Form K-40h - Kansas Homestead Claim - 2016 Page 2
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Providing this information should speed the processing of your claim. Income reported here should not be included on line 10 of this form.
Enter in the spaces provided the annual amount of all other income not included as household income on line 10:
00
00
(b) Nongovernmental Gifts ......................... $
(a) Food Stamps.............................. $
00
00
(d) Settlements (lump sum) ........................ $
(c) Child Support.............................. $
00
00
( f ) SSI, Social Security, Veterans or Railroad
(e) Personal and Student Loans...... $
Disability (enclose documentation) ........... $
00
(g) Other (See instructions)
Source
___________________________________________________
Amount
$
Complete the information below for ALL persons (including yourself) who resided in your household at any time during 2016. Indicate the number of
months they lived with you and whether or not their income is included on lines 4 through 9 of Form K-40H.
Number
Income
of months
included on
Name
Date of Birth
Relationship
resided in
lines 4-9,
Social Security Number
household
Yes/No
MAIL TO: Homestead Claim, Kansas Department of Revenue, 915 SW Harrison Street, Topeka KS 66612-1588
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Parent category: Financial