11019411
Scroll down to complete Form NYS-1-MN
Tab between entry areas and click on the check boxes to
mark and unmark them.
This form is set up for either printing on two separate sheets
of paper, or two-sided printing.
Scroll down to complete the back of Form NYS-1-MN
Cut on the dotted lines before filing this form.
New York State Department of Taxation and Finance
NYS-1-MN
(1/10)
Return of Tax Withheld
Employer’s
legal name:
For office
use only
Postmark
Received date
SI
1 New York State
tax withheld
2 New York City
tax withheld
3 Yonkers

tax withheld
4 Total withheld
( add lines 1, 2, & 3 )
5 Credit
claimed
6 Total tax due
( line 4 minus line 5 )

$
A Last payroll date – Enter date of last

payroll covered by this return (MMDDYY)
B If you permanently ceased paying wages,
enter date of final payroll (MMDDYY)
C Mark an X in the box for additional payment
Withholding identification number
I certify that this information is to the best of my knowledge and belief true, correct, and complete.
Mark
X if new
employer or address
change ( see back )
Please file the original form
(not a copy) and print or
type in black ink, not pencil.
Taxpayer’s signature
Taxpayer’s name ( print or type )
Date
Telephone number



( )

Scroll down to complete the back of Form NYS-1-MN
Cut on dotted lines before filing this form.
Paid preparer: If you are using a paid preparer or payroll service, have the preparer or payroll service complete the appropriate section(s) below.
NYS-1-MN (1/10) (back)

Preparer’s signature
Telephone number
Date
Preparer’s firm name
(or preparer’s name, if self-employed)
Address
Mark an
X if
self-employed
Preparer’s SSN or PTIN
Preparer’s EIN
New employer or address change: Enter at right the
address at which you will receive withholding tax forms
and notices. For other changes, see instructions.
Taxpayer’s business name
c/o
attn
( if applicable, mark
either box and enter name )
Number and street or PO box
City


State
ZIP code
Make check payable to
NYS Income Tax and mail to:
NYS TAX DEPARTMENT, PROCESSING UNIT
PO BOX 4111, BINGHAMTON NY 13902-4111
If you are a PrompTax participant and you are filing a paper return,
mail your return and payment to:
PROMPTAX, NYS TAX DEPARTMENT,
PO BOX 4131, BINGHAMTON NY 13902-4131
Payroll service’s name
Payroll service’s EIN
If the address above is for your paid preparer, mark an
X in the c/o box,
enter the preparer’s name on the second line, and mark an
X in this box ..
( )