Form K-40h - Kansas Homestead Claim - 2010 Page 2
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Providing this information should speed the processing of your claim. Income reported here should not be included on line 10 of this form.
Enter in the spaces provided the annual amount of all other income not included as household income on line 10:
.
.
,
,
00
00
(b) Nongovernmental Gifts. . . . . . . . $
(a) Food Stamps . . . . . . . . . . . . . . $
.
.
,
,
00
00
(d) Settlements (lump sum) . . . . . . . $
(c) Child Support . . . . . . . . . . . . . . $
.
( f) SSI, Social Security, Veterans
,
.
,
00
00
or Railroad Disability . . . . . . . . . $
(e) Personal and Student Loans. . $
(enclose documentation)
.
,
00
(g) Other (See instructions)
Source
Amount $
Is the property listed above owned by someone other than you OR you and your spouse?
Yes
No
If yes, did that person reside with you in 2010?
Yes
No
If the property was owned by someone other than you or you and your spouse, did they pay any portion of the property tax?
Yes
No
,
.
If yes, what amount of the total property tax due did they pay?
00
What portion, if any, of the homestead property was rented or used for business in 2010? __________ %
(See instructions)
Complete the information below for ALL persons (including yourself) who resided in your household at any time during 2010. Indicate the number of
months they lived with you and whether or not their income is included on lines 4 through 9 of Form K-40H.
Income
included on
Number of
Relationship months resided
lines 4-9,
Name
Date of birth
Social Security Number
- -
in household
Yes/No
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MAIL TO: Homestead Claim, Kansas Department of Revenue, 915 SW Harrison Street, Topeka KS 66699-2000
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