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Get NY DTF IT-2104.1 2000

Ete this form and return it to your employer. If you become a New York State, New York City, or Yonkers resident, or you substantially change the percentage of services performed within New York State or Yonkers, you must notify your employer within 10 days. A penalty of $500 may be imposed for furnishing false information that decreases the withholding amount. Employee s first name and middle initial Last name Social security number Street address Employer s name Street address City.

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