Fillable Printable Certificate of Exemption from Withholding - New York
Fillable Printable Certificate of Exemption from Withholding - New York
Certificate of Exemption from Withholding - New York
Mark an X in the box if a newly hired employee or a rehired employee .......
First date employee performed services for pay (mm-dd-yyyy)
(see instructions)
:
Are dependent health insurance benefits available for this employee? .............................. Yes No
If Yes, enter the date the employee qualifies (mm-dd-yyyy) : ......
First name and middle initial Last name Social security number
Mailing address (number and street or rural route) Apartment number Date of birth (mm-dd-yyyy)
City, village, or post office State ZIP code
New York State Department of Taxation and Finance
Certificate of Exemption from Withholding
New York State • New York City • Yonkers This certificate will expire on April 30, 2016.
Filing status: Mark an
X
in only one box
A
Single
B
Married
C
Qualifying widow(er)
with dependent child, or
head of household with
qualifying person ..............
To claim exemption from withholding for New York State personal income tax (and New York City and Yonkers personal income tax, if
applicable), you must meet the conditions in either Group A or Group B:
Group A
•
you must be under age 18, or over age 65, or a full time student under age 25; ‑ and
•
you did not have a New York income tax liability for 2014; and
• you do not expect to have a New York income tax liability for 2015 (for this purpose, you have a tax liability if your return shows tax
before the allowance of any credit for income tax withheld).
Group B
• you meet the conditions set forth under the Servicemembers Civil Relief Act (SCRA), as amended by the Military Spouses Residency
Relief Act. See Military spouses.
If you
do not meet all
of the conditions in either Group A or Group B above,
stop;
you cannot claim exemption from withholding
(see Note below)
.
IT-2104-E
Instructions
Are you a full time student?...... Yes ‑ No Are you a military spouse exempt under the SCRA? ..... Yes No
I certify that the information on this form is correct and that, for the year 2015, I expect to qualify for exemption from withholding of New York State income tax
under section 671(a)(3) of the Tax Law or under the SCRA. I will notify my employer within 10 days of any change requiring revocation of the exemption from
withholding as explained in the instructions.
Employer: complete this section only if you must send a copy of this form to the NYS Tax Department
(see instructions)
.
Employer name and address
Employer identification number
Employee’s signature (give the completed certificate to your employer)
Date
Employee
Who qualifies – To claim exemption from withholding for New
York State personal income tax (and New York City and Yonkers
personal income tax, if applicable), you must meet the conditions in
either Group A or Group B:
Group A
• you must be under age 18, or over age 65, or a full time student ‑
under age 25; and
•
you did not have a New York income tax liability for 2014; and
• you do not expect to have a New York income tax liability for
2015 (for this purpose, you have a tax liability if your return
shows tax before the allowance of any credit for income tax
withheld).
Group B
• you meet the conditions set forth under the Servicemembers
Civil Relief Act (SCRA), as amended by the Military Spouses
Residency Relief Act. See Military spouses.
If you meet the conditions in Group A or Group B, file this certificate,
Form IT 2104 E, with your employer. Otherwise, your employer must ‑ ‑
withhold New York State income tax (and New York City and Yonkers
personal income tax, if applicable) from your wages. Do not send this
certificate to the Tax Department.
Generally, as a resident, you are required to file a New York State
income tax return if you are required to file a federal income tax
return, or if your federal adjusted gross income plus your New
York additions is more than $4,000, regardless of your filing status.
However, if you are single and can be claimed as a dependent on
another person’s federal return, you must file a New York State
return if your federal adjusted gross income plus your New York
additions is more than $3,100.
If you are a nonresident and have income from New York sources,
you must file a New York return if the sum of your federal adjusted
gross income and New York additions to income is more than your
New York standard deduction.
A penalty of $500 may be imposed for furnishing false information
that decreases your withholding amount.
Note: If you do not qualify for exemption, or you want New York
State, New York City, or Yonkers personal income tax withheld
from your pay, file Form IT 2104, ‑ Employee’s Withholding
Allowance Certificate, with your employer. Follow the instructions
on Form IT 2104 to determine the correct number of allowances to ‑
claim for withholding tax purposes.
