Fillable Form Nys-1 - Return Of Tax Withheld

Form Nys-1 - Return Of Tax Withheld - 2016 Page 2

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NYS-1 (1/16) (back)

Paid preparer: If you are using a paid preparer or payroll service, have the preparer or payroll service complete the appropriate section(s) below.

Preparer’s signature

Date

Preparer’s NYTPRIN

Preparer’s SSN or PTIN

NYTPRIN

excl. code

Preparer’s firm name

Address

Firm’s EIN

Telephone number

(or yours, if self-employed)

(

)

Payroll service’s name

Payroll

service’s

EIN

New employer or address change: Enter below the address at which you will receive withholding tax and unemployment insurance notices. For other changes, see instructions.

Taxpayer’s business name

c/o

attn

( if applicable, mark either box and enter name )

If the address is for your paid preparer, mark

an X in the c/o box, enter the preparer’s

name, and mark an X in this box .......................

Number and street or PO box

City

State

ZIP code

Make check payable to NYS Income Tax and mail to: NYS Tax Department, Processing Unit, PO Box 4111, Binghamton NY 13902-4111.