It2104 Fill In

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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 ofce 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 17)........... 1

2 Total number of allowances for New York City (from line 28) .................................................................................. 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 ........................................................................................................................................ 34 New York City amount ........................................................................................................................................... 45 Yonkers amount .................................................................................................................................................... 5

New York State Department of Taxation and Finance

Employees Withholding Allowance Certifcate New York State New York City Yonkers

Single or Head of household Married Married, but withhold at higher single rate

Note:If married but legally separated, mark anXin

the Single or Head of household box.

I certify that I am entitled to the number of withholding allowances claimed on this certicate.

Employees signature Date

Employers name and address (Employer: complete this section only if you are sending a cop y of this form to the NYS Tax Department.) Employer identication number

Penalty A penalty of $500 may be imposed for any false statement you make that decreases the amount of money you have withheldfrom your wages. You may also be subject to criminal penalties.

Employee: detach this page and give it to your employer; keep a copy for your records.

Changes effective for 2015Form IT-2104 has been revised for tax year 2015. The worksheet onpage 3, the charts beginning on page 4, and the additional dollar amountsin the instructions on page 2, used to compute withholding allowancesor to enter an additional dollar amount on line(s) 3, 4, or 5, have been

revised. If you previously led a Form IT-2104 and used the worksheet,charts, or additional dollar amounts, you should complete a new 2015Form IT-2104 and give it to your employer.

Who should le this form

This certicate, Form IT-2104, is completed by an employee and givento the employer to instruct the employer how much New York State (andNew York City and Yonkers) tax to withhold from the employees pay. Themore allowances claimed, the lower the amount of tax withheld.

If you do not le Form IT-2104, your employer may use the same numberof allowances you claimed on federal Form W-4. Due to differences intax law, this may result in the wrong amount of tax withheld for New YorkState, New York City, and Yonkers. Complete Form IT-2104 each year

and le it with your employer if the number of allowances you may claimis different from federal Form W-4 or has changed. Common reasons forcompleting 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, youwere married or have an additional child).

You moved into or out of NYC or Yonkers.

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 led your personalincome tax return for the past year.

Your wages have increased and you expect to earn $106,200 or moreduring the tax year.

The total income of you and your spouse has increased to $106,200 ormore for the tax year.

You have signicantly more or less income from other sources or fromanother job.

You no longer qualify for exemption from withholding.

Instructions

Employer:Keep this certicate with your records.

Mark anXin box A and/or box B to indicate why you are sending a copy of this form to New York State(see instructions):

A Employee claimed more than 14 exemption allowances for NYS ............ A

B Employee is a new hire or a rehire... B First date employee performed services for pay (mm-dd-yyyy)(see instr.):

Are dependent health insurance benets available for this employee? ............. Yes No If Yes, enter the date the employee qualies (mm-dd-yyyy):

IT-2104

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Page 2 of 7 IT-2104 (2015)

You have been advised by the Internal Revenue Service that youare entitled to fewer allowances than claimed on your original federalForm W-4, and the disallowed allowances were claimed on youroriginal Form IT-2104.

Exemption from withholdingYou cannot use Form IT-2104 to claim exemption from withholding.To claim exemption from income tax withholding, you mustleForm IT-2104-E, Certicate of Exemption from Withholding, with youremployer. You must le a new certicate each year that you qualify for

exemption. This exemption from withholding is allowable only if you hadno New York income tax liability in the prior year, you expect none in thecurrent year, andyou are over 65 years of age, under 18, or a full-timestudent under 25. You may also claim exemption from withholding ifyou are a military spouse and meet the conditions set forth under theServicemembers Civil Relief Act as amended by the Military SpousesResidency Relief Act. If you are a dependent who is under 18 or afull-time student, you may owe tax if your income is more than $3,100.