IT-2104-E (2015) (back)
When to claim exemption from withholding – File this certificate
with your employer if you meet the conditions listed in Group A or
Group B above. You must file a new certificate each year if you
wish to continue to claim the exemption.
Military spouses – Under the Servicemembers Civil Relief Act
(SCRA), as amended by the Military Spouses Residency Relief Act,
you may be exempt from New York income tax (and New York City
and Yonkers personal income tax, if applicable) on your wages if:
1) your spouse is a member of the armed forces present in New
York in compliance with military orders; 2) you are present in New
York solely to be with your spouse; and 3) you are domiciled in
another state.
Liability for estimated tax – If, as a result of this exemption
certificate, your employer does not withhold income tax from your
wages and you later fail to qualify for exemption from tax, you may
be required to pay estimated tax and be subject to penalty if it is
not paid. For further information, see Form IT 2105, ‑ Estimated Tax
Payment Voucher for Individuals.
Multiple employers – If you have more than one employer, you
may claim exemption from withholding with each employer as long
as your total expected income will not cause you to incur a New
York income tax liability for the year 2015 and you had no liability
for 2014.
Revocation by employee – You must revoke this exemption
certificate (1) within 10 days from the day you expect to incur a
New York income tax liability for the year 2015, (2) on or before
December 1, 2015, if you expect to incur a tax liability for 2016, or
(3) when you no longer qualify for exemption under the SCRA.
If you are required to revoke this certificate, if you no longer meet
the age requirements for claiming exemption, or if you want income
tax withheld from your pay (because, for example, you expect your
income to exceed $3,100), you must file Form IT 2104, ‑ Employee’s
Withholding Allowance Certificate, with your employer. Follow the
instructions on Form IT 2104 to determine the correct number of ‑
allowances to claim for withholding tax purposes.
Filing status – Mark an X in one box on Form IT 2104 E that ‑ ‑
shows your present filing status for federal purposes.
Employer
Keep this certificate with your records. If an employee who
claims exemption from withholding on Form IT 2104 E usually ‑ ‑
earns more than $200 per week, you must send a copy of that
employee’s Form IT 2104 E to: ‑ ‑ NYS Tax Department, Income
Tax Audit Administrator, Withholding Certificate Coordinator,
W A Harriman Campus, Albany NY 12227. If the employee is also
a new hire or rehire, see Note below.
The Tax Department will not accept this form if it is incomplete. We
will review these certificates and notify you of any adjustments that
must be made.
Due dates for sending certificates received from employees who
claim exemption and earn more than $200 per week are:
Quarter Due date Quarter Due date
January – March April 30 July – September October 31
April – June July 31 October – December January 31
Revocation by employer – You must revoke this exemption
within 10 days if, on any day during the calendar year, the date of
birth stated on the certificate filed by the employee indicates the
employee no longer meets the age requirements for exemption.
The revocation must be in the form of a written notice to the
employee.
New hires and rehires – Mark an X in the box if you are submitting
a copy of this form to comply with New York State’s New Hire
Reporting Program. A newly hired or rehired employee means an
employee previously not employed by you, or previously employed
by you but separated from such employment for 60 or more
consecutive days. Enter the first day any services are performed
for which the employee will be paid wages, commissions, tips
and any other type of compensation. For services based solely
on commissions, this is the first day an employee working for
commissions is eligible to earn commissions. Also, mark an X in
the Yes or No box indicating if dependent health insurance benefits
are available to this employee. If Yes, enter the date the employee
qualifies for coverage. Mail the completed form, within 20 days of
hiring, to:
NYS TAX DEPARTMENT
NEW HIRE NOTIFICATION
PO BOX 15119
ALBANY NY 12212-5119
To report newly hired or rehired employees online go to
www.nynewhire.com.
Note: If the newly hired or rehired employee has also claimed
exemption from withholding but usually earns more than $200 per
week, mail Form IT 2104 E to the Tax Department at the New Hire ‑ ‑
Notification address above.
