Form It-2104 - Employee'S Withholding Allowance Certificate - 2016
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1Departme
nt
of
Taxat
ion and
Finance
Employee's Withholding
Allowance Certificate
IT-2104
New York State • New York City • Yonkers
First name and
middle
initial
Last
name
Your
social
sec urity number
Apartment
number
Single
or
Head
of household
D
Married
D
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~Ma~ed,
b~wilhho~~h~h~~n~era~
D
Permanent home address
(number
and street or
rural rout e)
City,
village,
or
post office
Are you
a
resident of New York
City?
...........
Yes
D
Are you
a resident
of
Yonkers?
.....................
Yes
D
State
NoO
NoO
ZIP code
Note:
If
marri
e
d but
legally separa
ted,
ma
rk an
X in
the
Single or Head of household
box.
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
--
··---------- ---.. ··-·H·---
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.
I
Employee 's signatu re
I
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 ........
..
..
AD
B Employee
is
a new hire
or
a
rehire
...
B D
First date employee performed seNices
for
pay
(mm-dd
-yyyy)
(see instr.
)
:
Are dependent health
insurance
benefits available for this employee?
.............
Yes
D
No
D
If
Yes,
enter the date
the employee
qualifies
(mm-dd-yyyy
)
:
Employe r's name and add ress
(Employer:
comple
te
this section
only if you
are sending
a
copy
of this form to
the
NYS
Tax
Department.)
Employe
r
identification number
Instructions
Changes effective for 2016
Form
IT-2104 has
been
revised fo
r
tax ye
ar
2016.
The
worksheet on
page
3 a nd
the
charts
beginn
ing on page
4.
used
to
compute
withhold
ing
allowances or to enter an
additional dollar
amo unt
on
line(s)
3. 4
,
or
5,
have
been
revised.
If
you previously
filed a
Form
IT-2104
and
used the
wo rksheet
or charts
,
you shou ld
complete
a new 2016
Form IT-2104
and
give
it to
your emp
loyer.
Who should file this form
Th
is certificate
,
Form
IT-2104
,
is
completed
by
an
employee and
given
to the employer
to instruct
the
employer how much
New
York
State
(and
New
York
City and
Yonkers)
tax
to
withhold from the emp loyee's pay. The
more allowances
claimed
.
the
lower the
amount of
tax
withheld.
If
you
do
not file Form IT-2104, your employe
r
may
use the
same
number
of
allowances
you claimed on federal Form W-4
.
Due
to diffe
rences in
tax law
,
this
may
result in the wrong amount of
tax
withheld
for New
York
State
.
New
York
C
ity,
and Yonkers.
Complete
Form
IT-2104 each
year
and
file
it
with your
employer if
the number
of allowances
you may
claim
is
different
from
federa
l
Form W-4 or has changed. Common reasons for
complet ing
a
new
Form
IT-2 104 each year include the follow
ing:
•
You started a new
job
.
•
You
are
no longe
r
a dependent.
•
Your
individual circumstances may
have
changed
(for example
,
you
were
marr
ied
or have
an addit
ional child)
.
•
You moved into
or
out of
NYC
or Yonkers
.
You
itemize
your deductions
on
your
persona
l
income
tax
return
.
•
You
claim
allowances
for
New York
State credits.
You
owed
tax
or
received
a large refund when you
filed
your
personal
incom
e
tax
retu
rn for the
past
yea
r.
Your wages have increased
and
you
expect
to earn $106,950 or more
during the tax year.
The tota
l
income of
you and
you
r
spouse has
increased to $106,950 or
more for the
tax
year
.
You
have significantly
more or less income from other
sources or from
another job.
•
You no longer qua lify
for exemption
from
withholding.
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