First name and middle initial Last name Your social security number
Permanent home address
(number and street or rural route) Apartment number
City,village,orpostofce State ZIPcode
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 TotalnumberofallowancesyouareclaimingforNewYorkStateandYonkers,ifapplicable
(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 NewYorkStateamount ........................................................................................................................................
3
4 New York City amount ...........................................................................................................................................
4
5 Yonkers amount ....................................................................................................................................................
5
Department of Taxation and Finance
Employee’s Withholding Allowance Certicate
New York State • New York City • Yonkers
SingleorHeadofhousehold
Married
Married, but withhold at higher single rate
Note:Ifmarriedbutlegallyseparated,markanX in
the Single or Head of household box.
IcertifythatIamentitledtothenumberofwithholdingallowancesclaimedonthiscerticate.
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.)
Employeridenticationnumber
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
FormIT-2104hasbeenrevisedfortaxyear2019.Additionalallowances
are allowed for covered employees of employers who elected to pay
the employer compensation expense tax and for employees who made
contributionstoaNewYorkCharitableGiftsTrustFundduring2018.
Theworksheetonpage3andthechartsbeginningonpage4,usedto
compute withholding allowances or to enter an additional dollar amount on
line(s)3,4,or5,havebeenrevised.IfyoupreviouslyledaFormIT-2104
andusedtheworksheetorcharts,youshouldcompleteanew2019
FormIT-2104andgiveittoyouremployer.
Who should le this form
Thiscerticate,FormIT-2104,iscompletedbyanemployeeandgiven
totheemployertoinstructtheemployerhowmuchNewYorkState(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.
IfyoudonotleFormIT-2104,youremployermayusethesamenumber
ofallowancesyouclaimedonfederalFormW-4.Duetodifferencesin
tax law, this may result in the wrong amount of tax withheld for New York
State,NewYorkCity,andYonkers.CompleteFormIT-2104eachyear
andleitwithyouremployerifthenumberofallowancesyoumayclaim
isdifferentfromfederalFormW-4orhaschanged.Commonreasonsfor
completinganewFormIT-2104eachyearincludethefollowing:
• 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.
• YouclaimallowancesforNewYorkStatecredits.
• Youowedtaxorreceivedalargerefundwhenyouledyourpersonal
income tax return for the past year.
• Yourwageshaveincreasedandyouexpecttoearn$107,650ormore
during the tax year.
• Thetotalincomeofyouandyourspousehasincreasedto$107,650or
more for the tax year.
• Youhavesignicantlymoreorlessincomefromothersourcesorfrom
another job.
• You no longer qualify for exemption from withholding.
Instructions
Employer: Keep this certicate with your records.
Mark an XinboxAand/orboxBtoindicatewhyyouaresendingacopyofthisformtoNewYorkState
(see instructions):
A Employeeclaimedmorethan14exemptionallowancesforNYS ............ A
B Employee is a new hire or a rehire ... B First d
ate employee performed services for pay (mm-dd-yyyy)
(see instr.):
Aredependenthealthinsurancebenetsavailableforthisemployee? ............. Yes No
IfYes,enterthedatetheemployeequalies(mm-dd-yyyy):
IT-2104