Mark an X in the appropriate boxes below:
(See denitions for resident, nonresident, and part-year resident on the back of this form.)
Part 1 – New York State
I certify that I am not a resident of New York State and that my residence is as stated above.
I estimate that     % of my services during the year will be performed within New York State and subject to New York 
State withholding tax.
Part 2 – New York City
I certify that I am not a resident of New York City and that my residence is as stated above.
Part 3 – Yonkers
I certify that I am not a resident of Yonkers and that my residence is as stated above.
I estimate that   % of my services during the year will be performed within Yonkers.
I will notify my employer within 10 days of any change in the percentage of my services performed within New York State 
or Yonkers, or of a change in my status from nonresident to resident of New York State, New York City, or Yonkers.
Employer: You must withhold the applicable amount of New York State, New York City, or Yonkers tax from wages (or 
from the percentage of wages shown above) paid to employees who le this certicate. Keep this certicate with your
records. You must keep this certicate and have it available for inspection by the Tax Department.
Employee’s signature  Date
Department of Taxation and Finance
New York State, City of New York, and
City of Yonkers Certicate of Nonresidence and
Allocation of Withholding Tax
Employee: Complete this form and return it to your employer. If you become a New York State, New York City, or Yonkers resident, or 
you substantially change the percentage of services performed within New York State or Yonkers, you must notify your employer within 
10 days. A penalty of $500 may be imposed for furnishing false information that decreases the withholding amount.
Employee’s rst name and middle initial   Last name   Social security number   Employer’s name
Street address  Street address
City  State  ZIP code  City  State  ZIP code
click to sign
click to edit
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Telephone assistance
Automated income tax refund status:  518-457-5149
Personal Income Tax Information Center:  518-457-5181
To order forms and publications:  518-457-5431
Text Telephone (TTY) or TDD  Dial 7-1-1 for the
equipment users   New York Relay Service
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Resident and nonresident dened
To determine whether or not you are a resident of New York 
State, New York City, or Yonkers, you must consider your 
domicile and permanent place of abode. In general, your 
domicile is the place you intend to have as your permanent 
home. In general, a permanent place of abode is a residence 
(a building or structure where a person can live) that you 
permanently maintain, whether you own it or not, that is suitable 
for year-round use. Apermanent place of abode usually 
includes a residence your spouse owns or leases. For additional 
information, visit our website.
New York State resident – You are a New York State resident 
You maintain a permanent place of abode in New York State 
for more than 11 months of the year and spend 184 days or 
more (a part of a day is a day for this purpose) in New York 
State during the taxable year, whether or not domiciled in New 
York State.
However, if you are a member of the armed forces, and your 
domicile is not New York State, you are not a resident under 
this denition. Also, if you are a military spouse domiciled in 
another state, but located in New York State solely to be with 
your spouse (who is a member of the armed services present 
in New York State in compliance with military orders), you 
are not considered a resident under this denition. For more 
information, see TSB-M-10(1)I, Military Spouses Residency
Relief Act; or
2.  Your domicile is New York State. However, even if your 
domicile is New York State, you are not a resident if you meet 
all three of the conditions in either Group A or Group B as 
Group A
1.  You did not maintain any permanent place of abode in 
New York State during the tax year, and
2.  you maintained a permanent place of abode outside New 
York State during the entire tax year, and
3.  you spent 30 days or less (a part of a day is a day for this 
purpose) in New York State during the tax year.
Group B
1.  You were in a foreign country for at least 450 days (a part 
of a day is a day for this purpose) during any period of 548 
consecutive days, and
2.  you, your spouse (unless legally separated), and minor 
children spent 90 days or less (a part of a day is a day 
for this purpose) in New York State during this 548-day 
period; and
3.  during the nonresident portion of the tax year in which the 
548-day period begins, and during the nonresident portion 
of the tax year in which the 548-day period ends, you were 
present in New York State for no more than the number 
of days which bears the same ratio to 90 as the number 
of days in such portion of the tax year bears to 548. The 
following formula illustrates this condition:
number of days in the maximum number of
nonresident portion
× 90 =
days allowed in
New York State
To determine if you are a New York City or Yonkers resident, 
substitute New York City or Yonkers, whichever is applicable, for 
New York State in the above denition.
Nonresident and part-year resident
You are a nonresident if you do not meet the above denition of 
a resident. You are a part-year resident if you meet the denition 
of resident or nonresident for only part of the year.
Percent of services
The percent of services performed in New York State or Yonkers 
may be computed using days, miles, time, or similar criteria. 
For example, an individual working in New York State two out of 
ve days for the entire year performs 40% of his or her services 
in New York State.
Privacy notication
New York State Law requires all government agencies that 
maintain a system of records to provide notication of the legal 
authority for any request for personal information, the principal 
purpose(s) for which the information is to be collected, and 
where it will be maintained. To view this information, visit our 
website, or, if you do not have Internet access, call and request 
Publication 54, Privacy Notication. See Need help? for the Web 
address and telephone number.
IT-2104.1 (12/18) (back)