Withholding allowancesYou may notclaim a withholding allowance for yourself or, if married,your spouse. Claim the number of withholding allowances you computein Part 1 and Part 3 on page 3 of this form. If you want more taxwithheld, you may claim fewer allowances. If you claim more than14 allowances, your employermust send a copy of yourForm IT-2104to the New York State Tax Department. You may then be asked toverify your allowances. If you arrive at negative allowances (less than

zero) on lines 1 or 2 and your employer cannot accommodate negativeallowances, enter 0and seeAdditional 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 allowancesclaimed on line 1 and line 2 (if applicable) of the IT-2104 certicate by onefor each $1,000 of nonwage income. If you arrive at negative allowances(less than zero), see Withholding allowancesabove. You may alsoconsider ling estimated tax, especially if you have signicant amountsof nonwage income. Estimated tax requires that payments be made bythe employee directly to the Tax Department on a quarterly basis. Formore information, see the instructions for Form IT-2105, Estimated TaxPayment Voucher for Individuals, or see Need help?on page 6.

Other credits (Worksheet line 13) If you will be eligible to claimany credits other than the credits listed in the worksheet, such as aninvestment tax credit, you may claim additional allowances.

Find your ling status and your New York adjusted gross income (NYAGI)in the chart below, and divide the amount of the expected credit by thenumber indicated. Enter the result (rounded to the nearest whole number)on line 13.

Example:You are married and expect your New York adjusted grossincome to be less than $318,750. In addition, you expect to receive aow-through of an investment tax credit from the S corporation of whichyou are a shareholder. The investment tax credit will be $160. Dividethe expected credit by 66. 160/66 = 2.4242. The additional withholdingallowance(s) would be 2. Enter 2on line 13.

Married couples with both spouses working If you and your spouseboth work, you should each le a separate IT-2104 certicate with yourrespective employers. Your withholding will better match your total tax ifthe higher wage-earning spouse claims all of the couples allowances andthe lower wage-earning spouse claims zero allowances. Do notclaimmore total allowances than you are entitled to. If your combined wagesare:

less than $106,200, you should each mark anXin the box Married,but withhold at higher single rateon the certicate front, and divide the

total number of allowances that you compute on line 17 and line 28 (ifapplicable) between you and your working spouse.

$106,200 or more, use the chart(s) in Part 4 and enter the additionalwithholding dollar amount on line 3.

Taxpayers with more than one job If you have more than one job,le a separate IT-2104 certicate with each of your employers. Besure to claim only the total number of allowances that you are entitledto. Your withholding will better match your total tax if you claim all ofyour allowances at your higher-paying job and zero allowances atthe lower-paying job. In addition, to make sure that you have enough

tax withheld, if you are a single taxpayer or head of household withtwo or more jobs, and your combined wages from all jobs are under$106,200, reduce the number of allowances by seven on line 1 andline 2 (if applicable) on the certicate you le with your higher-payingjob employer. If you arrive at negative allowances (less than zero), seeWithholdingallowancesabove.

If you are a single or a head of household taxpayer, and your combinedwages from all of your jobs are between $106,200 and $2,231,827, usethe chart(s) in Part 5 and enter the additional withholding dollar amountfrom the chart on line 3.

If you are a married taxpayer, and your combined wages from all ofyour jobs are $106,200 or more, use the chart(s) in Part 4 and enter theadditional withholding dollar amount from the chart on line 3 (Substitutethe words Higher-paying job forHigher earners wageswithin the chart).

Dependents If you are a dependent of another taxpayer and expect

your income to exceed $3,100, you should reduce your withholdingallowances by one for each $1,000 of income over $2,500. This willensure that your employer withholds enough tax.

Following the above instructions will help to ensure that you will not oweadditional tax when you le your return.

Heads of households with only one job If you will use thehead-of-household ling status on your state income tax return, markthe Single or Head of householdbox on the front of the certicate. If youhave only one job, you may also wish to claim two additional withholdingallowances on line 14.

Additional dollar amount(s)You may ask your employer to withhold an additional dollar amount eachpay period by completing lines 3, 4, and 5 on Form IT-2104. In mostinstances, if you compute a negative number of allowances and youremployer cannot accommodate a negative number, for each negative

allowance claimed you should have an additional $1.85 of tax withheld perweek for New York State withholding on line 3, and an additional $0.80of tax withheld per week for New York City withholding on line 4. Yonkersresidents should use 16.75% (.1675) of the New York State amount foradditional withholding for Yonkers on line 5.

