Form It-2104-Sny - Certificate Of Exemption From Withholding For Start-Up Ny Program - 2015
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1
2New York State Department of Taxation and Finance
IT-2104-SNY
Certificate of Exemption from
Withholding for START-UP NY Program
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New York State
New York City
Yonkers
If you are employed by a business approved to participate in the START-UP NY program that operates in a tax-free NY area, you
may be eligible to exclude from New York adjusted gross income (NYAGI) wages earned from this employer. Therefore, you may
choose to claim exemption from withholding on these wages for New York State personal income tax (and New York City and
Yonkers personal income tax, if applicable).
To be eligible, you must:
• be employed by an approved business certified to participate in the START-UP NY program;
• perform work exclusively at the approved business’s location within the tax-free NY area during the tax year;
• be employed in a net new job created by the approved business in the tax-free NY area; and
• work at least 6 months (or expect to work at least 6 months) of the tax year at the approved business’s location.
See Who qualifies below for additional information on eligibility.
If you do not meet all of the conditions above, stop; you cannot claim exemption from withholding.
Employee information
First name and middle initial
Last name
Social security number
Filing status: Mark an X in only one box
A Single . ...............................
Mailing address (number and street or PO box)
Apartment number
Date of birth (mm-dd-yyyy)
B Married filing joint return ...
City, village, or post office
State
ZIP code
C Head of household . ...........
I certify that the information on this form is correct and that, for 2015, I expect to qualify (as described above) for exemption from
withholding on my wages from this employer, for New York State income tax purposes.
Employee’s signature (give the completed form to your employer; keep a copy for your records)
Date
Employer information: complete this section and retain form for inspection upon request
Employer identification number (EIN)
Employer name
Certificate number
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Instructions
Employee
Note: You are not eligible to exclude these wages from NYAGI
if you do not work for this business at least 6 months of your
Who qualifies – If you are employed by a business approved
tax year. If you claim the exemption from withholding before
to participate in the START-UP NY program that operates in
you have worked 6 months, and you do not actually work
a tax-free NY area, you may be eligible to exclude from your
6 months for this employer, you will be liable for income taxes
NYAGI the wages earned while working for this business.
on all these wages, and may be subject to a penalty.
Therefore, you may choose not to have income tax withheld on
If you meet the conditions above, or expect to, file
these wages for New York State personal income tax (and New
York City and Yonkers personal income tax, if applicable). See
Form IT-2104-SNY with your employer. Otherwise, your
our Web site at for more information.
employer must withhold New York State income tax (and New
York City and Yonkers personal income tax, if applicable) from
To be eligible, you must:
your wages. Do not send this form to the New York State Tax
• be employed by an approved business certified to participate
Department.
in the START-UP NY program;
If your employer’s participation in the START-UP NY program is
• perform work exclusively at the approved business’s location
terminated during the tax year, and you would have otherwise
within the tax-free NY area during the tax year (if you worked
qualified to exclude your wages from NYAGI, you may still claim
for this employer at a different location during the tax year, you
exemption from withholding for wages paid by this employer for
do not qualify for the wage exclusion);
the rest of the year. However, you cannot exclude your wages
• be employed in a net new job created by the approved
from NYAGI unless you work at least 6 months of the tax year
business in the tax-free NY area (see your employer to
exclusively at the business’s location.
confirm you meet this qualification); and
Liability for estimated tax – You may still have a New York
• work at least 6 months (or expect to work at least 6 months)
State personal income tax liability (and New York City and
of the tax year at the approved business’s location.
Yonkers personal income tax, if applicable) if you have other
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