Form K-40 Pt - Kansas Property Tax Relief Claim For Low Income Seniors

Form K-40 Pt - Kansas Property Tax Relief Claim For Low Income Seniors - 2008 Page 2

135408

Providing this information should speed the processing of your claim. Income reported here should not be included on line 8 of this form.

13. Enter in the spaces provided the annual amount of all other income not included as household income on line 8:

(b) Nongovernmental Gifts. . . . . . . . $

(a) Food Stamps . . . . . . . . . . . . . . $

(d) Settlements (lump sum) . . . . . . . $

( f) SSI, Social Security, Veterans

or Railroad Disability . . . . . . . . . $

(e) Personal and Student Loans. . $

(enclose documentation)

(g) Other (See instructions on page 17): Source

Amount $

14. List the names of ALL persons who resided in your household at any time during 2008. 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

Name

- -

in household

Social Security Number

is included on line 10

- -

INSTRUCTIONS

MAIL TO: Homestead Claim, Kansas Department of Revenue, 915 SW Harrison Street, Topeka KS 66699-2000

Form K-40 Pt - Kansas Property Tax Relief Claim For Low Income Seniors - 2008 Page 2