Form K-40h - Kansas Homestead Claim - 2002 printable pdf download

K-40H

KANSAS HOMESTEAD CLAIM

134102

(Rev. 7/02)

FILE THIS CLAIM AFTER DECEMBER 31, 2002, BUT NO LATER THAN APRIL 15, 2003

- -

First four letters of

Claimant’s

Social Security

claimant’s last name.

Telephone

Use ALL CAPITAL letters.

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 . . .

State

Zip Code

County Abbreviation

City

Mark this box if this is an

amended claim . . . . . . . . . . . . . . .

YOU MUST HAVE BEEN A RESIDENT OF KANSAS THE ENTIRE YEAR OF 2002

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 1947.) . . . . . . . . . . . . .

ENCLOSE Social Security Benefit

2. Disabled or blind for the entire year. Enter date

Verification Statement or Schedule DIS

disability began. See instructions on page 16. . . . . .

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 2002.)

ENTER THE 727$/ RECEIVED IN 2002 FOR EACH TYPE OF INCOME.

SEE INSTRUCTIONS BEGINNING ON PAGE 15.

4. 2002 Wages OR Kansas Adjusted Gross Income ________________ plus Federal Earned Income Credit

_______________. Enter Total. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

5. All taxable income other than wages and pensions not included in Line 4. Do not subtract net operating

losses and capital losses. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6. Social Security, SSI, and Railroad Retirement benefits including Medicare deductions.

Do not include Social Security Disability benefits. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

7. All other pensions, annuities, and veterans benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

8. TAF payments, general assistance, worker’s compensation, grants and scholarships . . . . . . . . . . . . . . . . . .

9. All other income, including the income of others who resided with you at any time during 2002. . . . . . . . . . .

10.

TOTAL HOUSEHOLD INCOME (Add lines 4 through 9. If line 10 is more than $25,000, you do not qualify for a refund)

ENCLOSE 2002 PROPERTY

OWNER - 2002 general property taxes (See instructions, page 17). . . . . . . . . .

11.

TAX STATEMENT

ENCLOSE RNT SCHEDULE(S)

12. RENTER - Enter total of line 5 amounts from RNT Schedule(s) . . . . . . . . . . . . .

13. Total. Add lines 11 and 12, but do not enter more than $600. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

14. Using your total household income on line 10 and the chart on page 6, enter your refund percentage. . . . . . . . . . . . . .

15. Homestead refund (Multiply line 13 by percentage on line 14) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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 2002 property tax. See page 19.

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

Please allow 10 to 12 weeks processing time for your

Mail to:

Kansas Homestead Claim

refund. If you are a renter, you should allow an

Kansas Department of Revenue