2005
K-40H
134105
KANSAS HOMESTEAD CLAIM
(Rev. 7/05)
FILE THIS CLAIM AFTER DECEMBER 31, 2005, BUT NO LATER THAN APRIL 15, 2006
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-
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Claimant's
First four letters of
Claimant's
claimant's last name.
Social Security
Telephone
Number
Use ALL CAPITAL letters.
Number
First Name of Claimant
Initial
Last Name
Mark this box if claimant is
deceased (See instructions) . . . . .
Date of Death _____/_____/_____
Home Address (number and street or rural route)
IMPORTANT: Mark this box if
name or address has changed . . .
City
State
Zip Code
County Abbreviation
Mark this box if this is an
amended claim . . . . . . . . . . . . . . .
YOU MUST HAVE BEEN A RESIDENT OF KANSAS THE ENTIRE YEAR OF 2005
MONTH
DAY
YEAR
Answer ONLY the questions that apply to you:
1. Age 55 or over for the entire year. Enter date of birth. (Must be prior to 1950.) . . . . . . . . . . . . .
ENCLOSE Social Security Benefit
2. Disabled or blind for the entire year. Enter date
Verification Statement or Schedule DIS
disability began. See instructions on page 16. . . . .
3. Dependent child who resided with you and was under 18 years of age for the entire
year. Child's name _______________________. Enter date of birth. (Must be prior to 2005.)
ENTER THE TOTAL RECEIVED IN 2005 FOR EACH TYPE OF INCOME. See instructions, page 16.
4. 2005 Wages OR Kansas Adjusted Gross Income ________________ plus Federal Earned Income Credit
,
.
00
_______________. Enter Total. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
.
,
5. All taxable income other than wages and pensions not included in Line 4. Do not subtract net operating
00
losses and capital losses. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
,
.
6. Social Security, SSI, and Railroad Retirement benefits including Medicare deductions.
00
Do not include Social Security Disability benefits. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
.
,
00
7. All other pensions, annuities, and veterans benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
,
.
00
8. TAF payments, general assistance, worker's compensation, grants and scholarships . . . . . . . . . . . . . . . . . .
,
.
00
9. All other income, including the income of others who resided with you at any time during 2005. . . . . . . . . . .
.
,
00
10.
TOTAL HOUSEHOLD INCOME (Add lines 4 through 9. If line 10 is more than $27,000, you do not qualify for a refund)
,
.
ENCLOSE 2005 PROPERTY
00
OWNER - 2005 general property taxes (See instructions, page 17). . . . . . . .
11.
TAX STATEMENT
,
.
00
12. RENTER - Enter total of line 5 amounts from RNT Schedule(s) . . . . . . . . . . .
ENCLOSE RNT SCHEDULE(S)
.
00
13. Total. Add lines 11 and 12, but do not enter more than $600 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
%
14. Using your total household income on line 10 and the chart on page 6, enter your refund percentage. . . . . . . . . . . . . .
.
00
15. Homestead refund
(Multiply line 13 by percentage on line 14)
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Important: If you filed Form ELG with your county, your refund will be reduced by the ELG amount applied to the first half of your 2005 property tax. See page 19.
Mark this box if you wish to participate in the Homestead Refund Advancement Program (see instructions, page 20)
I authorize the Director of Taxation or the Director's designee to discuss my K-40H and enclosures with my preparer.
I declare under the penalties of perjury that to the best of my knowledge and belief, this is a true, correct and complete claim.
_______________________________________
_____________
____________________________________
_______________________
Claimant's signature
Date
Signature of preparer other than claimant
Preparer's phone number
IMPORTANT: Please allow 10 to 12 weeks processing
Mail to:
Kansas Homestead Claim
time for your refund. Renters should allow 20 weeks so
Kansas Department of Revenue
be verified with your landlord.
the rent can
915 SW Harrison Street
Topeka, KS 66699-2000
PLEASE COMPLETE REVERSE SIDE
