Form K-67 - Kansas Application For Carryback Of Net Operating Farm Loss Refund -

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K-67
KANSAS
APPLICATION FOR CARRYBACK OF
(Rev. 8/03)
NET OPERATING FARM LOSS REFUND
_________________ , 20____
_________________
20____
For the taxable year beginning,
, ending
,
.
Name of taxpayer (as shown on return)
Social Security Number
If partner, shareholder or member, enter name of partnership, S corporation, LLC or LLP
Employer Identification Number (EIN)
FILE THIS APPLICATION SEPARATELY FROM YOUR INCOME TAX RETURN
YOU MUST ENCLOSE A COPY OF YOUR FEDERAL FORM 1045 WITH THIS CLAIM
Did you experience a change in marital status or file any of the carry back years with a different filing status than the loss
q
q
year?
No
Yes
If yes, you need to complete Schedule IV (see instructions).
Schedules I, II and IV have been provided to assist you in completing Schedule III. For assistance in completing this refund
application you may contact the Kansas Department of Revenue, 915 SW Harrison St., Topeka, KS 66612-1588, or phone toll
free 877-526-7738.
SCHEDULE I
SCHEDULE II
KANSAS COMPUTATION SCHEDULE
KANSAS COMPUTATION SCHEDULE
(See Instructions)
(See Instructions)
LOSS YEAR
CARRYBACK YEARS
_________
________
________
________
________
________
(A)
(B)
(C)
(D)
(E)
(F)
1. Taxable income per Kansas return ..
2. Net operating loss from prior year ...
3. Net capital loss .................................
4. Nontaxable capital gain ....................
5. Exemptions ......................................
6. Excess nonbusiness deductions ......
7. Other adjustments:
a. Charitable contributions ...............
b. __________________ ................
8. Net operating loss ............................
9. Modified taxable income ...........................................
10. Net operating loss carryback:
a. Net operating loss carried to 5th preceding year
b. Net operating loss carried to 4th preceding year
b. Net operating loss carried to 3rd preceding year
b. Net operating loss carried to 2nd preceding year
b. Net operating loss carried to 1st preceding year
11. Remaining unused net operating loss .......................

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