First name and middle initial
Last name
Your social security number
Permanent home address (number and street or rural route)
Apartment number
City, village, or post office
State
ZIP code
Are you a resident of New York City? ........... Yes
No
Are you a resident of Yonkers? ..................... Yes
No
Complete the worksheet on page 3 before making any entries.
1 Total number of allowances you are claiming for New York State and Yonkers, if applicable (from line 20) ............. 1.
2 Total number of allowances for New York City (from line 31) ................................................................................... 2.
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 .......................................................................................................................................... 3.
4 New York City amount ............................................................................................................................................ 4.
5 Yonkers amount ..................................................................................................................................................... 5.
Print or type
New York State Department of Taxation and Finance
Employee’s Withholding Allowance Certificate
New York State • New York City • Yonkers
Employers only: Please mark an X in the appropriate box(es) to indicate why you are sending a copy of this form to New York State:
Employee is a new hire
Employee claimed more than 14 exemption allowances for New York State
Single or Head of household
Married
Married, but withhold at higher single rate
Note: If married but legally separated, mark an X in
the Single or Head of household box.
I certify that I am entitled to the number of withholding allowances claimed on this certificate.
Employee’s signature
Date
IT-2104
Employer’s name and address (Employer: complete this section only if