Fillable Form K-40pt - Kansas Property Tax Relief Claim

135415

Providing this information should speed the processing of your claim. Income reported here should not be included on line 10 of this form.

13. Enter in the spaces provided the annual amount of all other income not included as household income on line 10:

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

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

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

( f ) SSI, Social Security, Veterans or Railroad

(e) Personal and Student Loans ...... $

Disability (enclose documentation) ........... $

Amount $

(g) Other (See instructions)

Source

___________________________________________________

14. List the names of ALL persons who resided in your household at any time during 2015. Specify the number of months they lived you and report

their portion of income that is included in total household income on line 10 of this form.

Number of

Their portion of income that is

months resided

included on line 10

Social Security Number

Name

in household

FORM K-40PT LINE-BY-LINE INSTRUCTIONS

If you filed a Form K-40H for 2015, you cannot claim this refund.

If you do not have your statement of Social Security benefits, use the

method given for line 6 of Form K-40H to compute your total received in

NAME AND ADDRESS

2015. Instructions are on page 4.

Use the instructions for Form K-40H on page 4 to complete the personal

Lines 7 through 9: Use the instructions for lines 7 through 9 of Form

information at the top of Form K-40PT.

K-40H on page 5 to complete these lines on Form K-40PT.

QUALIFICATIONS

Line 10: Add lines 4 through 9 and enter the result. If line 10 is more than

Lines 1 through 3: You must have been 65 years of age or older (born

$19,100, you do not qualify for a refund.

before January 1, 1950), a resident of Kansas all of 2015 and a home

REFUND

owner during 2015. If you meet these qualifications, enter your date of

Line 11: Enter the total 2015 general property tax you paid as shown on

birth on line 3.

your real estate tax statement. Enter only timely paid tax amounts. For a

list of items that you cannot include see the instructions for line 12 of Form

HOUSEHOLD INCOME

K-40H on page 5.

Enter on lines 4 through 10 the annual income amounts received by you

If you are filing on behalf of a claimant who died during 2015, the property

and your spouse during 2015. Enter on line 9 the income of ALL other persons

tax must be prorated based on the date of death. To determine the property

who lived with you at any time during 2015.

tax amount to enter here, follow the instructions for deceased claimants on

Lines 4 and 5: Use the instructions for lines 4 and 5 of Form K-40H that

page 6.

begin on page 4 to complete lines 4 and 5 of Form K-40PT.

Line 12: Multiply the amount on line 11 by 75 percent (.75). This is the

Line 6: Enter the total Social Security and Supplemental Security Income

amount of your property tax refund.

(SSI) benefits received by you and your spouse. Include amounts deducted

for Medicare, any Social Security death benefits, and any SSI payments not

EXCLUDED INCOME

shown on the annual benefit statement. Do not include Social Security

Line 13: To speed the processing of your refund, list in items (a) through

or SSI “disability” payments. (Note: Social Security disability or SSI

(g) all other income that you did not include on line 10. For more information

payments become regular Social Security payments when a recipient

on what to include here, see Excluded Income on page 5.

reaches age 65. These Social Security disability payments, that were once

Line 14: List all persons who resided in your household at any time during

Social Security disability or SSI payments, are NOT included in household

2015. Complete all requested information for each person. If more space is

income.) Enter the annual amount of any Social Security disability benefits

needed, enclose a separate sheet.

and Social Security payments of a person who has reached age 65 who

SIGNATURE

had previously been receiving Social Security disability payments, in the

You, as the claimant, MUST sign the claim. See the instructions for

Excluded Income section on the back of Form K-40PT and enclose a benefit

Signature on page 6.

statement or award letter with your claim.

MAIL TO: Homestead Claim, Kansas Department of Revenue, 915 SW Harrison Street, Topeka KS 66612-1588

Form K-40pt - Kansas Property Tax Relief Claim - 2015 Page 2

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