Form IT-2104:2010:Employee's Withholding Allowance Certificate: IT2104

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

Are you a resident of Yonkers? .................... Yes

Complete the worksheet on page 3 before making any entries.

Total number of allowances you are claiming for New York State and Yonkers, if applicable

( from line 20 )

.........

Total number of allowances for New York City

( from line 31 )

.................................................................................

Use lines 3, 4, and 5 below to have additional withholding per pay period under special agreement with your employer.

New York State amount ........................................................................................................................................

New York City amount ..........................................................................................................................................

Yonkers amount ....................................................................................................................................................

Print or type

New York State Department of Taxation and Finance

Employee’s Withholding Allowance Certifcate

New York State • New York City • Yonkers

Employers only:

Please mark an

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

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

Employer’s name and address

( Employer: complete this section only if you must send a copy of this form to the NYS Tax Department. )

Employer identification number

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: detach this page and give it to your employer; keep pages 3 and 4 for your records.

Changes for 2010

The additional withholding per week dollar amounts and the number of

allowances in the charts on page 4 of the instructions for this form have

been revised for tax year 2010. If you filed a 2009 Form IT-2104 (dated

4/09) based on the tax rate increase effective for tax year 2009, and

you used the charts on page 4 of the 2009 Form IT-2104 to compute an

additional dollar amount to claim on lines 3, 4, or 5 of Form IT-2104, you

should complete a new 2010 Form IT-2104 and give it to your employer.

Who should fle this form

This certificate, Form IT-2104, is completed by an employee and given

to the employer to instruct the employer how much New York State (and

New York City and Yonkers) tax to withhold from the employee’s pay. The

more allowances claimed, the lower the amount of tax withheld.

If you do not file Form IT-2104, your employer may use the same number

of allowances you claimed on federal Form W-4. Due to differences in

tax law, this may result in the wrong amount of tax withheld for New York

State, New York City, and Yonkers. Complete Form IT-2104 each year

and file it with your employer if the number of allowances you may claim

is different from federal Form W-4 or has changed. Common reasons for

completing a new Form IT-2104 each year include the following:

• You started a new job.

• You are no longer a dependent.

• Your individual circumstances may have changed (for example, you

were married or have an additional child).

• You itemize your deductions on your personal income tax return.

• You claim allowances for New York State credits.

• You owed tax or received a large refund when you fled your personal

income tax return for the past year.

• Your wages have increased and you expect to earn $100,000 or more

during the tax year.

• The total income of you and your spouse has increased to $100,000 or

more for the tax year.

• You have signifcantly more or less income from other sources or from

another job.

• You no longer qualify for exemption from withholding.

• You have been advised by the Internal Revenue Service that you are

entitled to fewer allowances than claimed on your original federal

Form W-4, and the disallowed allowances were claimed on your

original Form IT-2104.

Exemption from withholding

You cannot use Form IT-2104 to claim exemption from withholding.

To claim exemption from income tax withholding, you

must

file

Form IT-2104-E,

Certificate of Exemption from Withholding

, with your

employer. You must fle a new certifcate each year that you qualify for

exemption. This exemption from withholding is allowable only if you had

no New York income tax liability in the prior year, you expect none in the

current year,

and

you are over 65 years of age, under 18, or a full-time

student under 25. If you are a dependent who is under 18 or a full-time

student, you may owe tax if your income is more than $3,000.

Instructions

IT-2104

Need help?

Internet access:

www.nystax.gov

Get answers to frequently asked questions; check your refund status;

check your estimated tax account; download forms, publications; get tax updates

and other information.

Telephone assistance

is available from 8:00 A.M. to 5:00 P.M.

(eastern time), Monday through Friday.

Refund status

(518) 457-5149

In-state callers without free long distance:

1 800 443-3200

Personal Income Tax

Information Center:

(518) 457-5181

In-state callers without free long distance:

1 800 225-5829

To order forms and publications:

(518) 457-5431

In-state callers without free long distance:

1 800 462-8100

Fax-on-demand forms:

Forms are available

24 hours a day, 7 days a week.

1 800 748-3676

Text Telephone (TTY) Hotline

(for persons with

hearing and speech disabilities using a TTY):

1 800 634-2110

Page 2

of 4

IT-2104

(2010)

Withholding allowances

You may

not

claim a withholding allowance for yourself or, if married,

your spouse. Claim the number of withholding allowances you compute

in Part 1 and Part 3 on page 3 of this form. If you want more tax

withheld, you may claim fewer allowances.

