Form K-40pt - Kansas Property Tax Relief Claim

K-40PT

2015

KANSAS PROPERTY TAX RELIEF CLAIM

135315

(Rev. 7/15)

for Low Income Seniors

DO NOT STAPLE

FILE THIS CLAIM AFTER DECEMBER 31, 2015, BUT NO LATER THAN APRIL 15, 2016

Claimant’s

First four letters of

Social Security

claimant’s last name.

Telephone

Use ALL CAPITAL letters.

Number

Your First Name

Initial

Last Name

Mark this box if claimant is

deceased (See instructions) ...........

Date of Death ________________

Mailing Address (Number and Street, including Rural Route)

IMPORTANT: Mark this box if

name or address has changed .......

City, Town, or Post Office

State

Zip Code

County Abbreviation

Mark this box if this is an

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

To qualify for this property tax refund you must meet the household income

NOTE: If you filed a Form K-40H for

limitation and you must have been:

2015, you DO NOT qualify for this

property tax refund.

1. A resident of Kansas during the entire year of 2015;

2. A home owner during 2015; and,

MONTH

DAY

YEAR

3. Age 65 or over for the entire year. Enter your date of birth (must be prior to 1950) ...........................

ENTER THE TOTAL RECEIVED IN 2015 FOR EACH TYPE OF INCOME. See instructions.

4. 2015 Wages OR Kansas Adjusted Gross Income $ ________________ plus Federal Earned Income Credit

$ ________________ . Enter the 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. Total Social Security and SSI benefits, including Medicare deductions, received in 2015 (do not include disability

payments from Social Security or SSI). ....................................................................................................................

7. Railroad Retirement benefits and all other pensions, annuities, and veterans benefits (do not include disability

payments from Veterans and Railroad Retirement) ..............................................................................................

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 2015 .........................

10. TOTAL HOUSEHOLD INCOME (Add lines 4 through 9. If line 10 is more than $19,100, you do not qualify for a refund) ........

11. General property taxes paid timely in 2015, excluding specials. (Tax on property valued at more than $350,000 does

not qualify. See instructions on the back of this form.) .........................................................................................................

12. PROPERTY TAX REFUND. Multiply the amount on line 11 by 75% (.75). This is the amount of your refund .........................

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 2015 property tax.

Mark this box if you wish to participate in the Refund Advancement Program (see instructions) .....................................

I authorize the Director of Taxation or the Director’s designee to discuss my K-40PT and enclosures with my preparer.

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

Preparer’s phone number

IMPORTANT: Please allow 20 to 24 weeks to process your refund.

COMPLETE THE BACK OF THIS FORM