Form It-2104 - Employee'S Withholding Allowance Certificate
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2IT-2104
New York State Department of Taxation and Finance
Employee’s Withholding Allowance Certificate
New York State • New York City • Yonkers
First name and middle initial
Last name
Your social security number
Permanent home address
Apartment number
(number and street or rural route)
Single or Head of household
Married
Married, but withhold at higher single rate
City, village, or post office
State
ZIP code
Note: If married but legally separated, mark an X in
the Single or Head of household box.
Are you a resident of New York City?
Yes
No
Are you a resident of Yonkers?
Yes
No
Complete the worksheet on page 3 before making any entries.
1.
1 Total number of allowances you are claiming for New York State and Yonkers, if applicable
.............
(from line 19)
2.
2 Total number of allowances for New York City (from line 28) .................................................................................
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.
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.
Employee’s signature
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.
Employer’s name and address
Employer identification number
(Employer: complete this section only if you must send a copy of this form to the NYS Tax Department.)
Employers only: Please mark an X in the appropriate box(es) to indicate why you are sending a copy of this form to New York State:
Employee is a new hire
Employee claimed more than 14 exemption allowances for New York State
Need help?
Privacy notification
The Commissioner of Taxation and Finance may collect and
Internet access:
maintain personal information pursuant to the New York State
Access our Answer Center for answers to frequently
Tax Law, including but not limited to, sections 171, 171-a,
asked questions; check your refund status; check your
287, 308, 429, 475, 505, 697, 1096, 1142, and 1415 of that
estimated tax account; download forms, publications;
Law; and may require disclosure of social security numbers
get tax updates and other information.
pursuant to 42 USC 405(c)(2)(C)(i).
Fax-on-demand forms: Forms are
This information will be used to determine and administer tax
available 24 hours a day,
liabilities and, when authorized by law, for certain tax offset
7 days a week.
1 800 748-3676
and exchange of tax information programs as well as for any
other lawful purpose.
Telephone assistance is available from 8:00 A.M. to
Information concerning quarterly wages paid to employees
iday.
5:00 P.M. (eastern time), Monday through Fr
is provided to certain state agencies for purposes of
fraud prevention, support enforcement, evaluation of the
Refund status:
1 800 443-3200
effectiveness of certain employment and training programs
(Automated service for refund status is available
and other purposes authorized by law.
24 hours a day, 7 days a week.)
To order forms and publications:
1 800 462-8100
Failure to provide the required information may subject you to
civil or criminal penalties, or both, under the Tax Law.
Personal Income Tax Information Center:
1 800 225-5829
From areas outside the U.S. and outside Canada:
(518) 485-6800
This information is maintained by the Director of Records
Hearing and speech impaired: (telecommunications
Management and Data Entry, NYS Tax Department,
W A Harriman Campus, Albany NY 12227; telephone
device for the deaf (TDD) callers only):
1 800 634-2110
1 800 225-5829. From areas outside the United States and
Persons with disabilities: In compliance with the
outside Canada, call (518) 485-6800.
Americans with Disabilities Act, we will ensure that our
lobbies, offices, meeting rooms, and other facilities are
accessible to persons with disabilities. If you have
questions about special accommodations for persons with disabilities,
please call 1 800 225-5829.
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