Submission #

• Paper: Letter (8.5in x 11in)

• Copies to print: 2

• This certificate much be filed each year to continue exemption.

• Employers must keep a copy for their records.

• The employer must be notified within 10 days of any change making the employee no longer eligible for the exemption.

• Employers may use this form to report a newly hired or rehired employee. Mail completed form, within 20 days of hiring to:

  New York State Dept of Taxation and Finance
  New Hire Notification
  PO Box 15119
  Albany NY  12212-5119
  

• If an employee claims an exemption but usually earns more than $200 per week, mail to:

  NYS Tax Department - Income Tax Audit Administrator
  Withholding Certificate Coordinator
  W A Harriman Campus
  Albany NY 12227-0865
  

Notes#

• A penalty of $500 may be imposed for furnishing false information that decreases your withholding amount.
• The following conditions must apply to qualify for exemption:
  • The employee must be under age 18, or over age 65, or a full-time student under age 25.
  • The employee did not have income tax liability for the previous year.
  • The employee does not expect to have income tax liability for 2017.
• The employee may also claim exemption if they meet the conditions set forth under the Servicemembers Civil Relief Act:
  • The employee's spouse is a member of the armed forces present in New York in compliance with military order.
  • The employee is present in New York solely to be with their spouse.
  • The employee is domiciled in a different state.

Purpose#

To be used by residents to file exemption from state withholding tax.

Learn more#

Employer's Guide to Withholding Tax

Download#

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