New York Certificate of Income Tax Withheld

Certificate of Income Tax Withheld
Form IT-2102.6 Certificate of Income Tax Withheld Tax Year 2023
IT-2102.6

Department of Taxation and Finance

Certificate of Income Tax Withheld
(with instructions)

If every effort to get a federal Form W-2, Wage and Tax Statement,
from your employer has failed, file this certificate with this year’s tax
return, for this employer. If you were unable to get a federal Form
W-2 from more than one employer, file a separate certificate for
each employer. Complete this form, sign, and submit it with your
return.
Explain why you were unable to obtain a federal Form W-2 from
your employer: 

Enter any other information, such as the employer identification
number (EIN), that will help the Tax Department locate your
employer, or if you prefer, submit a copy of your payroll stub:

Privacy notification

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.

Enter your employer’s present name and address if different from
that entered on the certificate:

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.
See our website or Publication 54, Privacy Notification, for more information.
There may be additional information about UI Law and the Department of Labor.

Do not detach.

IT-2102.6

Certificate of Income Tax Withheld
New York State • New York City • Yonkers

	 Employee’s first name and initial	

Last name	

Your Social Security number

	 Mailing address (number and street or PO Box)	
	 City, village, or post office	

Apt no.
State	

ZIP code

State	

ZIP code

Use this form only
when you are unable to
obtain federal Form W-2
from your employer.

	 Employer’s name
	Address (number and street or rural route)
	 City, village, or post office	

	

	 1	 Total wages before any deductions ......................................................................................................	
	 2	 New York State income tax withheld .....................................................................................................	
	 3	 New York City income tax withheld .......................................................................................................	
	 4	 .Yonkers income tax withheld ................................................................................................................	

Whole dollars only 	

.00
.00	
.00		
.00

1	
2	
3	
4	

I certify that the total amount of wages paid and New York State, New York City, and Yonkers tax withheld by the employer shown on this form are, to the
best of my knowledge, correct. I further state that it was not possible to obtain federal Form W-2 from the employer for the reason noted above.
	 Employee signature 	

110001230094

Date