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NONRESIDENT MILITARY – KANSAS INCOME TAX
On December 19, 2003, President Bush signed into law the “Servicemembers Civil Relief Act”, (H.B. 100;
Public Law 108-189). Among other provisions, the new law prohibits states from utilizing a nonresident
servicemember’s military compensation to determine the rate of tax to be applied to that state’s source
income:

        A tax jurisdiction may not use the military compensation of a nonresident
        servicemember to increase the tax liability imposed on other income earned by
        the nonresident servicemember or spouse subject to tax by the jurisdiction. PL
        108-189, Section 511(d).

        *The term “servicemember” means a member of the uniformed services, as that term is
        defined in section 101(a)(5) of title 10 United States Code.

This law is effective for Tax Year 2003 and all tax years thereafter.

For Kansas Income Tax purposes, a nonresident military service member’s compensation for military
service, as defined above, will be a subtraction modification on the Kansas Income Tax Return. The
nonresident military service member’s compensation for military service will be subtracted out of Federal
Adjusted Income on Schedule S, line A11.

Nonresident military service members will continue to complete Part B of Schedule S, to determine the
Nonresident Allocation Percentage, Line 9 of the K-40.

EXAMPLE:
Fred and Janice Wilson are a married couple. Fred is an active duty servicemember in the USAF,
stationed at McConnell AFB in Wichita, Kansas since July 2003. They are residents of the State of Texas.
Janice is a social worker employed by the State of Kansas. They have one dependent. Income is as
follows:

Fred:                                             Both:
W-2, Box 1 – USAF Wages - $45,000                 2004 Interest from a Kansas Bank - $100
W-2, Box 17 - KS Tax Withheld - $0                1099-G, State of Kansas (Income Tax refund) - $80
                                                  1099, Kansas Unemployment Compensation - $620
Janice:
W-2, Box 1 – Wages - $15,000
W-2, Box 14 – KPERS Contributions - $500
W-2, Box 17 – Kansas Tax Withheld - $300



            A completed K-40 and Schedule S follow on next page
K-40                                                                                                                                                                              114504
                                                                          KANSAS INDIVIDUAL INCOME TAX
 (Rev. 8/04)

                                                                                   and/or FOOD SALES TAX REFUND
DO NOT STAPLE
                      Your First Name                                Initial Last Name
                                                                                                                                          Enter the first four letters of your last name.
                                                                                                                                                                                            WILS
                         FRED                                        M           WILSON                                                   Use ALL CAPITAL letters.




                                                                                                                                                                       --
                      Spouse's First Name                            Initial   Last Name
                                                                                                                                          Your Social
                                                                                                                                                                400256789
                         JANICE                                      M           WILSON                                                   Security number
                      Mailing Address (Number and Street, including Rural Route)                                   School District No.
                                                                                                                                          Enter the first four letters of your spouse's
                                                                                                                                                                                            WILS
                         1410 MARKET                                                                                   260                last name. Use ALL CAPITAL letters.




                                                                                                                                                                       --
                                                                                                Zip Code          County Abbreviation
                     City, Town, or Post Office                                      State
                                                                                                                                          Spouse's Social
                         DERBY                                                        KS 67037                          SG                                      500002000
                                                                                                                                          Security number




                                                                                                                                                                       --
                                                                                                                                          Daytime
                                                                                             If taxpayer (or spouse if filing
                                If your name or address has
Filing Information




                                                                                                                                                         3167882222
                                                                                                                                          telephone
                                                                                             joint) died during this tax year,
                                changed since last year, mark
                                                                                                                                          number
                                                                                             mark an quot;Xquot; in this box
                                an quot;Xquot; in this box



                                                                                                                   Reason for amending your 2004 original Kansas return:
                          Mark this box if you are filing this as
                          an AMENDED 2004 Kansas return:                                                                    Amended affects                     Amended Federal                Adjustment by
                          NOTE: This form cannot be used for tax years prior to 2004.                                       Kansas only                         tax return                     the IRS



                        Filing Status (Mark ONE)                                      Residency Status (Mark ONE)                                           Exemptions
                                                                                                                                                            Number of exemptions claimed
                                                                                                                                                                                                           3
                              Single                                                          Resident
                                                                                                                                                            on your 2004 federal return . . . . . . .
                              Married filing joint
                         x                                                               x    Nonresident or Part-year resident
                              (Even if only one had income)                                                                                                  If filing status is head of
                                                                                              from ___/___/___ to ___/___/___                                household, add one exemption . . . . . . .
                               Married filing separate
                                                                                              (Complete Schedule S, Part B)
                                                                                                                                                                                                           3
                               Head of household                                                                                                            Total Kansas exemptions . . . . . . .



