NEW YORK Employee Withholding Allowance Cert: IT-2104

IT-2104

New York State • New York City • Yonkers
Employee’s Withholding Allowance Certificate

Department of Taxation and Finance
First name and middle initial*
Last name*
Your Social Security number*
Single or Head of householdMarriedMarried, but withhold at higher single rate
Note: If married but legally separated, mark an X in

the Single or Head of household box.
Permanent home address (number and street or rural route)
Apartment number
City, village, or post office
State
ZIP code
YesNo
YesNo
Before making any entries, see the Note below, and if applicable, complete the worksheet in the instructions.
1. Total number of allowances you are claiming for New York State and Yonkers, if applicable (from line 19, if using worksheet)
2. Total number of allowances for New York City (from line 31, if using worksheet)
Use lines 3, 4, and 5 below to have additional withholding per pay period under special agreement with your employer.
3. New York State Amount
4. New York City Amount
5. Yonkers Amount
I certify that I am entitled to the number of withholding allowances claimed on this certificate. 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 Signature*

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IT-2104