If you claim more than

14 allowances,

your employer

must send

a copy of your

Form IT-2104

to the New York State Tax Department. You may then be asked to verify

your allowances. If you arrive at negative allowances (less than zero) on

lines 1, 2, 20, or 31, and your employer cannot accommodate negative

allowances,

enter

and see

Additional dollar amount(s)

below.

Income from sources other than wages —

If you have more than

$1,000 of income from sources other than wages (such as interest,

dividends, or alimony received), reduce the number of allowances

claimed on line 1 and line 2 (if applicable) of the IT-2104 certificate

by one for each $1,000 of nonwage income. If you arrive at negative

allowances (less than zero), see Withholding

allowances

above. You

may also consider filing estimated tax, especially if you have significant

amounts of nonwage income. Estimated tax requires that payments be

made by the employee directly to the Tax Department on a quarterly

basis. For more information, see the instructions for Form IT -2105,

Estimated Income Tax Payment Voucher for Individuals

, or see

Need

help?

below.

Other credits

(Worksheet line 13)

—

If you will be eligible to claim

any credits other than the credits listed in the worksheet, such as an

investment tax credit, you may claim additional allowances as follows:

• If you expect your New York adjusted gross income to be less than

$300,000, divide the amount of the expected credit by 70 and enter

the result (rounded to the nearest whole number) on line 13.

• If you expect your New York adjusted gross income to be between

$300,000 and $500,000, divide the amount of the expected credit

by 80 and enter the result (rounded to the nearest whole number) on

line 13.

• If you expect your New York adjusted gross income to be over

$500,000, divide the amount of the expected credit by 90 and enter

the result (rounded to the nearest whole number) on line 13.

Example:

You expect your New York adjusted gross income to be

less than $300,000. In addition, you expect to receive a fow-through

of an investment tax credit from the S corporation of which you are a

shareholder. The investment tax credit will be $160. Divide the expected

credit by 70. 160/70 = 2.2857. The additional withholding allowance(s)

would be 2. Enter

on line 13.

Married couples with both spouses working —

If you and your spouse

both work, you should each file a separate IT -2104 certificate with your

respective employers. You should each mark an

in the box

Married,

but withhold at higher single rate

on the certificate front, and divide the

total number of allowances that you compute on line 20 and line 31 (if

applicable) between you and your working spouse. Your withholding will

better match your total tax if the higher wage-earning spouse claims

all of the couple’s allowances and the lower wage-earning spouse

claims zero allowances. Do

not

claim more total allowances than you

are entitled to. If you and your spouse’s combined wages are between

$100,000 and $1,100,000, use one of the charts in Part 4 to compute the

number of allowances to transfer to line 19.

Taxpayers with more than one job —

If you have more than one

job, file a separate IT-2104 certificate with each of your employers. Be

sure to claim only the total number of allowances that you are entitled

to. Your withholding will better match your total tax if you claim all of

your allowances at your higher-paying job and zero allowances at the

lower-paying job. In addition, to make sure that you have enough tax

withheld, if you are a single taxpayer or head of household with two

or more jobs, reduce the number of allowances by six on line 1 and

line 2 (if applicable) on the certificate you file with your higher -paying

job employer. If you arrive at negative allowances (less than zero), see

Withholding allowances

above.

If your combined wages are between $100,000 and $1,100,000, use one

of the charts in Part 4 to compute the number of allowances to transfer

to line 19. Substitute the words

Highest paying job

for

Higher earner’s

wages

within the charts.

Dependents —

If you are a dependent of another taxpayer and expect

your income to exceed $3,000, you should reduce your withholding

allowances by one for each $1,000 of income over $2,500. This will

ensure that your employer withholds enough tax.

Following the above instructions will help to ensure that you will not owe

additional tax when you file your return.

Heads of households with only one job —

If you will use the

head-of-household filing status on your state income tax return, mark

the

Single or Head of household

box on the front of the certificate. If you

have only one job, you may also wish to claim two additional withholding

allowances on line 14.

Married couples with only one spouse working —

If your spouse does

not work and has no income subject to state income tax, mark the

Married

box on the front of the certificate. You may also wish to claim

two additional allowances on line 15.

Additional dollar amount(s)

You may ask your employer to withhold an additional dollar amount

each pay period by completing lines 3, 4, and 5 on Form IT -2104. In

most instances, if you compute a negative number of allowances using

the worksheet on page 3 and your employer cannot accommodate

a negative number, for each negative allowance claimed you should

have an additional $1.90 of tax withheld per week for New York State

withholding on line 3, and an additional $0.80 of tax withheld per week

for New York City withholding on line 4. Yonkers residents should use

10% (.10) of the New York State amount for additional withholding for

Yonkers on line 5.

