New York Annuitant's Request for Income Tax Withholding

Annuitant's Request for Income Tax Withholding
Form IT-2104-P Annuitant's Request for Income Tax Withholding Revised 12/24
Department of Taxation and Finance

Annuitant’s Request for Income Tax Withholding

IT-2104-P

Print or type

New York State • New York City • Yonkers
	 First name and middle initial	

Last name				

	 Permanent mailing address (number and street or PO Box)			
		
	
	

Apartment number	
	
	

	 City, village, or post office	

ZIP code

Enter the whole dollar
amount to be withheld
from each annuity or
pension payment:

	

State	

Your Social Security number
Annuity contract claim or
identification number

	1	 New York State income tax ................................................................... 	  1
	 2	 New York City income tax (if a New York City resident).............................. 	  2
	 3	 Yonkers income tax surcharge (if a Yonkers resident)............................... 	  3

	I request voluntary income tax withholding from my annuity or pension payments as authorized by Tax Law § 671(b).
	 Signature of annuitant	

For more information, see the instructions on page 2.

Date

(12/24)

Page 2 of 2  IT-2104-P (12/24)

Instructions
Payee
Who may submit

If you receive an annuity or pension payment that you are
required to include in your New York State adjusted gross
income, you may use this form to voluntarily have New York
State personal income tax withheld from each payment.
If you are a New York City or Yonkers resident, you may also
choose to have that city’s personal income tax withheld.

Requirements

The annuity or pension must be payable over a period longer
than one year.
If you submit this form, you must request an amount that is at
least $5 per month.
You should not request a total amount of withholding that would
reduce your annuity or pension payment to less than $10.

Where and how to submit

Submit this form to the payer of your annuity or pension. On
the front of the form, enter (in whole dollars) the amount of
New York State (and, if applicable, New York City or Yonkers)
income tax that you want withheld from each annuity or pension
payment.
If you choose, you may make quarterly payments of estimated
income tax in addition to, or instead of, withholding. For more
information, see the instructions for Form IT‑2105, Estimated
Tax Payment Voucher for Individuals.
If you need help completing this form, call 518-457‑5181.

Duration of withholding request

Your request for voluntary withholding will remain in effect until
you ask your payer in writing to terminate it.

Statement of income tax withheld

After the end of the year, your payer will give you federal
Form 1099‑R, Distributions From Pensions, Annuities,
Retirement or Profit‑Sharing Plans, IRAs, Insurance Contracts,
etc., showing the gross distribution amount of annuity or pension
payments and the total amount your payer deducted and
withheld as personal income tax during the calendar year.

Payer

Keep this certificate with your records.
You must report and pay the New York State, New York City,
and Yonkers personal income taxes that you withheld from
annuity or pension payments. For payer responsibilities, see:
•	 instructions for Form NYS‑1, Return of Tax Withheld
•	 instructions for Form NYS‑45, Quarterly Combined
Withholding, Wage Reporting, and Unemployment Insurance
Return

Privacy notification

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