Note:If you are requesting your employer to withhold an additional dollaramount on lines 3, 4, or 5 of this allowance certicate, the additionaldollar amount, as determined by these instructions or by using thechart(s) in Part 4 or Part 5, is accurate for a weekly payroll. Therefore,if you are not paid on a weekly basis, you will need to adjust the dollaramount(s) that you compute. For example, if you are paid biweekly, youmust double the dollar amount(s) computed.

Avoid underwithholdingForm IT-2104, together with your employers withholding tables, isdesigned 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 owea large tax liability when you le your return. The Tax Department mustassess interest and may impose penalties in certain situations in additionto the tax liability. Even if you do not le a return, we may determinethat you owe personal income tax, and we may assess interest andpenalties on the amount of tax that you should have paid during the year.

Single and NYAGI is:

Head of householdand NYAGI is:

Marriedand NYAGI is:

Divide amount ofexpected credit by:

Less than Less than Less than 66 $212,500 $265,600 $318,750

Between Between Between $212,500 and $265,600 and $318,750 and 68 $1,062,650 $1,594,050 $2,125,450

Over Over Over88

$1,062,650 $1,594,050 $2,125,450

(continued)

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IT-2104 (2015) Page 3 of 7

Worksheet

See the instructions before completing this 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.

18 Enter your estimated federal itemized deductions for the tax year ........................................................................................... 18

19 Enter your estimated state, local, and foreign income taxes or state and local general sales taxes included on line 18 ........ 19

20 Subtract line 19 from line 18 .................................................................................................................................................... 20

21 Enter your estimated college tuition itemized deduction .......................................................................................................... 21

22 Add lines 20 and 21 ................................................................................................................................................................. 22

23 Based on your federal ling status, enter the applicable amount from the table below ........................................................... 23

Single (cannot be claimed as a dependent).... $ 7,900 Qualifying widow(er) ........................................ $15,850 Single (can be claimed as a dependent) ....... $ 3,100 Married ling jointly .......................................... $15,850

Head of household ......................................... $11,100 Married ling separate returns ......................... $ 7,900

24 Subtract line 23 from line 22 (if line 23 is larger than line 22, enter 0here and on line 16 above) ....................................................... 24

25 Divide line 24 by $1,000. Drop any fraction and enter the result here and on line 16 above ................................................... 25

26 Enter the amount from line 6 above ......................................................................................................................................... 26

27 Add lines 14 through 16 above and enter total here .............. ................ ............... ............... ................ ............... ................ ..... 27

28 Add lines 26 and 27. Enter the result here and on line 2 ............... ............... ................ ............... ................ ............... ............. 28

6 Enter the number of dependents that you will claim on your state return (do not include yourself or, if married, your spouse)..... 6 For lines 7, 8, and 9, enter 1for each credit you expect to claim on your state return.

7 College tuition credit ............... ............... ................ ............... ............... ................ ............... ................ ............... ............... ......... 7

8 New York State household credit .............. ................ ............... ................ ............... ............... ................ ............... ................ ..... 8

9 Real property tax credit .............................................................................................................................................................. 9

For lines 10, 11, and 12, enter 3for each credit you expect to claim on your state return.

