Form It-2104 - Employee'S Withholding Allowance Certificate - 2015
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7New York State Department of Taxation and Finance
IT-2104
Employee’s Withholding Allowance Certificate
New York State • New York City • Yonkers
First name and middle initial
Last name
Your social security number
Permanent home address
Apartment number
(number and street or rural route)
Single or Head of household
Married
Married, but withhold at higher single rate
City, village, or post office
State
ZIP code
Note: If married but legally separated, mark an X in
the Single or Head of household box.
Are you a resident of New York City? ........... Yes
No
Are you a resident of Yonkers? ..................... Yes
No
Complete the worksheet on page 3 before making any entries.
1 Total number of allowances you are claiming for New York State and Yonkers, if applicable
1
...........
(from line 17)
2
2 Total number of allowances for New York City
..................................................................................
(from line 28)
Use lines 3, 4, and 5 below to have additional withholding per pay period under special agreement with your employer.
3 New York State amount ........................................................................................................................................
3
4 New York City amount ...........................................................................................................................................
4
5 Yonkers amount ....................................................................................................................................................
5
I certify that I am entitled to the number of withholding allowances claimed on this certificate.
Employee’s signature
Date
Penalty – A penalty of $500 may be imposed for any false statement you make that decreases the amount of money you have withheld
from your wages. You may also be subject to criminal penalties.
Employee: detach this page and give it to your employer; keep a copy for your records.
Employer: Keep this certificate with your records.
:
Mark an X in box A and/or box B to indicate why you are sending a copy of this form to New York State
(see instructions)
A Employee claimed more than 14 exemption allowances for NYS ............ A
B Employee is a new hire or a rehire ... B
First date employee performed services for pay
:
(mm-dd-yyyy) (see instr.)
Are dependent health insurance benefits available for this employee? ............. Yes
No
If Yes, enter the date the employee qualifies
:
(mm-dd-yyyy)
Employer identification number
Employer’s name and address
(Employer: complete this section only if you are sending a copy of this form to the NYS Tax Department.)
Instructions
and file it with your employer if the number of allowances you may claim
Changes effective for 2015
is different from federal Form W-4 or has changed. Common reasons for
Form IT-2104 has been revised for tax year 2015. The worksheet on
completing a new Form IT-2104 each year include the following:
page 3, the charts beginning on page 4, and the additional dollar amounts
in the instructions on page 2, used to compute withholding allowances
• You started a new job.
or to enter an additional dollar amount on line(s) 3, 4, or 5, have been
• You are no longer a dependent.
revised. If you previously filed a Form IT-2104 and used the worksheet,
• Your individual circumstances may have changed (for example, you
charts, or additional dollar amounts, you should complete a new 2015
were married or have an additional child).
Form IT-2104 and give it to your employer.
• You moved into or out of NYC or Yonkers.
Who should file this form
• You itemize your deductions on your personal income tax return.
• You claim allowances for New York State credits.
This certificate, Form IT-2104, is completed by an employee and given
to the employer to instruct the employer how much New York State (and
• You owed tax or received a large refund when you filed your personal
New York City and Yonkers) tax to withhold from the employee’s pay. The
income tax return for the past year.
more allowances claimed, the lower the amount of tax withheld.
• Your wages have increased and you expect to earn $106,200 or more
during the tax year.
If you do not file Form IT-2104, your employer may use the same number
of allowances you claimed on federal Form W-4. Due to differences in
• The total income of you and your spouse has increased to $106,200 or
tax law, this may result in the wrong amount of tax withheld for New York
more for the tax year.
State, New York City, and Yonkers. Complete Form IT-2104 each year
• You have significantly more or less income from other sources or from
another job.
• You no longer qualify for exemption from withholding.
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