Schedule Rnt - Kansas Certification Of Rent Paid - 2001

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Schedule
KANSAS
2001
RNT
CERTIFICATION OF RENT PAID
(Rev. 9/01)
First Name
Last Name
Social Security Number
RENTAL PERIOD: From: ________________________ 2001, to: ______________________ 2001.
Month
Day
Month
Day
Complete a Schedule RNT for each place you resided in 2001, even if you paid no rent. See instructions on reverse side.
ADDRESS OF RENTAL PROPERTY
Number and Street or Rural Route
for the above time period.
City
State
Zip Code
Landlord/Property Owner Name
LANDLORD or PROPERTY OWNER:
Enter ALL requested information. Your
Mailing Address
claim for refund cannot be processed if
this information is missing or incomplete.
City
State Zip Code
(
)
Landlord/Property Owner Telephone Number
Fax Number (if applicable)
TYPE OF RENTAL PROPERTY
(Check all that apply):
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 2001 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 gross rent,
2
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 a boarding home, multiply line 2 by 25% (.25), and enter the result
3
on line 4. See the instructions for “Special Rental Situations” on the back of this form.
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.
5
00
MONTHLY
# of MONTHS
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. (Add items A through O). Enter on line 3 above. ……………………..
$
______________
ENCLOSE SCHEDULE RNT WITH YOUR HOMESTEAD CLAIM, FORM K-40H.
INSTRUCTIONS FOR SCHEDULE RNT

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