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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. Modications (from Schedule S, line A23; enclose Schedule S)
3. Kansas adjusted gross income (line 2 added to or subtracted from line 1)
Deductions
4. Standard deduction OR itemized deductions (if itemizing, complete Kansas Schedule A)
5. Exemption allowance ($2,250 x number of exemptions claimed)
6. Total deductions (add lines 4 and 5)
7. Taxable income (subtract line 6 from line 3; if less than zero, enter 0)
Tax
Computation
8. Tax (from Tax Tables or Tax Computation Schedule)
9. Nonresident percentage (from Schedule S, line B23; or if 100%, enter 100.0000)
10. Nonresident tax (multiply line 8 by line 9)
11. Kansas tax on lump sum distributions (residents only - see instructions)
12 TOTAL INCOME TAX (residents: add lines 8 & 11; nonresidents: enter amount from line 10)
Credits
13. Credit for taxes paid to other states (see instructions; enclose return(s) from other states)
1
4. Credit for child and dependent care expenses (residents only - see instructions)
15. Other credits (enclose all appropriate credit schedules)
16. Subtotal (subtract lines 13, 14 and 15 from line 12)
17. Earned income tax credit (from worksheet on page 8 of instructions)
18. Food sales tax credit (from line H, front of this form)
19. Tax balance after credits (subtract lines 17 and 18 from line 16: cannot be less than zero)
Use Tax
20. Use tax due (out of state and internet purchases; see instructions)
21. Total tax balance (add lines 19 and 20)
Withholding
and
Payments
If this is an
AMENDED return,
complete lines
27 and 28
22. Kansas income tax withheld from W-2s and/or 1099s
23. Estimated tax paid
24. Amount paid with Kansas extension
25. Refundable portion of earned income tax credit (from worksheet, page 8 of instructions)
26. Refundable portion of tax credits
27. Payments remitted with original return
28. Overpayment from original return (this gure is a subtraction; see instructions)
29. Total refundable credits (add lines 22 through 27; then subtract line 28)
Balance
Due
30. Underpayment (if line 21 is greater than line 29, enter the dierence here)
31. Interest (see instructions)
32. Penalty (see instructions)
33. Estimated Tax Penalty
Mark box if engaged in commercial farming or shing in 2021
34. AMOUNT YOU OWE (add lines 30 through 33 and any entries on lines 37 through 43)
Overpayment
You may donate to
any of the programs
on lines 37 through 43.
The amount you enter
will reduce your refund
or increase the amount
you owe.
35. Overpayment (if line 21 is less than line 29, enter the dierence here)
36. CREDIT FORWARD (enter amount you wish to be applied to your 2022 estimated ta
x)
37. CHICKADEE CHECKOFF (Kansas Nongame Wildlife Improvement Program)
38. SENIOR CITIZENS MEALS ON WHEELS CONTRIBUTION PROGRAM
39. BREAST CANCER RESEARCH FUND
40. MILITARY EMERGENCY RELIEF FUND
41. KANSAS HOMETOWN HEROES FUND
42. KANSAS CREATIVE ARTS INDUSTRY FUND
43. LOCAL SCHOOL DISTRICT CONTRIBUTION FUND School District Number
44. REFUND (subtract lines 36 through 43 from line 35)
Signature(s)
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.
Signature of taxpayer Date Signature of preparer other than taxpayer Phone number of preparer
Signature of spouse if Married Filing Joint Tax Preparer’s PTIN, EIN or SSN:
ENCLOSE any necessary documents with this form. DO NOT STAPLE.