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Get and Sign Form it 2104 ECertificate of Exemption from Clover Sites 2021
Mark an X in
the Single or Head of household box.
Are you a resident of New York City? . .......... Yes
No
Are you a resident of Yonkers?...................... Yes
No
Complete the worksheet on page 3 before making any entries.
1 Total number of allowances you are claiming for New York State and Yonkers, if applicable (from line 17) ........... 1
2 Total number of allowances for New York City (from line 28)...
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