Form IT-2104-E – Fill Out and Use This PDF

New York State Department of Taxation and Finance

Certiicate of Exemption from Withholding

IT-2104-E

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 ofice		State	ZIP code

Filing status: Mark an X in only one box

A Single

B Married

CQualifying widow(er) with dependent child, or head of household with qualifying person..............

......Are you a full‑time student?

Yes

No

Are you a military spouse exempt under the SCRA? ..... Yes

No

Employer name and address

Employer identiication number

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 beneits available for this employee?	.............................. Yes
If Yes, enter the date the employee qualiies (mm-dd-yyyy):

No

Employee

Who qualiies – 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 2013; and

• you do not expect to have a New York income tax liability for 2014 (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, ile this certiicate, 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 certiicate to the Tax Department.

Generally, as a resident, you are required to ile a New York State income tax return if you are required to ile 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 iling status.

However, if you are single and can be claimed as a dependent on

another person’s federal return, you must ile a New York State

return if your federal adjusted gross income plus your New York additions is more than $3,000.

If you are a nonresident and have income from New York sources, you must ile 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, ile Form IT‑2104, Employee’s Withholding Allowance Certiicate, 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 (2014) (back)

When to claim exemption from withholding – File this certiicate

with your employer if you meet the conditions listed in Group A or Group B above. You must ile a new certiicate 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 certiicate, 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 Income

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 2014 and you had no liability for 2013.

Revocation by employee – You must revoke this exemption certiicate (1) within 10 days from the day you expect to incur a New York income tax liability for the year 2014, (2) on or before December 1, 2014, if you expect to incur a tax liability for 2015, or

(3) when you no longer qualify for exemption under the SCRA.

If you are required to revoke this certiicate, 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 $3,000), you must ile Form IT‑2104, Employee’s Withholding Allowance Certiicate, 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 iling status for federal purposes.

Employer

Keep this certiicate 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 Certiicate 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 certiicates and notify you of any adjustments that

must be made.

Due dates for sending certiicates 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 certiicate iled 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 irst 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 irst 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 beneits

are available to this employee. If Yes, enter the date the employee qualiies 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