Form It-2104-E - Certificate Of Exemption From Withholding - 2013
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2IT-2104-E
New York State Department of Taxation and Finance
Certificate of Exemption from Withholding
New York State • New York City •
Yonkers
This certificate will expire on April 30, 2014.
To claim exemption from withholding for New York State personal income tax (and New York City and Yonkers personal income tax, if
applicable), you must meet the conditions in either Group A or Group B:
Group A
• you must be under age 18, or over age 65, or a full‑time student under age 25; and
• you did not have a New York income tax liability for 2012; and
• you do not expect to have a New York income tax liability for 2013 (for this purpose, you have a tax liability if your return shows tax
before the allowance of any credit for income tax withheld).
Group B
• you meet the conditions set forth under the Servicemembers Civil Relief Act (SCRA), as amended by the Military Spouses Residency
Relief Act. See Military spouses.
If you do not meet all of the conditions in either Group A or Group B above, stop; you cannot claim exemption from withholding.
First name and middle initial
Last name
Social security number
Filing status: Mark an X in only one box
A Single
B Married
Mailing address (number and street or rural route)
Apartment number
Date of birth (mm-dd-yyyy)
C Qualifying widow(er)
with dependent child, or
City, village, or post office
State
ZIP code
head of household with
qualifying person ..............
Are you a full‑time student?...... Yes
No
Are you a military spouse exempt under the SCRA? ..... Yes
No
I certify that the information on this form is correct and that, for the year 2013, I expect to qualify for exemption from withholding of New York State income tax
under section 671(a)(3) of the Tax Law or under the SCRA. I will notify my employer within 10 days of any change requiring revocation of the exemption from
withholding as explained in the instructions.
Employee’s signature (give the completed certificate to your employer)
Date
Employer: complete this section only if you must send a copy of this form to the NYS Tax Department
.
(see instructions)
Employer name and address
Employer identification number
Mark an X in the box if a newly hired employee or a rehired employee .......
First date employee performed services for pay (mm-dd-yyyy)
:
(see instructions)
Are dependent health insurance benefits available for this employee? .............................. Yes
No
If Yes, enter the date the employee qualifies (mm-dd-yyyy) : ......
Instructions
Employee
personal income tax, if applicable) from your wages. Do not send this
certificate to the Tax Department.
Who qualifies – To claim exemption from withholding for New
Generally, as a resident, you are required to file a New York State
York State personal income tax (and New York City and Yonkers
income tax return if you are required to file a federal income tax
personal income tax, if applicable), you must meet the conditions in
either Group A or Group B:
return, or if your federal adjusted gross income plus your New
York additions is more than $4,000, regardless of your filing status.
Group A
However, if you are single and can be claimed as a dependent on
• you must be under age 18, or over age 65, or a full‑time student
another person’s federal return, you must file a New York State
under age 25; and
return if your federal adjusted gross income plus your New York
additions is more than $3,000.
• you did not have a New York income tax liability for 2012; and
• you do not expect to have a New York income tax liability for
If you are a nonresident and have income from New York sources,
2013 (for this purpose, you have a tax liability if your return
you must file a New York return if the sum of your federal adjusted
shows tax before the allowance of any credit for income tax
gross income and New York additions to income is more than your
withheld).
New York standard deduction.
A penalty of $500 may be imposed for furnishing false information
Group B
that decreases your withholding amount.
• you meet the conditions set forth under the Servicemembers
Civil Relief Act (SCRA), as amended by the Military Spouses
When to claim exemption from withholding – File this certificate
Residency Relief Act. See Military spouses.
with your employer if you meet the conditions listed in Group A or
Group B above. You must file a new certificate each year if you
If you meet the conditions in Group A or Group B, file this certificate,
wish to continue to claim the exemption.
Form IT‑2104‑E, with your employer. Otherwise, your employer must
withhold New York State income tax (and New York City and Yonkers
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