                                                                                                                                            -
                                                        If amount is negative, shade the minus (-) in box.                   Example:

                                                                                                                                                        -                ,        6 0 , 8 0 0 .00
Income




                      1. Federal adjusted gross income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

                                                                                                                                                        -                ,        4 4 , 5 8 0 .00
                      2. Modifications to Federal adjusted gross income (From Schedule S, Part A, line A15). .

                                                                                                                                                                         ,        1 6 , 2 2 0 .00
                                                                                                                                                        -
                      3. Kansas adjusted gross income (Line 2 added to or subtracted from line 1; see
                         instructions, page 14) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .



                                                                                                                                                                         ,          6, 0                0 .00
                                                                                                                                                                                                  0
                      4. Standard deduction OR itemized deductions (See instructions, page 15). . . . . . . . . . . . . . . . . . . .
Deductions




                                                                                                                                                                                    6, 7                0 .00
                                                                                                                                                                                                  5
                      5. Exemption allowance ($2,250 x number of exemptions claimed) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

                                                                                                                                                                         ,        1 2, 7                0 .00
                                                                                                                                                                                                  5
                      6. Total deductions (Add lines 4 and 5). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

                                                                                                                                                                         ,          3, 4                0 .00
                                                                                                                                                                                                  7
                      7. Taxable income (Subtract line 6 from line 3. If less than zero, enter 0.) . . . . . . . . . . . . . . . . .




                                                                                                                                                                         ,                  ,1    2 2.00
                      8. Tax (From Tax Tables or Tax Computation Schedules beginning on page 25) . . . . . . . . . . . . . . .
Tax Computation




                                                                                                                                                                                              1   00%
                      9. Nonresident allocation percentage (From Schedule S, Part B, line B23) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

                                                                                                                                                                         ,                  ,1    2 2.00
                     10. Nonresident tax (Multiply line 8 by line 9) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

                                                                                                                                                                         ,                  ,       0.00
                     11. Kansas tax on lump sum distributions (Residents only - see instructions, page 16). . . . . . . . . . . .

                                                                                                                                                                         ,                  ,1    2 2.00
                     12. TOTAL INCOME TAX (Residents: add lines 8  11; Nonresidents: enter amount from line 10). . .




                                                  PLEASE COMPLETE REVERSE SIDE
114204
                                                                                            122.00
TAX: Enter the income tax amount from line 12 ___________________



                                                                                                                                                                                              ,               .00
                           13. Credit for taxes paid to other states (See instructions, page 16) . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

                                                                                                                                                                                              ,               .00
                           14. Credit for child  dependent care expenses (See instructions, page 17). . . . . . . . . . . . . . . . . . . . . . .
Credits




                                                                                                                                                                                              ,               .00
                           15. Other credits (Enclose all appropriate credit schedules) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

                                                                                                                                                                                              ,               .00
                           16. Total tax credits (Add lines 13, 14 and 15) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

                                                                                                                                                                                ,             ,1            2 .00
                                                                                                                                                                                                     2
                           17. Income tax balance after credits (Subtract line 16 from line 12; cannot be less than zero) . . . . .



                                                                                                                                                                                                              .00
  Use Tax




                           18. Use tax due (See instructions on page 18). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

                                                                                                                                                                                ,             ,1            2.00
                                                                                                                                                                                                     2
                           19. Total Tax Balance (Add lines 17 and 18). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .



                                                                                                                                                                                ,             ,3            0 .00
                                                                                                                                                                                                     0
                           20. Kansas income tax withheld from W-2, 1099, or K-19 (Enclose K-19; see instructions) . . . . . . .

                                                                                                                                                                                ,             ,               .00
                           21. Estimated tax paid. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Withholding and Payments




                                                                                                                                                                                ,             ,               .00
                           22. Amount paid with Kansas extension . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

                                                                                                                                                                                                              .00
                           23. Earned income credit (See instructions, page 18). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

                                                                                                                                                                                              ,               .00
                           24. Refundable portion of tax credits (Enclose all appropriate credit schedules) . . . . . . . . . . . . . . . . . . . .