Note: If you are requesting that your employer withhold an additional

dollar amount on lines 3, 4, or 5 of this allowance certificate, the

additional dollar amount, as determined by these instructions or by using

the chart in Part 4, is accurate for a weekly payroll. Therefore, if you are

paid other than weekly, you will need to adjust the dollar amount(s) that

you compute. For example, if you are paid biweekly, you must double

the dollar amount(s) computed using the worksheet on page 3.

Avoid underwithholding

Form IT-2104, together with your employer’s withholding tables, is

designed to ensure that the correct amount of tax is withheld from

your pay. If you fail to have enough tax withheld during the entire year,

you may owe a large tax liability when you file your return. The Tax

Department must assess interest and may impose penalties in certain

situations in addition to the tax liability. Even if you do not file a return,

we may determine that you owe personal income tax, and we may

assess interest and penalties on the amount of tax that you should have

paid during the year.

Privacy notifcation

The Commissioner of Taxation and Finance may collect and maintain personal

information pursuant to the New York State Tax Law, including but not limited to,

sections 5-a, 171, 171-a, 287, 308, 429, 475, 505, 697, 1096, 1142, and 1415

of that Law; and may require disclosure of social security numbers pursuant to

42 USC 405(c)(2)(C)(i).

This information will be used to determine and administer tax liabilities and, when

authorized by law, for certain tax offset and exchange of tax information programs

as well as for any other lawful purpose.

Information concerning quarterly wages paid to employees is provided to certain

state agencies for purposes of fraud prevention, support enforcement, evaluation

of the effectiveness of certain employment and training programs and other

purposes authorized by law.

Failure to provide the required information may subject you to civil or criminal

penalties, or both, under the Tax Law.

This information is maintained by the Manager of Document Management, NYS Tax

Department, W A Harriman Campus, Albany NY 12227; telephone (518) 457-5181.

IT-2104

(2010)

Page 3

of 4

Worksheet

Part 1 —

Complete this part to compute your withholding allowances for New York State and Yonkers

(line 1) .

Part 3 — Complete this part to compute your withholding allowances for New York City

(line 2).

Part 2 — Complete this part only if you expect to itemize deductions on your state return.

Enter your estimated federal itemized deductions for the tax year

..........................................................................................

21.

Enter your estimated state, local, and foreign income taxes included on line 21

( if your estimated New York AGI is over $1 million,

you must enter on line 22 all estimated federal itemized deductions included on line 21 except charitable contributions )

........................

22.

Subtract line 22 from line 21 ....................................................................................................................................................

23.

Enter your estimated college tuition itemized deduction .........................................................................................................

24.

Add lines 23 and 24 .................................................................................................................................................................

25.

Based on your federal filing status, enter the applicable amount from the table below .........................................................

26.

Single ( cannot be claimed as a dependent ) ... $ 7,500

Qualifying widow(er) ........................................

$15,000

Single ( can be claimed as a dependent ) ....... $ 3,000

Married filing jointly .........................................

$15,000

Head of household ........................................

$10,500

Married filing separate returns ........................ $ 7,500

Subtract line 26 from line 25

( if line 26 is larger than line 25, enter

here and on line 17 above )

.......................................................

27.

Divide line 27 by $1,000. Drop any fraction and enter the result here and on line 17 above

..................................................

28.

Enter the amount from line 6 above .........................................................................................................................................

29.

Add lines 14 through 17 above and enter total here ................................................................................................................

30.

Add lines 29 and 30. Enter the result here and on line 2 .........................................................................................................

31.

Enter the number of dependents that you will claim on your state return

( do not include yourself or, if married, your spouse )

...

For lines 7, 8, and 9, enter

for each credit you expect to claim on your state return.

College tuition credit ..................................................................................................................................................................

New York State household credit ..............................................................................................................................................

Real property tax credit.............................................................................................................................................................

For lines 10, 11, and 12, enter

for each credit you expect to claim on your state return.

Child and dependent care credit ..............................................................................................................................................

10.

Earned income credit ................................................................................................................................................................

11.

Empire State child credit ...........................................................................................................................................................

12.

Other credits

( see instructions )

....................................................................................................................................................

13.

For lines 14 and 15, enter

if either situation applies.

