Form K-40 Individual Income Tax and/or Food Sales Tax Refund

(Complete Sch S Part B) (Even if only one had income) (Mark ONE) (Mark ONE) (Rev 7/12) KANSAS INDIVIDUAL INCOME TAX 10 Nonresident tax (Multiply line 8 by line 9) 10 00 11 Kansas tax on lump sum distributions (Residents only see instructions) 11 00 114212 114512 12 TOTAL INCOME TAX (Residents: add lines 8 & 11; Nonresidents: enter amount from line 10) 12 00 14 00 15 Other credits (Enclose all appropriate credit schedules) 15 00 16 Total tax credits (Add lines 13 14 and 15) 16 00 17 Income tax balance after credits (Subtract line 16 from line 12; cannot be less than zero) 17 00 19 Total Tax Balance (Add lines 17 and 18) 19 00 21 00 22 00 23 Earned income credit (Seeinstructions) 23 00 25 00 28 26 00 00 00 29 00 30 Penalty (See instructions) 30 00 31 Estimated Tax Penalty Mark box if engaged in commercial farming or fishing in 2012 31 00 32 AMOUNT YOU OWE (Add lines 28 thru 31 and any entries on lines 35 thru 39) 32 00 34 00 35 00 36 00 37 00 38 00 39 00 40 00 6 Total deductions (Add lines 4 and 5) 6 00 7 Taxable income (Subtract line 6 from line 3; if less than zero enter 0) 7 00 A Had a dependent child who lived with you all year and was under the age of 18 all of 2012? YES Adjustment by the IRS Amended affects Kansas only Amended Federal tax return Amended If this is an AMENDED 2012 Kansas return mark one of the following boxes: and Dependents Balance Due If this is an AMENDED return complete lines 25 and 26 28 Underpayment (If line19is greater than line 27 enter the difference here) 29 Interest (See instructions) Tax refund amount from line E; then subtract amount on line 26) 27 24 Refundable portion of tax credits (Enclose all appropriate credit schedules) 25 Payments remitted with original return 26 Overpayment from original return (This figure is a subtraction; see instructions) 27 Total refundable credits (Add lines 20 through 25 and if applicable your Food Sales 24 00 C Were you (or spouse) totally and permanently disabled or blind all of 2012 regardless of age? YES NO City Town or Post Office State Zip Code County Abbreviation Credits 13 Credit for taxes paid to other states (See instructions Enclose return(s) from other states ) 14 Credit for child & dependent care expenses (See instructions) 13 00 D If you answered YES to A B or C complete the worksheet on page 11 and enter the Daytimetelephone Deductions 4 Standard deduction OR itemized deductions (See instructions) 5 Exemption allowance ($2 250 x number of exemptions claimed) 4 00 DO NOT STAPLE and/or FOOD SALES TAX REFUND E If amount on line D is less than $36 701 see instructions in the tax booklet to figure your refund Enter the amount here This is your FOOD SALES TAX REFUND ENCLOSE any necessary documents with this form DO NOT STAPLE ENTER AMOUNTS IN WHOLE DOLLARS ONLY Enter the first four letters of your last name Use ALL CAPITAL letters Enter the first four letters of your spouse'slast name Use ALL CAPITAL letters Enter the number of exemptions you claimed on your 2012 federal return If no federal return is required enter totalexemptions for you your spouse (if applicable) and each person you claim as a dependent Exemptions Filing Status Food Sales If you were a Kansas resident for all 2012 complete this section to determine if you qualify for a Food Sales Tax refund Head of household (Do not 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 If filing status above is Head of household add one exemption If taxpayer (or spouse if filing joint) died during this tax year mark an "X" in this box number If you are filing for a Food Sales Tax refund only you do not need to complete lines 1 through 40 Just SIGN this return on the back and mail it to the address shown below Refunds are not issued for unsigned returns If your name or address has changed since last year mark an "X" in this box In the following spaces provide the requested information for all persons you claimed as dependents Do NOT include you or your spouse If additional space is needed enclose a separate schedule Income Shade the box for negative amounts Example: 1 Federal adjusted gross income (as reported on your federal income tax return) 2 Modifications (From Schedule S line A21 Enclose Schedule S ) 3 Kansas adjusted gross income (Line 2 added to or subtracted from line 1) 1 K 40 2012 Mail to: Kansas Income Tax Kansas Dept of Revenue915 SW Harrison St Topeka KS 66699 1000 Mailing Address (Number and Street including Rural Route) School District No mark if filing a joint return) Married filing joint Married filing separate Name (please print) Date of Birth (mm/dd/yy) Relationship SSN (Social Security Number) NO box Nonresident Part year resident from / / to / / Qualification Mark ONE B Were you (or spouse) 55 years of age or older during 2012 (born prior to January 1 1958)? YES QUALIFYING INCOME from line 14 If line 14 is zero you must enter "0" here If line 14 is a negative amount shade the box Example: Residency Resident Return Signature of spouse if Married Filing Joint Signature of taxpayer Date Signature of preparer other than taxpayer Phone number of preparer Tax preparer's EIN or SSN: Signature(s) Single Spouse's First Name Initial Last Name Spouse's SocialSecurity number Status Tax { Tax Computation 8 Tax (From Tax Tables or Tax Computation Schedules) 9 Nonresident percentage (from Schedule S line B23; or if 100% enter 100 0000) 8 00 Total Kansas exemptions Use Tax 18 Use tax due (See instructions) 18 00 Withholdingand Payments 20 Kansas income tax withheld from W 2 1099 or K 19 (Enclose K 19; see instructions) 21 Estimated tax paid 22 Amount paid with Kansas extension 20 00 You may donate to any of the programs on lines 35 through 39 The amount you enter will reduce your refund or increase the amount you owe Overpayment 33 Overpayment (If line 19 is less than line 27 enter the difference here) 34 CREDIT FORWARD (Enter amount you wish to be applied to your 2013 estimated tax) 35 CHICKADEE CHECKOFF (Kansas Nongame Wildlife Improvement Program) 36 SENIOR CITIZENS MEALS ON WHEELS CONTRIBUTION PROGRAM 37 BREAST CANCER RESEARCH FUND 38 MILITARY EMERGENCY RELIEF FUND 39 KANSAS HOMETOWN HEROES FUND 40 REFUND (Subtract lines 34 through 39 from line 33) 33 00 Your First Name Initial Last Name Your Social Security number