                                                                                                                                                                                                              .00
                           25. FOOD SALES TAX REFUND (You must meet the qualifications listed on page 14) . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
                           For an ORIGINAL return, skip to line 28. For an AMENDED return, complete lines 26 and/or 27 before continuing to line 28.

                                                                                                                                                                               ,              ,               .00
                           26. Payments remitted with original return . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

                                                                                                                                                                             -                ,               .00
                           27. Overpayment from original return (This figure is a subtraction; see instructions, page 18). . . . . .

                                                                                                                                                                               ,              ,3            0 .00
                                                                                                                                                                                                     0
                           28. Total refundable credits (Add lines 20 through 26 and subtract line 27) . . . . . . . . . . . . . . . . . . .


                                                                                                                                                                               ,              ,               .00
                           29. UNDERPAYMENT (If line 19 is greater than line 28) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

                                                                                                                                                                                              ,
Balance Due




                                                                                                                                                                                                              .00
                           30. Interest (See instructions, page 18) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

                                                                                                                                                                                              ,               .00
                           31. Penalty (See instructions, page 18) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

                                                                                                                                                                                              ,               .00
                                                                                                                          Check here if you were engaged in
                           32. Estimated Tax Penalty (See instructions, page 18) . . . .                                  commercial farming or fishing in 2004.


                                                                                                                                                                                ,             ,               .00
                           33. AMOUNT YOU OWE (Add lines 29 through 32. Include amounts from lines 36 and 37 if
                               applicable.) See payment options on page 19 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


                                                                                                                                                                                ,             ,1            8 .00
                                                                                                                                                                                                     7
                           34. OVERPAYMENT (If line 19 is less than line 28). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

                                                                                                                                                                                ,             ,               .00
                           35. CREDIT FORWARD (Enter the amount of line 34 you wish to be applied to your 2005 estimated tax) . . .
Overpayment




                                 If you wish to donate to either the Chickadee Checkoff or the Senior Citizens Meals on Wheels Program, enter the amount
                                 of your donation on the appropriate line. This donation will reduce your refund or increase the amount you owe.

                                                                                                                                                                                ,             ,               .00
                           36. CHICKADEE CHECKOFF (Kansas Nongame Wildlife Improvement Program). . . . . . . . . . . . . .

                                                                                                                                                                                ,             ,               .00
                           37. SENIOR CITIZENS MEALS ON WHEELS CONTRIBUTION PROGRAM . . . . . . . . . . . . . . . . . .

                                                                                                                                                                                ,             ,1            8 .00
                                                                                                                                                                                                     7
                           38. REFUND (Subtract lines 35, 36 and 37 from line 34) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


                                  I authorize the Director of Taxation or the Director's designee to discuss my return and enclosures with my preparer.
 Signatures




                           I declare under the penalties of perjury that to the best of my knowledge and belief this is a true, correct, and complete return.
                              )UHG :LOVRQ                                                                        
                                                                                                                     Date
                                                         Signature of taxpayer                                                                Signature of preparer other than taxpayer       Phone number of preparer
                              -DQLFH :LOVRQ                                                                                         Tax preparer's EIN (Employer
                                                                                                                                    Identification Number) OR
                           If joint return, BOTH taxpayer and spouse must sign even if only one had income                          SSN (Social Security Number)


                                              ENCLOSE any necessary documents                                                                 KANSAS INCOME TAX
                                                                                                                             MAIL TO:
                                                                                                                                              KANSAS DEPARTMENT OF REVENUE
                                              with this form. DO NOT STAPLE.                                                                  915 SW HARRISON ST
                                                                                                                                              TOPEKA, KS 66699-1000
SCHEDULE S                                                                  2004 KANSAS                                                                 114304
                                                           SUPPLEMENTAL SCHEDULE
(Rev. 8/04)




                                                                                                                  Enter the first four letters of your last name.
                                                                                                                                                                       WILS
 Your First Name                                   Initial Last Name                                              Use ALL CAPITAL letters.




                                                                                                                                                      --
              FRED                                  M         WILSON                                              Your Social
                                                                                                                                        400256789
                                                                                                                  Security number

                                                                                                                  Enter the first four letters of your spouse's last
                                                                                                                                                                       WILS
 Spouse's First Name                               Initial Last Name                                              name. Use ALL CAPITAL letters.



