’s social security number above)
X in one
(1) Did you receive a property tax freeze or
box):
property tax relief credit?
Married filing separate return
................................................. Yes
No
(enter spouse’s social security number above)
(see page 14)
(2) If Yes, enter the
Head of household
.
(with qualifying person)
00
total amount ...........
E
(1) Did you or your spouse maintain living
Qualifying widow(er) with dependent child
quarters in NYC during 2016?
.. Yes
No
(see page 14)
B
Did you itemize your deductions on
(2) Enter the number of days spent in NYC in 2016
your 2016 federal income tax return? ............ Yes
No
.........
(any part of a day spent in NYC is considered a day)
C
F
Can you be claimed as a dependent
NYC residents and NYC part-year
on another taxpayer’s federal return? ........... Yes
No
residents only
:
(see page 14)
(1) Number of months you lived in NYC in 2016 ................
(2) Number of months your spouse
lived in NYC in 2016 ........................................................
G
Enter your 2-character special condition
code(s) if applicable
......................
(see page 14)
H Dependent exemption information
(see page 15)
First name
MI
Last name
Relationship
Social security number
Date of birth
(mmddyyyy)
If more than 7 dependents, mark an X in the box.
201001160094
For office use only
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