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

in only one box

Single

Married

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.