10 Child and dependent care credit ............... ................ ............... ............... ................ ............... ................ ............... ............... ...... 10

11 Earned income credit .............. ............... ................ ............... ............... ................ ............... ................ ............... ............... ......... 11

12 Empire State child credit ............................................................................................................................................................ 12

13 Other credits (see instructions)...................................................................................................................................................... 13

14 Head of household status andonly one job (enter 2if the situation applies)............... ............... ................ ............... ............... ....... 14

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 .............................................................................. 15

16 If you expect to itemize deductions on your state tax return, complete Part 2 below and enter the number from line 25. All others enter 0 .............. ............... ................ ............... ................ ............... ................ ............... ............... ................ .......... 16

17 Add lines 6 through 16. Enter the result here and on line 1. If you have more than one job, or if you and your spouse both

work, see instructions for Taxpayers with more than one jobor Married couples with both spouses working. ..................... 17

Standard deduction table

EmployersBox A If you are required to submit a copy of an employeesForm IT-2104 to the Tax Department because the employee claimedmore than 14 allowances, mark anX in box A and send a copyof Form IT-2104 to: NYS Tax Department, Income Tax AuditAdministrator, Withholding Certicate Coordinator, W A HarrimanCampus, Albany NY 12227-0865.If the employee is also a new hire orrehire, see Box Binstructions.

Due dates for sending certicates received from employees claimingmore than 14 allowances are:

Quarter Due date Quarter Due dateJanuary March April 30 July September October 31April June July 31 October December January 31

Box B If you are submitting a copy of this form to comply with NewYork States New Hire Reporting Program, mark an X in box B. Enter therst day any services are performed for which the employee will be paidwages, commissions, tips and any other type of compensation. Forservices based solely on commissions, this is the rst day an employeeworking for commissions is eligible to earn commissions. Also, mark anXin the Yesor Nobox indicating if dependent health insurance benets areavailable to this employee. If Yes, enter the date the employee qualiesfor coverage. Mail the completed form, within 20 days of hiring, to: NYSTax Department, New Hire Notifcation, PO Box 15119, Albany NY12212-5119. To report newly-hired or rehired employees online instead ofsubmitting this form, go to www.nynewhire.com.

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Page 4 of 7 IT-2104 (2015)

Part 4 These charts are only for married couples with both spouses working or married couples with one spouse working more thanone job, and whose combined wages are between $106,200 and $2,231,827.

Enter the additional withholding dollar amount on line 3.

The additional dollar amount, as shown below, is accurate for a weekly payroll. If you are not paid on a weekly basis, you will need toadjust these dollar amount(s). For example, if you are paid biweekly, you must double the dollar amount(s) computed.

$106,200 $127,500 $148,700 $169,950 $191,200 $233,700 $276,250 $318,750 $371,900 $425,050 $478,200 $127,499 $148,699 $169,949 $191,199 $233,699 $276,249 $318,749 $371,899 $425,049 $478,199 $531,299

$53,100 $74,299 $11 $16

$74,300 $95,549 $11 $17 $22 $27

$95,550 $116,799 $8 $15 $20 $27 $34

$116,800 $127,499 $2 $10 $16 $23 $32 $31

$127,500 $138,099 $4 $13 $20 $30 $29

$138,100 $148,699 $2 $10 $17 $27 $29 $26

$148,700 $159,349 $4 $14 $25 $29 $24

$159,350 $170,149 $2 $11 $21 $27 $24 $22

$170,150 $191,199 $4 $16 $22 $23 $22 $18

$191,200 $233,699 $6 $12 $18 $20 $18 $19

$233,700 $276,249 $6 $12 $23 $25 $19 $18

$276,250 $318,749 $6 $18 $30 $26 $19

$318,750 $371,899 $10 $20 $27 $22

$371,900 $425,049 $8 $16 $23

$425,050 $478,199 $8 $16

$478,200 $531,299 $8

Combined wages between $106,200 and $531,299

Higher earners wages

$531,300 $584,450 $637,600 $690,700 $743,850 $797,000 $850,150 $903,300 $956,450 $1,009,550 $1,062,650 $1,115,850 $584,449 $637,599 $690,699 $743,849 $796,999 $850,149 $903,299 $956,449 $1,009,549 $1,062,649 $1,115,849 $1,168,949