                                                                                                                                                      --
              JANICE                                M         WILSON                                              Spouse's Social
                                                                                                                                        500002000
                                                                                                                  Security number




 PART A - MODIFICATIONS TO FEDERAL ADJUSTED GROSS INCOME (See instructions, page 22)

ADDITIONS TO FEDERAL ADJUSTED GROSS INCOME:


                                                                                                                                                  ,                    ,         .00
  A1. State and municipal bond interest not specifically exempt from Kansas Income Tax
      (Reduced by related expenses). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

                                                                                                                                                  ,                    ,5       0.00
                                                                                                                                                                            0
  A2. Contributions to all Kansas public employee's retirement systems (See instructions) . . . . . . . . . . .

                                                                                                                                                  ,                    ,         .00
  A3. Federal net operating loss carry forward . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

                                                                                                                                                  ,                    ,         .00
  A4. Contributions to a Regional Foundation (See instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

                                                                                                                                                  ,                    ,         .00
  A5. Other additions to federal adjusted gross income (See instructions and enclose list) . . . . . . . . . .

                                                                                                                                                  ,                    ,5       0.00
                                                                                                                                                                            0
  A6. Total additions to federal adjusted gross income (Add lines A1 through A5) . . . . . . . . . . . . . . . . .




SUBTRACTIONS FROM FEDERAL ADJUSTED GROSS INCOME:

                                                                                                                                                  ,                  ,           .00
  A7. Interest on U.S. Government obligations (Reduced by related expenses) . . . . . . . . . . . . . . . . . . . .

                                                                                                                                                  ,                  ,          0.00
                                                                                                                                                                            8
  A8. State income tax refund (If included on line 1 of Form K-40 or the Telefile worksheet) . . . . . . . . . .

                                                                                                                                                  ,                  ,           .00
  A9. Kansas net operating loss carry forward. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
                                                                                                                                                  ,                  ,           .00
A10. Retirement benefits specifically exempt from Kansas Income Tax. . . . . . . . . . . . . . . . . . . . . . . . . .

                                                                                                                                                  ,                 5, 0        0.00
                                                                                                                                                           4                0
A11. Military Compensation of a Nonresident Servicemember (Nonresidents only; see instructions) . . .

                                                                                                                                                  ,                  ,           .00
A12. Learning Quest Education Savings Program contributions (See instructions) . . . . . . . . . . . . . . . . .

                                                                                                                                                  ,                  ,           .00
A13. Other subtractions from federal adjusted gross income (See instructions and enclose list) . . . . . .

                                                                                                                                                  ,                 5, 0        0.00
                                                                                                                                                           4                8
A14. Total subtractions from federal adjusted gross income (Add lines A7 through A13) . . . . . . . . . . . .



NET MODIFICATIONS:

                                                                                 -
If amount is negative, shade the minus (-) in box. Example:


                                                                                                                                 -                ,        4 4, 5 8 0.00
A15. Net modifications to federal adjusted gross income (Subtract line A14 from line A6).
     Enter on line 2, Form K-40. If negative, shade minus (-) in box. . . . . . . . . . . . . . . . . . . .
114404

PART B - NONRESIDENT ALLOCATION (See instructions, page 24)

                                                                                  -
If amount is negative, shade the minus (-) in box. Example:


INCOME:
                                                                                 Total From Federal Return:                      Amount From Kansas Sources:

                                                                                                                                      ,       1 5 , 0 0 0.00
                                                                                                   60,000
 B1. Wages, salaries, tips, etc. . . . . . . . . . . . . . . . . . . . .

                                                                                                                                      ,              ,                 .00
                                                                                                      100
 B2. Interest and dividend income. . . . . . . . . . . . . . . . . .

                                                                                                                                      ,              ,                0.00
                                                                                                       80                                                       8
 B3. Refunds of state and local income taxes. . . . . . . . .

                                                                                                                                      ,              ,                 .00
 B4. Alimony received . . . . . . . . . . . . . . . . . . . . . . . . . . .

                                                                                                                          -           ,              ,                 .00
 B5. Business income or loss . . . . . . . . . . . . . . . . . . . . .

                                                                                                                          -           ,              ,                 .00
 B6. Farm income or loss. . . . . . . . . . . . . . . . . . . . . . . . .

