Form K-40pt - Kansas Property Tax Relief Claim For Low Income Seniors 2013 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.
13. Enter in the spaces provided the annual amount of all other income not included as household income on line 10:
00
00
(a) Food Stamps . . . . . . . . . . . . . . $
(b) Nongovernmental Gifts . . . . . . . . $
00
00
(d) Settlements (lump sum) . . . . . . . $
(c) Child Support . . . . . . . . . . . . . . $
( f) SSI, Social Security, Veterans
00
00
or Railroad Disability . . . . . . . . . $
(e) Personal and Student Loans. . $
(enclose documentation)
00
(g) Other (See instructions)
Source
Amount
$
14. List the names of ALL persons who resided in your household at any time during 2013. Specify the number of months they lived with
you and report their portion of income that is included in total household income on line 10 of this form.
Number of
months resided
Their portion of income that is
Name
in household
included on line 10
Social Security Number
00
$
$
00
$
00
$
00
$
00
$
00
$
-
-
-
MAIL TO: Homestead Claim, Kansas Department of Revenue, 915 SW Harrison Street, Topeka KS 66612-1588
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