$233,700 $276,249 $18

$276,250 $318,749 $20 $16

$318,750 $371,899 $15 $17 $19 $14

$371,900 $425,049 $18 $11 $13 $15 $7 $7

$425,050 $478,199 $23 $18 $11 $13 $15 $7 $7 $7

$478,200 $531,299 $16 $23 $18 $11 $13 $15 $7 $7 $7 $7

$531,300 $584,449 $8 $16 $23 $18 $11 $13 $15 $7 $7 $7 $8 $11

$584,450 $637,599 $8 $16 $23 $18 $11 $13 $15 $7 $7 $8 $11

$637,600 $690,699 $8 $16 $23 $18 $11 $13 $15 $7 $8 $11

$690,700 $743,849 $8 $16 $23 $18 $11 $13 $15 $8 $11

$743,850 $796,999 $8 $16 $23 $18 $11 $13 $16 $11

$797,000 $850,149 $8 $16 $23 $18 $11 $14 $19

$850,150 $903,299 $8 $16 $23 $18 $12 $17

$903,300 $956,449 $8 $16 $23 $20 $15

$956,450 $1,009,549 $8 $16 $24 $23

$1,009,550 $1,062,649 $8 $17 $27

$1,062,650 $1,115,849 $9 $19

$1,115,850 $1,168,949 $9

Combined wages between $531,300 and $1,168,949


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IT-2104 (2015) Page 5 of 7

$1,168,950 $1,222,100 $1,275,300 $1,328,400 $1,381,500 $1,434,700 $1,487,800 $1,540,900 $1,594,050 $1,647,250$1,222,099 $1,275,299 $1,328,399 $1,381,499 $1,434,699 $1,487,799 $1,540,899 $1,594,049 $1,647,249 $1,700,399

$584,450 $637,599 $14 $17

$637,600 $690,699 $14 $17 $20 $23

$690,700 $743,849 $14 $17 $20 $23 $26 $30

$743,850 $796,999 $14 $17 $20 $23 $26 $30 $33 $36

$797,000 $850,149 $14 $17 $20 $23 $26 $30 $33 $36 $39 $42

$850,150 $903,299 $22 $17 $20 $23 $26 $30 $33 $36 $39 $42

$903,300 $956,449 $20 $25 $20 $23 $26 $30 $33 $36 $39 $42

$956,450 $1,009,549 $18 $23 $29 $23 $26 $30 $33 $36 $39 $42

$1,009,550 $1,062,649 $26 $21 $27 $32 $26 $30 $33 $36 $39 $42

$1,062,650 $1,115,849 $29 $27 $23 $28 $33 $28 $31 $34 $37 $40

$1,115,850 $1,168,949 $19 $29 $27 $23 $28 $33 $28 $31 $34 $37

$1,168,950 $1,222,099 $9 $19 $29 $27 $23 $28 $33 $28 $31 $34

$1,222,100 $1,275,299 $9 $19 $29 $27 $23 $28 $33 $28 $31

$1,275,300 $1,328,399 $9 $19 $29 $27 $23 $28 $33 $28

$1,328,400 $1,381,499 $9 $19 $29 $27 $23 $28 $33

$1,381,500 $1,434,699 $9 $19 $29 $27 $23 $28

$1,434,700 $1,487,799 $9 $19 $29 $27 $23

$1,487,800 $1,540,899 $9 $19 $29 $27

$1,540,900 $1,594,049 $9 $19 $29

$1,594,050 $1,647,249 $9 $19

$1,647,250 $1,700,399 $9

Combined wages between $1,168,950 and $1,700,399


$1,700,400 $1,753,500 $1,806,650 $1,859,800 $1,912,900 $1,966,050 $2,019,200 $2,072,350 $2,125,450 $2,178,650$1,753,499 $1,806,649 $1,859,799 $1,912,899 $1,966,049 $2,019,199 $2,072,349 $2,125,449 $2,178,649 $2,231,827

