New York Certificate of Exemption from Withholding (Native Americans)

Certificate of Exemption from Withholding (Native Americans)
Form IT-2104-IND New York State Certificate of Exemption from Withholding Revised 12/24
IT-2104-IND

Print or type

Department of Taxation and Finance

	 First name and middle initial	

New York State Certificate of
Exemption from Withholding
Last name		

(12/24)

Social Security number

	 Home address (number and street or rural route)	

			

Apartment number

	 City, village, or post office	

	

	

State	

	

ZIP code

	 Employee’s certification – This is to certify that I am an enrolled member of the
	Nation or Tribe and that I live on and my income is earned from employment on the
	 Native American Reservation.
	I will notify my employer within 10 days of any change in my status.
	 Employee’s signature	

Date

To be used only by a Native American who is not subject to New York State income tax (see instructions on page 2).

Page 2 of 2  IT-2104-IND (12/24)

Instructions
Employee

If you are an enrolled member of a tribe or nation recognized by
the United States or by New York State, and you are a Native
American who works and lives on that tribe’s reservation,
you are not subject to state tax on income you earned on
the reservation. If you qualify, submit this certificate to your
employer and your employer will not withhold New York State
tax from your wages.
Note: If you also earn income outside the reservation, you
must submit a separate Form IT-2104, Employee’s Withholding
Allowance Certificate, to each place of employment outside the
reservation. Income you earn outside the reservation is subject
to state income tax.
If you provide false information that decreases your withholding
tax amount, the Tax Department may impose a penalty of $500.

Employer

If any employee submits this certificate to you and meets the
Qualifications below, do not withhold New York State tax from
the wages of that employee. If the employee’s status changes,
and either of the qualifications no longer applies, you must
begin to withhold New York State tax.
Keep this form with your records; do not send it to the New York
State Tax Department.

Caution: If an employee also works for you outside the
reservation, the employee must submit a separate Form IT-2104
and you must withhold New York State tax from that income.
Example: You operate a store on the reservation and another
store in a nearby town outside the reservation. If your qualifying
employee works for you in both locations, and submits
Form IT-2104-IND, you must still withhold tax on income your
employee earns at the location outside the reservation. Ask your
employee to submit a separate Form IT-2104 for income earned
at the location outside the reservation.

Qualifications

To qualify, your employee must:
•	 be an enrolled member of a tribe or nation recognized by the
United States or by New York State, and
•	work and live on that tribe’s reservation.

Privacy notification

See our website at www.tax.ny.gov or Publication 54, Privacy
Notification.