Form Do-41 - Request For Copy Of Kansas Tax Documents - 2014
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1Division of Taxation
Phone: 785-296-3081
915 SW Harrison St
Fax: 785-296-7928
Topeka, KS 66612-1588
Nick Jordan, Secretary of Revenue
Department of Revenue
Sam Brownback, Governor
Steve Stotts, Director of Taxation
REQUEST FOR COPY OF KANSAS TAX DOCUMENTS
PART I —Taxpayer Information
Name (Taxpayer or Corporate Name)
Your SS No.
Joint Filer’s Name
Spouse’s SS No.
Address
Registration No.
Employer ID No. (EIN)
City, State and Zip Code
Daytime Phone Number
E-mail Address
PART II — Mailing Information
(if different from above)
Name
Address
City, State and Zip Code
PART III — Tax Return / Document Requested
(see instructions)
N
C
P
A
UMBER OF
OST
ER
MOUNT
Y
/ P
Y
/ P
Y
/ P
Y
/ P
R
R
D
EAR
ERIOD
EAR
ERIOD
EAR
ERIOD
EAR
ERIOD
ETURNS
ETURN
UE
T
Individual Income & Food Sales (K-40)
=
$
X
$ 5.00
T
Fiduciary (K-41)
=
$
X
$ 5.00
T
Homestead (K-40H)
=
$
X
$ 5.00
T
Withholding Return/Report (KW-3/KW-5)
=
$
X
$ 5.00
T
Sales Tax (ST-16/ST-36)
=
$
X
$ 5.00
T
Cigarette Tax Report
=
$
X
$ 5.00
T
Tobacco Tax Report
=
$
X
$ 5.00
T
Misc. Tax: _______________________
=
$
X
$ 5.00
Y
E
Y
E
Y
E
Y
E
EAR
NDING
EAR
NDING
EAR
NDING
EAR
NDING
T
Corporate (K-120)
=
$
X
$ 20.00
T
Privilege (K-130)
=
$
X
$ 20.00
T
Small Business/Partnership (K-120S)
=
$
X
$ 20.00
T
Federal Corporate (see instructions)
=
$
X
$ 20.00
T
T
D
D
Y
AX
YPE OR
OCUMENT
ESCRIPTION
EAR
X
$ 5.00
=
T
Copy of Refund Check
$
$
T
Copy of Tax Warrant
X
$ 15.00
=
$
T
Copy of Satisfaction of Judgment
X
$ 5.00
=
$
T
Transcript of Account
X
$ 5.00
=
$
T
Other (see instructions)
X
$ _____ =
$
X
$ _____ =
Total number of returns/documents and total cost (see instructions)
$
PART IV — Signature and Date (read carefully before signing)
I request the Director of Taxation furnish me with a copy of items checked. Under the penalties of perjury I declare that the information
furnished above, to the best of my knowledge, is true, correct, and complete. I further declare that I am the taxpayer, officer for the
taxpayer, or authorized tax preparer and have authorization to receive this information.
Printed Name and Title
Name of Your Business/Organization
Signature
Date
DO-41 (Rev. 7/14)
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