Form It-2104-E - Certificate Of Exemption From Withholding - 1999

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New York State Department of Taxation and Finance
IT-2104-E
Certificate of Exemption from Withholding
New York State ● City of New York ● City of Yonkers
This certificate will expire on April 30, 2000.
Social security number
First name and middle initial
Last name
Filing status - check only one box
(A)
(B)
Single
Married
Mailing address
Apartment number
Date of birth
(number and street or rural route)
Qualifying widow(er) with
/
/
(C)
dependent child, or
City, village or post office
State
ZIP code
Are you a full-time student?
head of household with
qualifying person
Yes
No
1
Are you under age 18, a full-time student under age 25, or over age 65? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes
No
2
Did you have a New York income tax liability for 1998? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes
No
3
Do you expect to have a New York income tax liability for 1999? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes
No
Note: If you checked a shaded box on line 1, 2, or 3, stop; you cannot claim exemption from withholding.
Employee’s signature
Date
I certify that the information on this form is correct and that for 1999, I expect to qualify
for exemption from withholding of New York State income tax under section 671(a)(3) of
the Tax Law. I will notify my employer within 10 days of any change requiring revocation
of the exemption from withholding as explained in the instructions.
Employer’s name and address
(Employer: complete this section only if sending to New York State Tax Department.)
Employer identification number
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Cut here and give the certificate to your employer
Instructions
If you want to discontinue (e.g., you expect that your income will
Employee
exceed $3,000) or you are required to revoke this exemption, you
Who qualifies - You may claim exemption from withholding if:
must file a Form IT-2104, Employee’s Withholding Allowance
(1) you are under age 18, a full-time student under age 25, or over
Certificate, with your employer and follow the instructions to have
age 65 and (2) you had no New York income tax liability for 1998 and
enough tax withheld.
expect none for 1999. (For this purpose, you have a tax liability if your
return shows tax before the allowance of any credit for income tax
For more information on how to complete this form, call toll free
withheld.)
1 800 225-5829. From areas outside the U.S. and outside Canada,
call (518) 485-6800.
If you meet these conditions, file this certificate, Form IT-2104-E, with
Filing status - Check the box on Form IT-2104-E that shows your
your employer. Otherwise, your employer must withhold New York
present filing status for federal purposes.
State income tax (and city of New York and city of Yonkers personal
income tax, if applicable) from your wages. Do not send this certificate
Privacy Notification
to the Department of Taxation and Finance.
The right of the Commissioner of Taxation and Finance and the Department of Taxation and
Finance to collect and maintain personal information, including mandatory disclosure of
Generally, as a resident, you are required to file a New York State
social security numbers in the manner required by tax regulations, instructions, and forms, is
found in Articles 22, 26, 26-A, 26-B, 30, 30-A, and 30-B of the Tax Law; Article 2-E of the
income tax return if you are required to file a federal income tax return
General City Law; and 42 USC 405(c)(2)(C)(i).
or if your federal adjusted gross income plus your New York additions
is more than $4,000 (or more than your standard deduction, if that
The Tax Department will use this information primarily to determine and administer tax
liabilities due the state and city of New York and the city of Yonkers. We will also use this
deduction is under $4,000).
information for certain tax offset and exchange of tax information programs authorized by
law, and for any other purpose authorized by law.
If you are single and can be claimed as a dependent on another
Information concerning quarterly wages paid to employees and identified by unique random
person’s federal return, you must file a New York State return if your
identifying code numbers to preserve the privacy of the employees’ names and social
federal adjusted gross income plus your New York additions is more
security numbers will be provided to certain state agencies for research purposes to
than $3,000.
evaluate the effectiveness of certain employment and training programs.
Failure to provide the required information may result in civil or criminal penalties, or both,
If you are a nonresident and have income from New York sources, you
under the Tax Law.
must file a New York return if the sum of your federal adjusted gross
income and New York additions to income is more than your New York
This information will be maintained by the Director of the Registration and Data Services
Bureau, NYS Tax Department, Building 8 Room 924, W A Harriman Campus, Albany NY
standard deduction.
12227; telephone 1 800 225-5829. From areas outside the U.S. and outside Canada, call
(518) 485-6800.
A penalty of $500 may be imposed for furnishing false information that
Employer
decreases your withholding amount.
Keep this certificate with your records. If an employee who claims
When to claim exemption from withholding - File this certificate
exemption from withholding on Form IT-2104-E usually earns more
with your employer as soon as you determine that you meet the
than $200 per week, you must send a copy of that employee’s Form
conditions listed above. You must file a new certificate each year if you
IT-2104-E to: NYS Tax Department, Income Tax Audit Administrator,
wish to claim the exemption.
Withholding Certificate Coordinator, Building 9, W A Harriman
Campus, Albany NY 12227.
Liability for estimated tax - If, as a result of this exemption
certificate, your employer does not withhold income tax from your
The Tax Department will not accept this form if it is incomplete. We will
wages and you later fail to qualify for exemption from tax, you may be
review these certificates and notify you of any adjustments that must
required to pay estimated tax and be subject to penalty if it is not paid.
be made.
For further information, see Form IT-2105, Estimated Income Tax
Due dates for sending certificates received from employees who claim
Payment Voucher.
exemption and earn more than $200 per week are:
Multiple employers - If you have more than one employer, you may
Quarter
Due date
Quarter
Due Date
claim exemption from withholding with each employer as long as your
January - March
April 30
July - September
October 31
total expected income will not cause you to incur a New York income
April - June
July 31
October - December
January 31
tax liability for 1999 and you had no liability for 1998.
Revocation by employer - You must revoke this exemption within 10
Revocation by employee - You must revoke this exemption certificate
days if, on any day during the calendar year, the date of birth stated
(1) within 10 days from the day you expect to incur a New York
on the certificate filed by the employee indicates the employee no
income tax liability for 1999 or (2) on or before December 1, 1999, if
longer meets the age requirements for exemption. The revocation must
you expect to incur a tax liability for 2000.
be in the form of a written notice to the employee.

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