Form It-2104 - Employee'S Withholding Allowance Certificate - Nys Department Of Taxation - 2012 Page 2

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IT-2104 (1/12) Page 3 of 7

Employers

Box B — If you are submitting a copy of this form to comply with New

York State’s New Hire Reporting Program, mark an X in box B. Enter the

Box A — If you are required to submit a copy of an employee’s

first day any services are performed for which the employee will be paid

Form IT-2104 to the Tax Department because the employee claimed

wages, commissions, tips and any other type of compensation. For

more than 14 allowances, mark an X in box A and send a copy

services based solely on commissions, this is the first day an employee

of Form IT-2104 to: NYS Tax Department, Income Tax Audit

working for commissions is eligible to earn commissions. Also, mark an X

Administrator, Withholding Certificate Coordinator, W A Harriman

in the Yes or No box indicating if dependent health insurance benefits are

Campus, Albany NY 12227.

available to this employee. If Yes, enter the date the employee qualifies

Due dates for sending certificates received from employees claiming

for coverage. Mail the completed form, within 20 days of hiring, to: NYS

more than 14 allowances are:

Tax Department, New Hire Notification, PO Box 15119, Albany NY

12212-5119. To report newly-hired or rehired employees online instead of

Quarter

Due date

Quarter

Due date

submitting this form, go to

January – March

April 30

July – September

October 31

April – June

July 31

October – December

January 31

Worksheet

See the instructions before completing this worksheet.

Part 1 — Complete this part to compute your withholding allowances for New York State and Yonkers

(line 1)

6 Enter the number of dependents that you will claim on your state return ( do not include yourself or, if married, your spouse ) ... 6.

For lines 7, 8, and 9, enter 1 for each credit you expect to claim on your state return.

7 College tuition credit .................................................................................................................................................................. 7.

8 New York State household credit .............................................................................................................................................. 8.

9 Real property tax credit ............................................................................................................................................................. 9.

For lines 10, 11, and 12, enter 3 for each credit you expect to claim on your state return.

10 Child and dependent care credit .............................................................................................................................................. 10.

11 Earned income credit ................................................................................................................................................................ 11.

12 Empire State child credit ........................................................................................................................................................... 12.

13 Other credits

.................................................................................................................................................... 13.

( see instructions )

14 Head of household status and only one job

................................................................................... 14.

(enter 2 if the situation applies)

15 Enter an estimate of your federal adjustments to income, such as alimony you will pay for the tax year

and deductible IRA contributions you will make for the tax year. Total estimate $ .

Divide this estimate by $1,000. Drop any fraction and enter the number ............................................................................. 15.

16 If you expect to itemize deductions on your state tax return, complete Part 2 below and enter the number from line 25.

All others enter 0 ................................................................................................................................................................... 16.

17 Add lines 6 through 16. Enter the result here and on line 1. If you have more than one job, or if you and your spouse both

work, see instructions for Taxpayers with more than one job and Married couples with both spouses working. ................ 17.

Part 2 — Complete this part only if you expect to itemize deductions on your state return.

18 Enter your estimated federal itemized deductions for the tax year .......................................................................................... 18.

19 Enter your estimated state, local, and foreign income taxes or state and local general sales taxes included on line 18

( if your estimated New York AGI is over $1 million, you must enter on line 19 all estimated federal itemized deductions included on

....................................................................................................................................... 19.

line 18 except charitable contributions )

20 Subtract line 19 from line 18 .................................................................................................................................................... 20.

21 Enter your estimated college tuition itemized deduction ......................................................................................................... 21.

22 Add lines 20 and 21 ................................................................................................................................................................. 22.

23 Based on your federal filing status, enter the applicable amount from the table below ......................................................... 23.

Standard deduction table

Single ( cannot be claimed as a dependent ) ... $ 7,500

Qualifying widow(er) ........................................ $15,000

Single ( can be claimed as a dependent ) ....... $ 3,000

Married filing jointly ......................................... $15,000

Head of household ........................................ $10,500

Married filing separate returns ........................ $ 7,500

24 Subtract line 23 from line 22

....................................................... 24.

( if line 23 is larger than line 22, enter 0 here and on line 16 above )

25 Divide line 24 by $1,000. Drop any fraction and enter the result here and on line 16 above .................................................. 25.

Part 3 — Complete this part to compute your withholding allowances for New York City

(line 2)

26 Enter the amount from line 6 above ......................................................................................................................................... 26.

27 Add lines 14 through 16 above and enter total here ................................................................................................................ 27.

28 Add lines 26 and 27. Enter the result here and on line 2 ......................................................................................................... 28.