Form K W-7a - Kansas Nonresident Owner Withholding Affidavit printable pdf download

KANSAS

K W-7A

(Rev. 10/04)

Nonresident Owner Withholding Affidavit

PART A - PARTNERSHIP, S CORPORATION, LLC OR LLP

Partnership, S Corporation, LLC or LLP

Employer Identification Number (EIN)

Street Address, City, State & Zip Code

PART B - WITHHOLDING TAX EXEMPTION

Nonresident Owner’s Name

Social Security Number (If not an individual, enter the EIN)

Street Address, City, State & Zip Code

I, ____________________________________, as a partner/shareholder/member of the above-named partnership, S corporation,

LLC or LLP, request to be exempt from the Kansas income tax withholding required on my share of the Kansas taxable income of the

above-named partnership, S corporation, LLC or LLP for tax year ____________, and all subsequent years, until I notify the department

of a change in this election. By signing this affidavit, I agree to:

1) File a Kansas income tax return, and make timely payment of all Kansas income tax imposed by the laws of this state with

respect to my share of the Kansas taxable income of the above-named partnership, S corporation, LLC or LLP for every

year in which I maintain my exemption status.

2) Be subject to the “personal jurisdiction” of the Kansas Department of Revenue in courts of the state of Kansas for the purpose

of determining and collecting any Kansas taxes, including estimated taxes, together with any related interest and penalties,

imposed on me by the state of Kansas with respect to my share of the Kansas taxable income of the above-named partnership,

S corporation, LLC or LLP.

If I fail to abide by the terms of this affidavit, I understand that the department may revoke the exemption from withholding at any time.

PART C - WITHHOLDING TAX EXEMPTION REVOCATION

Nonresident Owner’s Name

Social Security Number (If not an individual, enter the EIN)

Street Address, City, State & Zip Code

I, ____________________________________, as a partner/shareholder/member of the above-named partnership, S corporation,

LLC or LLP, hereby revoke my previous withholding election dated _______________. At this time, I request to be subject to withholding

on my share of the Kansas taxable income of the above-named partnership, S corporation, LLC or LLP for tax year ____________, and

all subsequent years, until I notify the department of a change in this election.

PART D - SIGNATURE

(

)

Signature of Nonresident Owner

Date

Daytime Phone

(If not an individual, signature of officer or director.)

INFORMATION and INSTRUCTIONS: Partnerships, S

requirement by providing this completed affidavit to the pass-through

corporations, LLCs and LLPs are required to withhold Kansas income

entity. A copy of this affidavit must be submitted by the pass-through

tax from a nonresident owner’s share (whether distributed or

entity with Form KW-7S to show why withholding tax is not being

undistributed) of Kansas taxable income from the partnership, S

paid on behalf of that nonresident owner. Part C of the affidavit is to

corporation, LLC or LLP. This withholding requirement imposed by

be used only to revoke a prior election.

K.S.A. 79-32,100e, is effective July 1, 2003 for all taxable years

beginning after 2002. The nonresident owner withholding rate is

TAXPAYER ASSISTANCE: Please contact our Taxpayer

6.45% of the nonresident owner’s share of Kansas taxable income.

Assistance Center if you need assistance with this form. Call (785)

368-8222; Hearing Impaired: (785) 296-6461. Docking State Office

A nonresident owner who elects to be subject to the personal

Building, 1st Floor, 915 SW Harrison St., Topeka, KS 66625-2007.

jurisdiction of the department for the purpose of determining and

Additional copies of this and other tax forms are available from our

collecting any Kansas taxes may “opt-out” of this withholding

office or web site:

Form K W-7a - Kansas Nonresident Owner Withholding Affidavit

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