Form K-40 - Kansas Individual Income Tax And/or Food Sales Tax Refund - 2012 Page 2
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1
2114212
ENTER AMOUNTS IN WHOLE DOLLARS ONLY
Income
00
1
1. Federal adjusted gross income (as reported on your federal income tax return). . . . . . . .
Shade the box for
00
2
2. Modifications (From Schedule S, line A21. Enclose Schedule S.) . . . . . . . . . . . . . . . . .
negative amounts.
Example:
3. Kansas adjusted gross income (Line 2 added to or subtracted from line 1) . . . . . . . . . . .
00
3
Deductions
00
4
4. Standard deduction OR itemized deductions (See instructions). . . . . . . . . . . . . . . . . . . . . . . .
00
5. Exemption allowance ($2,250 x number of exemptions claimed) . . . . . . . . . . . . . . . . . . . . . .
5
6. Total deductions (Add lines 4 and 5) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
00
0
6
7. Taxable income (Subtract line 6 from line 3; if less than zero, enter 0) . . . . . . . . . . . . . . . . . .
00
0
7
Tax
00
8
8. Tax (From Tax Tables or Tax Computation Schedules) . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Computation
.
9
9. Nonresident percentage (from Schedule S, line B23; or if 100%, enter 100.0000). . . . . . . . . .
00
10. Nonresident tax (Multiply line 8 by line 9) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
10
00
11. Kansas tax on lump sum distributions (Residents only - see instructions). . . . . . . . . . . . . . . .
11
12. TOTAL INCOME TAX (Residents: add lines 8 & 11; Nonresidents: enter amount from line 10)
00
12
Credits
00
13
13. Credit for taxes paid to other states (See instructions. Enclose return(s) from other states.)
00
14
14. Credit for child & dependent care expenses (See instructions) . . . . . . . . . . . . . . . . . . . . . . . .
00
15. Other credits (Enclose all appropriate credit schedules) . . . . . . . . . . . . . . . . . . . . . . . . . .
15
16. Total tax credits (Add lines 13, 14 and 15). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
00
0
16
17. Income tax balance after credits (Subtract line 16 from line 12; cannot be less than zero). . .
00
0
17
Use Tax
00
18. Use tax due (See instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
18
00
19. Total Tax Balance (Add lines 17 and 18). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
19
0
Withholding
00
20
20. Kansas income tax withheld from W-2, 1099, or K-19 (Enclose K-19; see instructions). . . . .
and
00
21
21. Estimated tax paid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Payments
00
22
22. Amount paid with Kansas extension . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
00
23
23. Earned income credit (See instructions). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
If this is an
00
24. Refundable portion of tax credits (Enclose all appropriate credit schedules) . . . . . . . . . . . . .
24
AMENDED return,
25. Payments remitted with original return. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
00
25
complete lines
-
25 and 26.
26. Overpayment from original return (This figure is a subtraction; see instructions) . . . . .
00
26
27. Total refundable credits (Add lines 20 through 25 and, if applicable, your Food Sales
27
00
Tax refund amount from line E; then subtract amount on line 26) . . . . . . . . . . . . . . . . .
0
Balance
00
28
28. Underpayment (If line 19 is greater than line 27, enter the difference here) . . . . . . . . . . . . . .
Due
00
29
29. Interest (See instructions). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
00
30
30. Penalty (See instructions). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
00
31. Estimated Tax Penalty
Mark box if engaged in commercial farming or fishing in 2012.
31
32. AMOUNT YOU OWE (Add lines 28 thru 31 and any entries on lines 35 thru 39)
00
32
0
Overpayment
00
33
33. Overpayment (If line 19 is less than line 27, enter the difference here) . . . . . . . . . . . . . . . . .
00
34
34. CREDIT FORWARD (Enter amount you wish to be applied to your 2013 estimated tax) . . . .
00
35
You may donate
35. CHICKADEE CHECKOFF (Kansas Nongame Wildlife Improvement Program) . . . . . . . . . . .
to any of the
00
36
36. SENIOR CITIZENS MEALS ON WHEELS CONTRIBUTION PROGRAM. . . . . . . . . . . . . . . .
programs on lines
35 through 39.
00
37
37. BREAST CANCER RESEARCH FUND . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . .
The amount you
enter will reduce
00
38
38. MILITARY EMERGENCY RELIEF FUND . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
your refund or
increase the
00
39
39. KANSAS HOMETOWN HEROES FUND. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
amount you owe.
00
40
40. REFUND (Subtract lines 34 through 39 from line 33). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
0
Signature(s)
I authorize the Director of Taxation or the Director's designee to discuss my return and enclosures with my preparer.
I declare under the penalties of perjury that to the best of my knowledge this is a true, correct, and complete return.
Signature of taxpayer
Date
Signature of preparer other than taxpayer
Phone number of preparer
Tax preparer's EIN or SSN:
Signature of spouse if Married Filing Joint
ENCLOSE any necessary documents with this form. DO NOT STAPLE.
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