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.
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