$850,150 $903,299 $45 $48

$903,300 $956,449 $45 $48 $51 $54

$956,450 $1,009,549 $45 $48 $51 $54 $57 $60

$1,009,550 $1,062,649 $45 $48 $51 $54 $57 $60 $63 $66

$1,062,650 $1,115,849 $43 $46 $49 $53 $56 $59 $62 $65 $480 $904

$1,115,850 $1,168,949 $40 $43 $46 $49 $53 $56 $59 $62 $477 $904

$1,168,950 $1,222,099 $37 $40 $43 $46 $49 $53 $56 $59 $474 $901

$1,222,100 $1,275,299 $34 $37 $40 $43 $46 $49 $53 $56 $471 $898

$1,275,300 $1,328,399 $31 $34 $37 $40 $43 $46 $49 $53 $468 $895

$1,328,400 $1,381,499 $28 $31 $34 $37 $40 $43 $46 $49 $465 $892

$1,381,500 $1,434,699 $33 $28 $31 $34 $37 $40 $43 $46 $462 $889

$1,434,700 $1,487,799 $28 $33 $28 $31 $34 $37 $40 $43 $459 $886

$1,487,800 $1,540,899 $23 $28 $33 $28 $31 $34 $37 $40 $456 $883

$1,540,900 $1,594,049 $27 $23 $28 $33 $28 $31 $34 $37 $453 $880

$1,594,050 $1,647,249 $29 $27 $23 $28 $33 $28 $31 $34 $450 $877

$1,647,250 $1,700,399 $19 $29 $27 $23 $28 $33 $28 $31 $447 $874

$1,700,400 $1,753,499 $9 $19 $29 $27 $23 $28 $33 $28 $443 $871

$1,753,500 $1,806,649 $9 $19 $29 $27 $23 $28 $33 $440 $867

$1,806,650 $1,859,799 $9 $19 $29 $27 $23 $28 $446 $864

$1,859,800 $1,912,899 $9 $19 $29 $27 $23 $440 $869

$1,912,900 $1,966,049 $9 $19 $29 $27 $435 $864

$1,966,050 $2,019,199 $9 $19 $29 $440 $859

$2,019,200 $2,072,349 $9 $19 $441 $864

$2,072,350 $2,125,449 $9 $431 $865

$2,125,450 $2,178,649 $216 $443

$2,178,650 $2,231,827 $14



Note:These charts do not account for additional withholding in the following instances:

a married couple with both spouses working, where one spouses wages are more than $1,115,914 but less than $2,231,827, and the otherspouses wages are also more than $1,115,914 but less than $2,231,827;

married taxpayers with only one spouse working, and that spouse works more than one job, with wages from each job under $2,231,827, butcombined wages from all jobs is over $2,231,827.

If you are in one of these situations and you would like to request an additional dollar amount of withholding from your wages, please contact the TaxDepartment for assistance (see Need help?on page 6).

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Need help?

Telephone assistance

Automated income tax refund status: (518) 457-5149

Personal Income TaxInformation Center: (518) 457-5181

To order forms and publications: (518) 457-5431

Text Telephone (TTY) Hotline(for persons with hearing and speech disabilities using a TTY): (518) 485-5082

Visit our Web site at www.tax.ny.gov get information and manage your taxes online

check for new online services and features

Page 6 of 7 IT-2104 (2015)

$106,200 $127,500 $148,700 $169,950 $191,200 $233,700 $276,250 $318,750 $371,900 $425,050 $478,200 $127,499 $148,699 $169,949 $191,199 $233,699 $276,249 $318,749 $371,899 $425,049 $478,199 $531,299

$53,100 $74,299 $13 $18$74,300 $95,549 $12 $19 $26 $25

$95,550 $116,799 $8 $16 $23 $26 $27

$116,800 $127,499 $2 $11 $18 $21 $25 $28

$127,500 $138,099 $4 $15 $18 $22 $28

$138,100 $148,699 $2 $11 $14 $19 $28 $26

$148,700 $159,349 $4 $11 $15 $27 $24

$159,350 $170,149 $2 $8 $13 $26 $25 $21

$170,150 $191,199 $3 $11 $25 $27 $22 $24

$191,200 $233,699 $8 $20 $29 $26 $24 $18

$233,700 $276,249 $8 $15 $23 $18 $18 $12

$276,250 $318,749 $7 $15 $22 $15 $16

$318,750 $371,899 $8 $16 $22 $14

$371,900 $425,049 $8 $16 $22

$425,050 $478,199 $8 $16

$478,200 $531,299 $8

Combined wages between $106,200 and $531,299

Higher wage

$531,300 $584,450 $637,600 $690,700 $743,850 $797,000 $850,150 $903,300 $956,450 $1,009,550 $1,062,650 $1,115,850 $584,449 $637,599 $690,699 $743,849 $796,999 $850,149 $903,299 $956,449 $1,009,549 $1,062,649 $1,115,849 $1,168,949