                                                                                                                          -           ,              ,                 .00
 B7. Capital gain or loss. . . . . . . . . . . . . . . . . . . . . . . . . .

                                                                                                                          -           ,              ,                 .00
 B8. Other gains or losses. . . . . . . . . . . . . . . . . . . . . . . .

                                                                                                                                      ,              ,                 .00
 B9. Pensions, IRA distributions, and annuities. . . . . . . .

                                                                                                                          -           ,              ,                 .00
B10. Rental real estate, royalties, partnerships,
     S corporations, estates, trusts, etc. . . . . . . . . . . . . .

                                                                                                                                      ,              ,6               0.00
                                                                                                                                                                2
                                                                                                          620
B11. Unemployment compensation, taxable Social
     Security benefits, and other income. . . . . . . . . . . . .
                                                                                                                          -           ,             5, 7              0.00
                                                                                                                                              1                 0
B12. Total income from Kansas sources (Add lines B1 through B11). . . . . . . . . . . . . . . . . . . . .




ADJUSTMENTS AND MODIFICATIONS TO KANSAS SOURCE INCOME:

                                                                                 Total From Federal Return:                      Amount From Kansas Sources:

                                                                                                                                      ,              ,                 .00
B13. IRA Retirement Deductions . . . . . . . . . . . . . . . . . . .

                                                                                                                                      ,              ,                 .00
B14. Penalty on early withdrawal of savings. . . . . . . . . . .
                                                                                                                                      ,              ,                 .00
B15. Alimony paid. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

                                                                                                                                      ,              ,                 .00
B16. Moving expenses . . . . . . . . . . . . . . . . . . . . . . . . . . .

                                                                                                                                      ,              ,                 .00
B17. Other federal adjustments. . . . . . . . . . . . . . . . . . . . .

                                                                                                                                      ,              ,                 .00
B18. Total federal adjustments to Kansas source income (Add lines B13 through B17). . . . . . .
                                                                                                                          -           ,             5,7               0.00
                                                                                                                                              1                   0
B19. Kansas source income after federal adjustments (Subtract line B18 from line B12). . . . . .
                                                                                                                          -           ,              ,4               0.00
                                                                                                                                                                  2
B20. Net modifications applicable to Kansas source income (See instructions) . . . . . . . . . . . . .

                                                                                                                                      ,             6,1               0.00
                                                                                                                                                              1   2
B21. Modified Kansas source income (Line B19 plus or minus line B20) . . . . . . . . . . . . . . . . . .
                                                                                                                          -           ,             6,2               0.00
                                                                                                                                                              1   2
B22. Kansas adjusted gross income (From line 3, Form K-40). . . . . . . . . . . . . . . . . . . . . . . . . .

                                                                                                                                                                100     %
B23. Nonresident allocation percentage (Divide line B21 by line B22 and round to nearest whole
     percent, enter on line 9, Form K-40) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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Nonres Military Notice ksrevenue.org

