Schedule Rnt - Kansas Certification Of Rent Paid - 1999

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KANSAS
1999
RNT
CERTIFICATION OF RENT PAID
First Name
Last Name
Social Security Number
From: ______________________ 1999,
To: _____________________ 1999
RENTAL PERIOD:
Month
Day
Month
Day
Complete a schedule RNT for each place you resided in 1999, even if you paid no rent. See instructions on reverse.
ADDRESS OF RENTAL PROPERTY
Number and Street or Rural Route
for the above time period
City
State
Zip Code
LANDLORD or PROPERTY OWNER:
Landlord/Property owner name
Enter ALL requested information.
Mailing Address
Your claim for refund cannot be processed
if this information is missing or incomplete.
City
State
Zip Code
(
)
TYPE OF RENTAL PROPERTY:
Landlord/Property owner telephone number
Check all that apply:
Fax Number (if applicable)
Low income housing
Nursing home or assisted
Mobile home
Section eight housing
living facility
Mobile home lot
Apartment
Hotel
Manufactured home
House
Boarding Home
Other (Explain)
Duplex or similar facility
Live with landlord
Follow the instructions on the back of this form to accurately complete Lines 1 through 5.
1. Is the rental property above subject to property tax?
YES
NO
2. Total rent you paid for the 1999 rental period shown above. See instructions on back.
Do not include deposits or rent that is owed the landlord. Section 8 residents: Do not enter
2
gross rent, only the amount you paid.
3. Value of utilities, furnishings, or services included in your rent (from schedule below).
If you live in a nursing home or boarding home, you MUST multiply line 2 by 25% (.25),
and enter the result on line 4. See instructions on back.
3
4. Subtract line 3 from line 2. This is your rent paid for occupancy.
4
5. Multiply line 4 by 20% (.20). Enter on line 12, front of Form K-40H.
00
5
MONTHLY
NO. OF MO.
ITEMS
CHARGE
RENTED
AMOUNT
A. Furniture (other than appliances) ....................................................................
$ 20.00
X _________ $ _________
B. Stove ...............................................................................................................
10.00
X _________
_________
C. Refrigerator ......................................................................................................
10.00
X _________
_________
D. Dishwasher ......................................................................................................
6.00
X _________
_________
E. Washer and Dryer ...........................................................................................
10.00
X _________
_________
F. Heat (for months used) ....................................................................................
46.00
X _________
_________
G. Electricity (other than heat) ..............................................................................
40.00
X _________
_________
H. Gas (other than heat) ......................................................................................
18.00
X _________
_________
I.
Air Conditioning (for months used) ..................................................................
20.00
X _________
_________
J. Cable ...............................................................................................................
30.00
X _________
_________
K. Water and Sewer .............................................................................................
20.00
X _________
_________
L. Trash ...............................................................................................................
10.00
X _________
_________
M. Laundry ...........................................................................................................
25.00
X _________
_________
N. Meals ...............................................................................................................
300.00
X _________
_________
$
O. Other (specify and estimate) ........................................................................... _______
X _________
_________
........................ _________
P. TOTAL EXPENSES TO BE ENTERED ON LINE 3 ABOVE (Add items A through O)
(ENCLOSE SCHEDULE RNT WITH YOUR
HOMESTEAD CLAIM, FORM K-40H)

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