Head of household status

and

only one job .............................................................................................................................

14.

Married couples with only

one

spouse working

and

only one job ...........................................................................................

15.

Enter an estimate of your federal adjustments to income, such as alimony you will pay for the tax year

and deductible IRA contributions you will make for the tax year. Total estimate $ .

Divide this estimate by $1,000. Drop any fraction and enter the number

.............................................................................

16.

If you expect to itemize deductions on your state tax return, complete Part 2 below and enter the number from line 28.

All others enter

...................................................................................................................................................................

17.

Add lines 6 through 17 ..............................................................................................................................................................

18.

If you have more than one job, or are married with both spouses working, and your combined wages are between

$100,000 and $1,100,000, enter the appropriate number from one of the charts in Part 4. All others enter

...................

19.

Subtract line 19 from line 18. Enter the result, including negative amounts, here and on line 1. If your employer cannot

accommodate negative allowances, enter

here and on line 1 and see

Additional dollar amounts

in the instructions

( If you have more than one job, or if you and your spouse both work, see instructions. ) ....................................................

20.

Standard deduction table

( continued on page 4 )

Page 4

of 4

IT-2104

(2010)

Part 4 —

These charts are for taxpayers with more than one job, or married couples with both spouses working, and combined wages

between $100,000 and $1,100,000. All others do not have to use these charts.

Enter the number of allowances (top number ) on line 19; or the additional withholding (bottom

dollar amount ) on line 3.

Combined wages between $100,000 and $500,000

Combined wages between $500,000 and $1,100,000

Higher

earner’s

wages

$100,000

120,000

$120,000

140,000

$140,000

160,000

$160,000

180,000

$180,000

220,000

$220,000

260,000

$260,000

300,000

$300,000

350,000

$350,000

400,000

$400,000

450,000

$450,000

500,000

$ 55,000 –

$ 70,000

$12

$15

$ 70,000 –

$ 90,000

$12

$17

$22

$ 90,000 –

$110,000

$15

$20

$22

$23

$110,000 –

$120,000

$10

$16

$18

$21

$20

$120,000 –

$130,000

$14

$16

$19

$17

$130,000 –

$140,000

$10

$13

$16

$17

$13

$140,000 –

$150,000

$11

$14

$17

$11

$150,000 –

$160,000

$12

$16

$12

$15

$160,000 –

$180,000

$11

$14

$42

$180,000 –

$220,000

$11

$15

$46

$80

$220,000 –

$260,000

$11

$49

$83

$90

$99

$260,000 –

$300,000

$46

$88

$91

$99

$300,000 –

$350,000

$24

$51

$64

$66

$350,000 –

$400,000

$10

$22

$35

$400,000 –

$450,000

$10

$22

$450,000 –

$500,000

$10

Higher

earner’s

wages

$500,000

550,000

$550,000

600,000

$600,000

650,000

$650,000

700,000

$700,000

750,000

$750,000

800,000

$800,000

850,000

$850,000

900,000

$900,000

950,000

$950,000

1,000,000

$1,000,000

1,050,000

$1,050,000

1,100,000

$260,000 –

119

$300,000

$168

$300,000 –

$350,000

$135

$210

$234

$350,000 –

107

121

136

108

$400,000

$96

$172

$195

$218

$174

$400,000 –

101

116

130

144

117

126

$450,000

$94

$162

$186

$209

$232

$188

$202

$450,000 –

100

110

124

138

153

126

134

143

$500,000

$81

$160

$176

$199

$222

$246

$202

$215

$229

$500,000 –

$550,000

$39

$88

$115

$130

$154

$177

$200

$156

$170

$183

$197

$145

$550,000 –

$600,000

$13

$36

$62

$78

$101

$124

$148

$104

$117

$131

$145

$600,000 –

$650,000

$13

$36

$62

$78

$101

$124

$148

$104

$117

$131

$650,000 –

$700,000

$13

$36

$62

$78

$101

$124

$148

$104

$117

$700,000 –

$750,000

$13

$36

$62

$78

$101

$124

$148

$104

$750,000 –

$800,000

$13

$36

$62

$78

$101

$124

$148

$800,000 –

$850,000

$13

$36

$62

$78

$101

$124

$850,000 –

$900,000

$13

$36

$62

$78

$101

$900,000 –

$950,000

$13

$36

$62

$78

$950,000 –

$1,000,000

$13

$36

$62

$1,000,000 –

$1,050,000

$13

$36

$1,050,000 –

$1,100,000

$13