$233,700 $276,249 $9

$276,250 $318,749 $9 $8

$318,750 $371,899 $16 $8 $8 $8

$371,900 $425,049 $14 $16 $8 $8 $8 $8

$425,050 $478,199 $22 $14 $16 $8 $8 $8 $8 $8

$478,200 $531,299 $16 $22 $14 $16 $8 $8 $8 $8 $8 $8

$531,300 $584,449 $8 $16 $22 $14 $16 $8 $8 $8 $8 $8 $222 $446 $584,450 $637,599 $8 $16 $22 $14 $16 $8 $8 $8 $8 $222 $446

$637,600 $690,699 $8 $16 $22 $14 $16 $8 $8 $8 $222 $446

$690,700 $743,849 $8 $16 $22 $14 $16 $8 $8 $222 $446

$743,850 $796,999 $8 $16 $22 $14 $16 $8 $222 $446

$797,000 $850,149 $8 $16 $22 $14 $16 $222 $446

$850,150 $903,299 $8 $16 $22 $14 $230 $446

$903,300 $956,449 $8 $16 $22 $228 $454

$956,450 $1,009,549 $8 $16 $235 $452

$1,009,550 $1,062,649 $8 $229 $460

$1,062,650 $1,115,849 $114 $240

$1,115,850 $1,168,949 $14

Combined wages between $531,300 and $1,168,949

Higher wage

Part 5These charts are only for single taxpayers and head of household taxpayers with more than one job, and whose combinedwages are between $106,200 and $2,231,827.

Enter the additional withholding dollar amount on line 3.

The additional dollar amount, as shown below, is accurate for a weekly payroll. If you are not paid on a weekly basis, you will need toadjust these dollar amount(s). For example, if you are paid biweekly, you must double the dollar amount(s) computed.

Privacy noticationThe Commissioner of Taxation and Finance may collect and maintain personalinformation 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 1415of that Law; and may require disclosure of social security numbers pursuant to42 USC 405(c)(2)(C)(i).

This information will be used to determine and administer tax liabilities and, whenauthorized by law, for certain tax offset and exchange of tax information programsas well as for any other lawful purpose.

Information concerning quarterly wages paid to employees is provided to certainstate agencies for purposes of fraud prevention, support enforcement, evaluation ofthe effectiveness of certain employment and training programs and other purposesauthorized by law.

Failure to provide the required information may subject you to civil or criminalpenalties, or both, under the Tax Law.

This information is maintained by the Manager of Document Management, NYS TaxDepartment, W A Harriman Campus, Albany NY 12227; telephone (518) 457-5181.

(Part 5 continued on page 7)

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$1,168,950 $1,222,100 $1,275,300 $1,328,400 $1,381,500 $1,434,700 $1,487,800 $1,540,900 $1,594,050 $1,647,250$1,222,099 $1,275,299 $1,328,399 $1,381,499 $1,434,699 $1,487,799 $1,540,899 $1,594,049 $1,647,249 $1,700,399

