First name and middle initial Last name Your social security number
Permanent home address
(number and street or rural route) Apartment number
City,village,orpostofce State ZIPcode
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 TotalnumberofallowancesyouareclaimingforNewYorkStateandYonkers,ifapplicable
(from line 20) ...........
1
2 Total number of allowances for New York City
(from line 35) ..................................................................................
2
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
Department of Taxation and Finance
Employee’s Withholding Allowance Certicate
New York State • New York City • Yonkers
SingleorHeadofhousehold
Married
Married, but withhold at higher single rate
Note:Ifmarriedbutlegallyseparated,markanX in
the Single or Head of household box.
IcertifythatIamentitledtothenumberofwithholdingallowancesclaimedonthiscerticate.
Employee’s signature Date
Employer’s name and address
(Employer: complete this section only if you are sending a copy of this form to the NYS Tax Department.)
Employeridenticationnumber
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.
Changes effective for 2019
FormIT-2104hasbeenrevisedfortaxyear2019.Additionalallowances
are allowed for covered employees of employers who elected to pay
the employer compensation expense tax and for employees who made
contributionstoaNewYorkCharitableGiftsTrustFundduring2018.
Theworksheetonpage3andthechartsbeginningonpage4,usedto
compute withholding allowances or to enter an additional dollar amount on
line(s)3,4,or5,havebeenrevised.IfyoupreviouslyledaFormIT-2104
andusedtheworksheetorcharts,youshouldcompleteanew2019
FormIT-2104andgiveittoyouremployer.
Who should le this form
Thiscerticate,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 employee’s pay. The
more allowances claimed, the lower the amount of tax withheld.
IfyoudonotleFormIT-2104,youremployermayusethesamenumber
ofallowancesyouclaimedonfederalFormW-4.Duetodifferencesin
tax law, this may result in the wrong amount of tax withheld for New York
State,NewYorkCity,andYonkers.CompleteFormIT-2104eachyear
andleitwithyouremployerifthenumberofallowancesyoumayclaim
isdifferentfromfederalFormW-4orhaschanged.Commonreasonsfor
completinganewFormIT-2104eachyearincludethefollowing:
You started a new job.
You are no longer a dependent.
Your individual circumstances may have changed (for example, you
were married or have an additional child).
You moved into or out of NYC or Yonkers.
You itemize your deductions on your personal income tax return.
• YouclaimallowancesforNewYorkStatecredits.
• Youowedtaxorreceivedalargerefundwhenyouledyourpersonal
income tax return for the past year.
• Yourwageshaveincreasedandyouexpecttoearn$107,650ormore
during the tax year.
• Thetotalincomeofyouandyourspousehasincreasedto$107,650or
more for the tax year.
• Youhavesignicantlymoreorlessincomefromothersourcesorfrom
another job.
You no longer qualify for exemption from withholding.
Instructions
Employer: Keep this certicate 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 ............ A
B Employee is a new hire or a rehire ... B First d
ate employee performed services for pay (mm-dd-yyyy)
(see instr.):
Aredependenthealthinsurancebenetsavailableforthisemployee? ............. Yes No
IfYes,enterthedatetheemployeequalies(mm-dd-yyyy):
IT-2104