Form Nys-1 - Return Of Tax Withheld

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New York State Department of Taxation and Finance
Return of Tax Withheld
Withholding identification number
1 New York State tax withheld ...
2 New York City tax withheld .....
legal name:
3 Yonkers tax withheld ...............
A Last payroll date – Enter date of last
4 Total withheld
( add lines 1, 2, & 3 )
payroll covered by this return (mmddyy)
B If you permanently ceased paying wages,
5 Credit claimed ..........................
enter date of final payroll (mmddyy) ..........
6 Total tax due
( line 4 minus line 5 )
C Mark an X in the box for additional payment .........................
I certify that this information is to the best of my knowledge and belief true, correct, and complete.
Taxpayer’s signature
Taxpayer’s name
Telephone number
( print or type )
Mark X if new
For office
employer or address
use only
( see back )
Received date


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