$584,450 $637,599 $469 $493

$637,600 $690,699 $469 $493 $516 $539

$690,700 $743,849 $469 $493 $516 $539 $562 $585

$743,850 $796,999 $469 $493 $516 $539 $562 $585 $609 $632

$797,000 $850,149 $469 $493 $516 $539 $562 $585 $609 $632 $655 $678

$850,150 $903,299 $469 $493 $516 $539 $562 $585 $609 $632 $655 $678

$903,300 $956,449 $469 $493 $516 $539 $562 $585 $609 $632 $655 $678

$956,450 $1,009,549 $478 $493 $516 $539 $562 $585 $609 $632 $655 $678

$1,009,550 $1,062,649 $476 $501 $516 $539 $562 $585 $609 $632 $655 $678

$1,062,650 $1,115,849 $269 $285 $310 $325 $349 $372 $395 $418 $441 $465

$1,115,850 $1,168,949 $39 $68 $84 $109 $124 $147 $171 $194 $217 $240

$1,168,950 $1,222,099 $14 $39 $68 $84 $109 $124 $148 $171 $194 $217

$1,222,100 $1,275,299 $14 $39 $68 $84 $109 $124 $148 $171 $194

$1,275,300 $1,328,399 $14 $39 $68 $84 $109 $124 $148 $171

$1,328,400 $1,381,499 $14 $39 $68 $84 $109 $124 $147

$1,381,500 $1,434,699 $14 $39 $68 $84 $109 $124

$1,434,700 $1,487,799 $14 $39 $68 $84 $109

$1,487,800 $1,540,899 $14 $39 $68 $84

$1,540,900 $1,594,049 $14 $39 $68

$1,594,050 $1,647,249 $14 $39

$1,647,250 $1,700,399 $14


Higher wage

$1,700,400 $1,753,500 $1,806,650 $1,859,800 $1,912,900 $1,966,050 $2,019,200 $2,072,350 $2,125,450 $2,178,650$1,753,499 $1,806,649 $1,859,799 $1,912,899 $1,966,049 $2,019,199 $2,072,349 $2,125,449 $2,178,649 $2,231,827

$850,150 $903,299 $701 $725

$903,300 $956,449 $701 $725 $748 $771

$956,450 $1,009,549 $701 $725 $748 $771 $794 $817

$1,009,550 $1,062,649 $701 $725 $748 $771 $794 $817 $841 $864

$1,062,650 $1,115,849 $488 $511 $534 $557 $581 $604 $627 $650 $673 $270

$1,115,850 $1,168,949 $263 $287 $310 $333 $356 $379 $403 $426 $449 $471

$1,168,950 $1,222,099 $240 $263 $287 $310 $333 $356 $379 $403 $426 $449

$1,222,100 $1,275,299 $217 $240 $263 $287 $310 $333 $356 $379 $403 $426

$1,275,300 $1,328,399 $194 $217 $240 $264 $287 $310 $333 $356 $379 $403

$1,328,400 $1,381,499 $171 $194 $217 $240 $263 $287 $310 $333 $356 $379

$1,381,500 $1,434,699 $148 $171 $194 $217 $240 $263 $287 $310 $333 $356

$1,434,700 $1,487,799 $124 $147 $171 $194 $217 $240 $263 $287 $310 $333

$1,487,800 $1,540,899 $109 $124 $147 $171 $194 $217 $240 $263 $287 $310

$1,540,900 $1,594,049 $84 $109 $124 $147 $171 $194 $217 $240 $263 $287

$1,594,050 $1,647,249 $68 $84 $109 $124 $147 $171 $194 $217 $240 $263

$1,647,250 $1,700,399 $39 $68 $84 $109 $124 $147 $171 $194 $217 $240

$1,700,400 $1,753,499 $14 $39 $68 $84 $109 $124 $147 $171 $194 $217

$1,753,500 $1,806,649 $14 $39 $68 $84 $109 $124 $147 $171 $194

$1,806,650 $1,859,799 $14 $39 $68 $84 $109 $124 $147 $171

$1,859,800 $1,912,899 $14 $39 $68 $84 $109 $124 $147

$1,912,900 $1,966,049 $14 $39 $68 $84 $109 $124

$1,966,050 $2,019,199 $14 $39 $68 $84 $109

$2,019,200 $2,072,349 $14 $39 $68 $84

$2,072,350 $2,125,449 $14 $39 $68

$2,125,450 $2,178,649 $14 $39

$2,178,650 $2,231,827 $14


Higher wage

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