  • 1. NONRESIDENT MILITARY – KANSAS INCOME TAX On December 19, 2003, President Bush signed into law the “Servicemembers Civil Relief Act”, (H.B. 100; Public Law 108-189). Among other provisions, the new law prohibits states from utilizing a nonresident servicemember’s military compensation to determine the rate of tax to be applied to that state’s source income: A tax jurisdiction may not use the military compensation of a nonresident servicemember to increase the tax liability imposed on other income earned by the nonresident servicemember or spouse subject to tax by the jurisdiction. PL 108-189, Section 511(d). *The term “servicemember” means a member of the uniformed services, as that term is defined in section 101(a)(5) of title 10 United States Code. This law is effective for Tax Year 2003 and all tax years thereafter. For Kansas Income Tax purposes, a nonresident military service member’s compensation for military service, as defined above, will be a subtraction modification on the Kansas Income Tax Return. The nonresident military service member’s compensation for military service will be subtracted out of Federal Adjusted Income on Schedule S, line A11. Nonresident military service members will continue to complete Part B of Schedule S, to determine the Nonresident Allocation Percentage, Line 9 of the K-40. EXAMPLE: Fred and Janice Wilson are a married couple. Fred is an active duty servicemember in the USAF, stationed at McConnell AFB in Wichita, Kansas since July 2003. They are residents of the State of Texas. Janice is a social worker employed by the State of Kansas. They have one dependent. Income is as follows: Fred: Both: W-2, Box 1 – USAF Wages - $45,000 2004 Interest from a Kansas Bank - $100 W-2, Box 17 - KS Tax Withheld - $0 1099-G, State of Kansas (Income Tax refund) - $80 1099, Kansas Unemployment Compensation - $620 Janice: W-2, Box 1 – Wages - $15,000 W-2, Box 14 – KPERS Contributions - $500 W-2, Box 17 – Kansas Tax Withheld - $300 A completed K-40 and Schedule S follow on next page
  • 2. K-40 114504 KANSAS INDIVIDUAL INCOME TAX (Rev. 8/04) and/or FOOD SALES TAX REFUND DO NOT STAPLE Your First Name Initial Last Name Enter the first four letters of your last name. WILS FRED M WILSON Use ALL CAPITAL letters. -- Spouse's First Name Initial Last Name Your Social 400256789 JANICE M WILSON Security number Mailing Address (Number and Street, including Rural Route) School District No. Enter the first four letters of your spouse's WILS 1410 MARKET 260 last name. Use ALL CAPITAL letters. -- Zip Code County Abbreviation City, Town, or Post Office State Spouse's Social DERBY KS 67037 SG 500002000 Security number -- Daytime If taxpayer (or spouse if filing If your name or address has Filing Information 3167882222 telephone joint) died during this tax year, changed since last year, mark number mark an quot;Xquot; in this box an quot;Xquot; in this box Reason for amending your 2004 original Kansas return: Mark this box if you are filing this as an AMENDED 2004 Kansas return: Amended affects Amended Federal Adjustment by NOTE: This form cannot be used for tax years prior to 2004. Kansas only tax return the IRS Filing Status (Mark ONE) Residency Status (Mark ONE) Exemptions Number of exemptions claimed 3 Single Resident on your 2004 federal return . . . . . . . Married filing joint x x Nonresident or Part-year resident (Even if only one had income) If filing status is head of from ___/___/___ to ___/___/___ household, add one exemption . . . . . . . Married filing separate (Complete Schedule S, Part B) 3 Head of household Total Kansas exemptions . . . . . . . - If amount is negative, shade the minus (-) in box. Example: - , 6 0 , 8 0 0 .00 Income 1. Federal adjusted gross income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . - , 4 4 , 5 8 0 .00 2. Modifications to Federal adjusted gross income (From Schedule S, Part A, line A15). . , 1 6 , 2 2 0 .00 - 3. Kansas adjusted gross income (Line 2 added to or subtracted from line 1; see instructions, page 14) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , 6, 0 0 .00 0 4. Standard deduction OR itemized deductions (See instructions, page 15). . . . . . . . . . . . . . . . . . . . Deductions 6, 7 0 .00 5 5. Exemption allowance ($2,250 x number of exemptions claimed) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , 1 2, 7 0 .00 5 6. Total deductions (Add lines 4 and 5). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , 3, 4 0 .00 7 7. Taxable income (Subtract line 6 from line 3. If less than zero, enter 0.) . . . . . . . . . . . . . . . . . , ,1 2 2.00 8. Tax (From Tax Tables or Tax Computation Schedules beginning on page 25) . . . . . . . . . . . . . . . Tax Computation 1 00% 9. Nonresident allocation percentage (From Schedule S, Part B, line B23) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , ,1 2 2.00 10. Nonresident tax (Multiply line 8 by line 9) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , , 0.00 11. Kansas tax on lump sum distributions (Residents only - see instructions, page 16). . . . . . . . . . . . , ,1 2 2.00 12. TOTAL INCOME TAX (Residents: add lines 8 11; Nonresidents: enter amount from line 10). . . PLEASE COMPLETE REVERSE SIDE
