Fillable Form K-40h - Kansas Homestead Claim - 2016 printable pdf download

K-40H

2016

134116

KANSAS HOMESTEAD CLAIM

(Rev. 7/16)

DO NOT STAPLE

FILE THIS CLAIM AFTER DECEMBER 31, 2016, BUT NO LATER THAN APRIL 15, 2017

Claimant’s

First four letters of

Social Security

Telephone

claimant’s last name.

Number

Use ALL CAPITAL letters.

Number

Mark this box if claimant is

Your First Name

Initial

Last Name

deceased (See instructions) ...........

Date of Death _______________

Mailing Address (Number and Street, including Rural Route)

IMPORTANT: Mark this box if

name or address has changed .......

City, Town, or Post Office

State

Zip Code

County Abbreviation

Mark this box if this is an

amended claim ..............................

TO QUALIFY YOU MUST HAVE BEEN A RESIDENT OF KANSAS THE ENTIRE YEAR OF 2016 AND OWN YOUR HOME.

Answer ONLY the questions that apply to you:

MONTH

DAY

YEAR

1. Age 55 or over for the entire year? Enter date of birth (must be prior to 1961) .........................................

2. Disabled or blind for the entire year? Enter the date

ENCLOSE Social Security Benefit

Verification Statement or Schedule DIS

disability began. See instructions .............................................

3. Dependent child who resided with you and was under 18 years of age for the entire year?

Child’s name __________________________ . Enter date of birth (must be prior to 2016) ...................

Mark this box if you are filing as surviving spouse of a disabled veteran OR of an active duty service

member who died in the line of duty (see instructions for this qualification and for required enclosures).

ENTER THE TOTAL RECEIVED IN 2016 FOR EACH TYPE OF INCOME. See instructions.

4. 2016 Wages OR Kansas Adjusted Gross Income $ ________________ plus Federal Earned Income Credit

$ ________________ . Enter the total ....................................................................................................................

5. All taxable income other than wages and pensions not included in Line 4. Do not subtract net operating losses

and capital losses .....................................................................................................................................................

6. Total Social Security and SSI benefits, including Medicare deductions, received in 2016 (do not include

disability payments from Social Security or SSI) $ _______________ . Enter 50% of this total .........................

7. Railroad Retirement benefits and all other pensions, annuities, and veterans benefits (do not include

disability payments from Veterans and Railroad Retirement) ............................................................................

8. TAF payments, general assistance, worker’s compensation, grants and scholarships .....................................

9. All other income, including the income of others who resided with you at any time during 2016 ......................

10. TOTAL HOUSEHOLD INCOME (Add lines 4 through 9. If line 10 is more than $34,100, you do not qualify for a refund)

11. Percent of the homestead property that was rented or used for business in 2016 (see instructions) ......................................

12. 2016 general property taxes, excluding specials. (Tax on property valued at

Mark this box if you have

more than $350,000 does not qualify. See instructions.)..............................

delinquent property tax.

13. Amount of property tax allowed. Enter amount from line 12 or $700, whichever is less ...........................................................

14. Using your total household income on line 10 and the Refund Percentage Table, enter your refund percentage ....................

15. HOMESTEAD REFUND (Multiply line 13 by percentage on line 14) ........................................................................................

Important: If you filed Form ELG with your county, your refund will be reduced by the ELG amount applied to the first half of your 2016 property tax.

Mark this box if you wish to participate in the Refund Advancement Program

(see instructions)

..........................

I authorize the Director of Taxation or the Director’s designee to discuss my K-40H and enclosures with my preparer.

I declare under the penalties of perjury that to the best of my knowledge and belief, this is a true, correct and complete claim.

Claimant’s signature

Date

Signature of preparer other than claimant

Preparer’s phone number

IMPORTANT: Please allow 20 to 24 weeks to process your refund.

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