Kansas Individual Income Tax Form

The following individual income tax form has to be completed and submitted by anybody living in the State of Kansas.

Kansas Individual Income Tax.pdf A Kansas resident for income tax purposes is anyone who lives in Kansas, regardless of where they are employed. An individual who is away from Kansas for a period of tDownload

Extracted Text for Proper Search

________________________________________ ________________ 
________________________________________ 
________________ 
________________________________________  ________________ 
________________________________________  ________________ 
________________________________________  ________________ 
________________________________________  ________________ 
________________________________________  ________________ 	
114512	K-40	 	2012 	
(Rev. 7/12)	 	KANSAS INDIVIDUAL  INCOME TAX 	
DO NOT  STAPLE	 	and/or  FOOD SALES  TAX REFUND 	
Your  First Name  Initial Last Name 
Spouse's  First Name  Initial Last Name 
Mailing  Address  (Number  and Street,  including  Rural Route)  School District  No. 
City,  Town,  or Post  Office 
State Zip 
Code  County Abbreviation 	
Enter the first  four  letters  of your  last name.
Use  ALL  CAPITAL  letters. 
Your  Social 
Security  number 
Enter the first  four  letters  of your  spouse's
last  name.  Use ALL  CAPITAL  letters. 
Spouse's  Social
Security  number 	
If your  name  or address  has changed  since last year,  mark an "X"  in this  box 	Daytime
telephone	
If taxpayer  (or spouse  if filing  joint)  died during  this tax year,  mark an "X"  in this  box 	number 	
Amended	 	If this  is an  AMENDED  2012 Kansas  return mark one of the  following  boxes: 	Return 	Amended  affects Kansas  only 	Amended  Federal tax return 	Adjustment  by the  IRS 
(Mark  ONE) 	
Filing Status 	Head  of household  (Do not
Married  filing joint
Single 	Married  filing separate 	mark  if filing  a joint  return) 
(Mark  ONE)  (Even if only  one had income) 	
Residency	Part-year  resident from ___ / ___  / ___  to ___  / ___  / ___ 	Nonresident 	Status 	Resident 	(Complete  Sch. S, Part  B) 
(Complete  Sch. S, Part  B) 
(Mark  ONE) 	
Exemptions	Enter the number  of exemptions  you claimed  on your  2012  federal  return.  If no  federal  return is required,  enter total
exemptions  for you,  your  spouse  (if applicable),  and each  person  you claim  as a dependent. 	
and 
Dependents 	
If filing  status  above  is Head  of household , add  one exemption. 
Total  Kansas  exemptions. 	
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. 	
Name (please  print)  Date of Birth  (mm/dd/yy)  Relationship  SSN (Social  Security  Number) 	
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. 	
Tax	 	
{	
NO	Qualification	 	Mark 
ONE 	B. 	Were  you (or spouse)  55 years  of age  or older  during  2012 (born  prior to January  1, 1958)?  . . .  . . 	YES  NO 	box 	
00 
00 	
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. 	
Mail to: Kansas  Income Tax, Kansas  Dept. of Revenue
915  SW Harrison  St., Topeka,  KS 66699-1000

114212 	
ENTER AMOUNTS  IN WHOLE  DOLLARS  ONLY 	
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 	00 	
2 	00 	
3 	00 
Deductions 	
4.  Standard  deduction  OR itemized  deductions  (See instructions).  . . .  . .  . . .  . .  . . .  . .  . . .  . .  . . . 
5.  Exemption  allowance  ($2,250 x number  of exemptions  claimed) . . . .  . .  . . .  . .  . . .  . .  . . .  . .  . 	4 	00 	
5 	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 
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 	
9 	. 	
10.  Nonresident  tax (Multiply  line 8 by  line  9) . . .  . . .  . .  . . .  . .  . . .  . .  . .  . . .  . .  . . .  . .  . . .  . .  . . .  . . 	10 	00 	
11.  Kansas  tax on lump  sum distributions  (Residents only - see  instructions).  . . .  . .  . . .  . .  . . .  . . 	11 	00 	
12.  TOTAL  INCOME  TAX (Residents:  add lines  8 &  11;  Nonresidents:  enter amount  from line 10) 	12 	00 
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 	
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 
Use  Tax 	
18.  Use  tax due  (See  instructions)  . ...  .. ...  .. ...  .. ...  .. ...  .. ...  .. ...  .. ...  .. ...  .. .. 	18 	00 	
19.  Total  Tax Balance  (Add lines 17 and  18)..  ... .. ...  .. ...  .. ...  .. ...  .. ...  .. ...  .. ...  . 	19 	00 
Withholding
and 
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 	
21 	00 	
22 	00 	
23.  Earned  income  credit (Seeinstructions).  . ...  .. ...  .. ...  .. .. ...  .. ...  .. ...  .. ...  .. .. 	23 	00 
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 	
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 	
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 	
34 	00 	
35 	00 	
36 	00 	
37 	00 	
38 	00 	
39 	00 	
40 	00 
Signature(s) 	
ENCLOSE  any necessary  documents  with this form.  DO NOT  STAPLE.