  • 3. 114204 122.00 TAX: Enter the income tax amount from line 12 ___________________ , .00 13. Credit for taxes paid to other states (See instructions, page 16) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , .00 14. Credit for child dependent care expenses (See instructions, page 17). . . . . . . . . . . . . . . . . . . . . . . Credits , .00 15. Other credits (Enclose all appropriate credit schedules) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , .00 16. Total tax credits (Add lines 13, 14 and 15) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , ,1 2 .00 2 17. Income tax balance after credits (Subtract line 16 from line 12; cannot be less than zero) . . . . . .00 Use Tax 18. Use tax due (See instructions on page 18). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , ,1 2.00 2 19. Total Tax Balance (Add lines 17 and 18). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , ,3 0 .00 0 20. Kansas income tax withheld from W-2, 1099, or K-19 (Enclose K-19; see instructions) . . . . . . . , , .00 21. Estimated tax paid. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Withholding and Payments , , .00 22. Amount paid with Kansas extension . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .00 23. Earned income credit (See instructions, page 18). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , .00 24. Refundable portion of tax credits (Enclose all appropriate credit schedules) . . . . . . . . . . . . . . . . . . . . .00 25. FOOD SALES TAX REFUND (You must meet the qualifications listed on page 14) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . For an ORIGINAL return, skip to line 28. For an AMENDED return, complete lines 26 and/or 27 before continuing to line 28. , , .00 26. Payments remitted with original return . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . - , .00 27. Overpayment from original return (This figure is a subtraction; see instructions, page 18). . . . . . , ,3 0 .00 0 28. Total refundable credits (Add lines 20 through 26 and subtract line 27) . . . . . . . . . . . . . . . . . . . , , .00 29. UNDERPAYMENT (If line 19 is greater than line 28) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , Balance Due .00 30. Interest (See instructions, page 18) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , .00 31. Penalty (See instructions, page 18) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , .00 Check here if you were engaged in 32. Estimated Tax Penalty (See instructions, page 18) . . . . commercial farming or fishing in 2004. , , .00 33. AMOUNT YOU OWE (Add lines 29 through 32. Include amounts from lines 36 and 37 if applicable.) See payment options on page 19 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , ,1 8 .00 7 34. OVERPAYMENT (If line 19 is less than line 28). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , , .00 35. CREDIT FORWARD (Enter the amount of line 34 you wish to be applied to your 2005 estimated tax) . . . Overpayment If you wish to donate to either the Chickadee Checkoff or the Senior Citizens Meals on Wheels Program, enter the amount of your donation on the appropriate line. This donation will reduce your refund or increase the amount you owe. , , .00 36. CHICKADEE CHECKOFF (Kansas Nongame Wildlife Improvement Program). . . . . . . . . . . . . . , , .00 37. SENIOR CITIZENS MEALS ON WHEELS CONTRIBUTION PROGRAM . . . . . . . . . . . . . . . . . . , ,1 8 .00 7 38. REFUND (Subtract lines 35, 36 and 37 from line 34) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I authorize the Director of Taxation or the Director's designee to discuss my return and enclosures with my preparer. Signatures I declare under the penalties of perjury that to the best of my knowledge and belief this is a true, correct, and complete return. )UHG :LOVRQ Date Signature of taxpayer Signature of preparer other than taxpayer Phone number of preparer -DQLFH :LOVRQ Tax preparer's EIN (Employer Identification Number) OR If joint return, BOTH taxpayer and spouse must sign even if only one had income SSN (Social Security Number) ENCLOSE any necessary documents KANSAS INCOME TAX MAIL TO: KANSAS DEPARTMENT OF REVENUE with this form. DO NOT STAPLE. 915 SW HARRISON ST TOPEKA, KS 66699-1000
