Form K-40h - Kansas Homestead Claim 2013
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1
22013
K-40H
134113
KANSAS HOMESTEAD CLAIM
(Rev. 7/13)
DO NOT STAPLE
FILE THIS CLAIM AFTER DECEMBER 31, 2013, BUT NO LATER THAN APRIL 15, 2014
Claimant's
First four letters of
Claimant's
Social Security
claimant's last name.
Telephone
Use ALL CAPITAL letters.
Number
Number
First Name of Claimant
Last Name
Initial
Mark this box if claimant is
deceased (See instructions) . . . . .
Date of Death _______________
Home Address (number and street or rural route)
IMPORTANT: Mark this box if
name or address has changed . . .
City
State
County Abbreviation
Zip Code
Mark this box if this is an
amended claim . . . . . . . . . . . . . . .
TO QUALIFY YOU MUST HAVE BEEN A RESIDENT OF KANSAS THE ENTIRE YEAR OF 2013 AND OWN YOUR HOME.
MONTH
DAY
YEAR
Answer ONLY the questions that apply to you:
1. Age 55 or over for the entire year? Enter date of birth (must be prior to 1958).. . . . . . . . . . . . . . . . .
2. Disabled or blind for the entire year? Enter the date
ENCLOSE Social Security Benefit
disability began. See instructions. . . . . . . . . . . . . . .
Verification Statement or Schedule DIS
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 2013). . . . . . .
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 2013 FOR EACH TYPE OF INCOME. See instructions.
4. 2013 Wages OR Kansas Adjusted Gross Income $ _______________ plus Federal Earned Income Credit
00
$ _____________. Enter the total. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5. All taxable income other than wages and pensions not included in Line 4. Do not subtract net operating
00
losses and capital losses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6. Total Social Security and SSI benefits, including Medicare deductions, received in 2013 (do not include
00
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
00
disability payments from Veterans and Railroad Retirement) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
00
8. TAF payments, general assistance, worker's compensation, grants and scholarships. . . . . . . . . . . . . . . . . . .
00
9. All other income, including the income of others who resided with you at any time during 2013 . . . . . . . . . . .
00
10. TOTAL HOUSEHOLD INCOME (Add lines 4 through 9. If line 10 is more than $32,900, you do not qualify for a refund)
11. 2013 general property taxes, excluding specials. (Tax on property valued at
Mark this box if you have
00
delinquent property tax.
more than $350,000 does not qualify. See instructions.) . . . . . . . . . . . . . . .
00
12. Amount of property tax allowed. Enter amount from line 11 or $700, whichever is less . . . . . . . . . . . . . . . . . . . . . . . . . .
%
13. Using your total household income on line 10 and the Refund Percentage Table, enter your refund percentage . . . . . .
14. HOMESTEAD REFUND (Multiply line 12 by percentage on line 13) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
00
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 2013 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.
COMPLETE THE BACK OF THIS FORM
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