Form K-40h - Kansas Homestead Claim 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.
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 . . . . . . . . . . . . . . $
( f) SSI, Social Security, Veterans
00
00
or Railroad Disability . . . . . . . . . $
(e) Personal and Student Loans. . $
(enclose documentation)
00
(g) Other (See instructions)
Source
Amount
$
Is the property listed above owned by someone other than you OR you and your spouse?
Yes
No
If yes, did that person reside with you in 2013?
Yes
No
If the property was owned by someone other than you or you and your spouse, did they pay any portion of the property tax?
Yes
No
00
If yes, what amount of the total property tax due did they pay?
What portion, if any, of the homestead property was rented or used for business in 2013? __________ %
(See instructions)
Complete the information below for ALL persons (including yourself) who resided in your household at any time during 2013. 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 of
Income
months
included on
resided in
lines 4-9,
Name
Date of birth
Relationship
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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