  • 4. SCHEDULE S 2004 KANSAS 114304 SUPPLEMENTAL SCHEDULE (Rev. 8/04) Enter the first four letters of your last name. WILS Your First Name Initial Last Name Use ALL CAPITAL letters. -- FRED M WILSON Your Social 400256789 Security number Enter the first four letters of your spouse's last WILS Spouse's First Name Initial Last Name name. Use ALL CAPITAL letters. -- JANICE M WILSON Spouse's Social 500002000 Security number PART A - MODIFICATIONS TO FEDERAL ADJUSTED GROSS INCOME (See instructions, page 22) ADDITIONS TO FEDERAL ADJUSTED GROSS INCOME: , , .00 A1. State and municipal bond interest not specifically exempt from Kansas Income Tax (Reduced by related expenses). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , ,5 0.00 0 A2. Contributions to all Kansas public employee's retirement systems (See instructions) . . . . . . . . . . . , , .00 A3. Federal net operating loss carry forward . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , , .00 A4. Contributions to a Regional Foundation (See instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , , .00 A5. Other additions to federal adjusted gross income (See instructions and enclose list) . . . . . . . . . . , ,5 0.00 0 A6. Total additions to federal adjusted gross income (Add lines A1 through A5) . . . . . . . . . . . . . . . . . SUBTRACTIONS FROM FEDERAL ADJUSTED GROSS INCOME: , , .00 A7. Interest on U.S. Government obligations (Reduced by related expenses) . . . . . . . . . . . . . . . . . . . . , , 0.00 8 A8. State income tax refund (If included on line 1 of Form K-40 or the Telefile worksheet) . . . . . . . . . . , , .00 A9. Kansas net operating loss carry forward. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , , .00 A10. Retirement benefits specifically exempt from Kansas Income Tax. . . . . . . . . . . . . . . . . . . . . . . . . . , 5, 0 0.00 4 0 A11. Military Compensation of a Nonresident Servicemember (Nonresidents only; see instructions) . . . , , .00 A12. Learning Quest Education Savings Program contributions (See instructions) . . . . . . . . . . . . . . . . . , , .00 A13. Other subtractions from federal adjusted gross income (See instructions and enclose list) . . . . . . , 5, 0 0.00 4 8 A14. Total subtractions from federal adjusted gross income (Add lines A7 through A13) . . . . . . . . . . . . NET MODIFICATIONS: - If amount is negative, shade the minus (-) in box. Example: - , 4 4, 5 8 0.00 A15. Net modifications to federal adjusted gross income (Subtract line A14 from line A6). Enter on line 2, Form K-40. If negative, shade minus (-) in box. . . . . . . . . . . . . . . . . . . .
  • 5. 114404 PART B - NONRESIDENT ALLOCATION (See instructions, page 24) - If amount is negative, shade the minus (-) in box. Example: INCOME: Total From Federal Return: Amount From Kansas Sources: , 1 5 , 0 0 0.00 60,000 B1. Wages, salaries, tips, etc. . . . . . . . . . . . . . . . . . . . . , , .00 100 B2. Interest and dividend income. . . . . . . . . . . . . . . . . . , , 0.00 80 8 B3. Refunds of state and local income taxes. . . . . . . . . , , .00 B4. Alimony received . . . . . . . . . . . . . . . . . . . . . . . . . . . - , , .00 B5. Business income or loss . . . . . . . . . . . . . . . . . . . . . - , , .00 B6. Farm income or loss. . . . . . . . . . . . . . . . . . . . . . . . . - , , .00 B7. Capital gain or loss. . . . . . . . . . . . . . . . . . . . . . . . . . - , , .00 B8. Other gains or losses. . . . . . . . . . . . . . . . . . . . . . . . , , .00 B9. Pensions, IRA distributions, and annuities. . . . . . . . - , , .00 B10. Rental real estate, royalties, partnerships, S corporations, estates, trusts, etc. . . . . . . . . . . . . . , ,6 0.00 2 620 B11. Unemployment compensation, taxable Social Security benefits, and other income. . . . . . . . . . . . . - , 5, 7 0.00 1 0 B12. Total income from Kansas sources (Add lines B1 through B11). . . . . . . . . . . . . . . . . . . . . ADJUSTMENTS AND MODIFICATIONS TO KANSAS SOURCE INCOME: Total From Federal Return: Amount From Kansas Sources: , , .00 B13. IRA Retirement Deductions . . . . . . . . . . . . . . . . . . . , , .00 B14. Penalty on early withdrawal of savings. . . . . . . . . . . , , .00 B15. Alimony paid. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , , .00 B16. Moving expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . , , .00 B17. Other federal adjustments. . . . . . . . . . . . . . . . . . . . . , , .00 B18. Total federal adjustments to Kansas source income (Add lines B13 through B17). . . . . . . - , 5,7 0.00 1 0 B19. Kansas source income after federal adjustments (Subtract line B18 from line B12). . . . . . - , ,4 0.00 2 B20. Net modifications applicable to Kansas source income (See instructions) . . . . . . . . . . . . . , 6,1 0.00 1 2 B21. Modified Kansas source income (Line B19 plus or minus line B20) . . . . . . . . . . . . . . . . . . - , 6,2 0.00 1 2 B22. Kansas adjusted gross income (From line 3, Form K-40). . . . . . . . . . . . . . . . . . . . . . . . . . 100 % B23. Nonresident allocation percentage (Divide line B21 by line B22 and round to nearest whole percent, enter on line 9, Form K-40) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .