Form Rf-9 - Decedent Refund Claim
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1
2RF-9
KANSAS
Decedent Refund Claim
(Rev. 9/09)
IMPORTANT: Complete a Form RF-9 for each tax year and each refund type. Also enclose proof of death with each return.
Refer to the instructions on the back to complete an accurate claim for refund on behalf of a decedent.
REFUND TYPE (Check one):
❑
K-40, Individual Income Tax/Food Sales Tax Refund
❑
K-40H, Kansas Homestead Claim
❑
K-40PT, Kansas Property Tax Relief Claim for Low Income Seniors
REFUND TAX YEAR:
__ __ __ __
__ __ / __ __ / __ __
Calendar year:
; or fiscal year ending
.
DECEDENT INFORMATION (Please type or print):
Name of Decedent
Date of Death
Social Security Number of Decedent
CLAIMANT INFORMATION (Please type or print):
Name of Claimant
Social Security Number of EIN
Address of Claimant
City
State
Zip Code
Relationship to Decedent
Daytime Telephone Number, inlcuding Area Code
I am filing this request for the decedent’s refund as (check only one box):
‰
Surviving spouse. The refund claim is for a joint income tax return, or homestead claim of a deceased spouse. A copy of the death
certificate or proof of death is enclosed.
‰
Decedent’s personal representative. A court certificate of my appointment and proof of death are enclosed.
‰
Heir at law. No estate proceedings were held and there is no surviving spouse. A copy of the death certificate or proof of death is
enclosed. I shall distribute the refund to the decedent’s following heirs at law.
Name
Relationship
Age
SIGNATURE
I agree to hold the state of Kansas and its agents harmless from any claim and all costs that may arise out of delivery of the decedent’s refund
to me. I understand that I am required by Kansas law to distribute the refund to the decedent’s estate or heirs.
I declare under the penalties of perjury that to the best of my knowledge and belief this is a true, correct and complete claim.
Signature of Claimant
Date
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