REQUEST FOR COPY OF KANSAS TAX DOCUMENTS
PART I Taxpayer Information
Name (Taxpayer or Corporate Name) Your SSN No.
Joint Filer’s Name Spouse’s SSN No.
Address Registration No. Employ
er ID No. (EIN)
City, State and Zip Code Daytime Phone Number Email A
ddress
PART II Mailing Information (if different from above)
Name
Address City, State, and Address
PART III Tax Return / Document Requested (see instructions)
YEAR/PERIOD YEAR/PERIOD YEAR/PERIOD YEAR/PERIOD
N
UMBER OF
RETURNS
COST PER
RETURN
AMOUNT
DUE
Individual Income & Food Sales (K-40) X $ 5.00 = $
Fiduciary (K-41) X $ 5.00 = $
Homestead (K-40H) X $ 5.
00 = $
Withholding Return/Report (KW-3/KW
-5) X $ 5.00 = $
Sales Tax (ST-16/ST-36
) X $ 5.00 = $
Cigarette Tax Report X $ 5.00 = $
T
obacco Tax Report X $ 5.00 = $
M
isc. Tax: X $ 5.00 = $
YEAR/PERIOD YEAR/PERIOD YEAR/PERIOD YEAR/PERIOD
Corporate (K-120) X $20.00 = $
Privilege (K-130) X $20.00 = $
Small Business/Partnership (K-120S) X $20.
00 = $
Federal Corporate (see instructions) X $20.00 = $
TAX TYPE OR DOCUMENT DESCRIPTION YEAR
Copy of Refund Check X $ 5.00 = $
Copy of Tax Warrant X $15.00 = $
Copy of Satisfaction of Judgment X $ 5.00 = $
T
ranscript of Account X $ 5.00 = $
O
ther (see instructions) X $ = $
X
$ = $
Total number of returns/documents and total cost (see instructions)
$
PART IV Signature and Date (read carefully before signing)
I request the Director of Taxation furnish me with a copy of items checked. Under the penalties of perjury I declare that the information
furnished above, to the best of my knowledge, is true, correct, and complete. I further declare that I am the taxpayer, officer for the
taxpayer, or authorized tax preparer and have authorization to receive this information.
Printed Name and Title Name of Your Business/Organization
Signature Date
DO-41 Rev. 10-19
800718
INSTRUCTIONS FOR COMPLETING FORM DO-41
GENERAL INFORMATION
Use this form to request copies of filed returns and/or
reports filed with the Kansas Department of Revenue.
The Kansas Department of Revenue will provide records
upon a direct match. If you have not provided enough
information to establish a direct match, we will contact
you for additional information.
If you request a copy of your federal Corporate
Income Tax return, we will provide the portion of the
return that was submitted with your Kansas Corporate
Tax return.
No refunds will be issued for requests made in error
or for returns or reports that are not on file.
SPECIFIC INSTRUCTIONS
PART I Taxpayer Information
Provide information as requested. Be sure to include
a daytime phone number and email address in case we
need to reach you during office hours.
PART II Ma
iling Information
If t
he address provided in PART I is different than the
address where your return(s) are to be mailed, then
complete PART II.
PART III Tax Retur
n/Document Requested
Indic
ate the return(s) you are requesting by marking
the appropriate box(es) and specifying the tax year(s).
Mark the “Misc. Tax” box for tax returns not listed and
enter the tax type in the space provided (i.e., liquor
enforcement, liquor drink, transient guest, motor fuel,
IFTA, etc.); then specify the tax year(s).
For corporate, privilege and small business returns,
specify the year ending date(s).
To request a copy of a refund check, a tax warrant, a
Satisfaction of Judgment, or an account transcript, mark
the appropriate box and enter the tax type and year. For
documents that are not listed in this section, mark the
“Other” box and provide a description under “Tax Type
or Document Description.” If the document you are
requesting can be found, and a copy provided, the
Kansas Department of Revenue will use the fee
structure in the next column to compute the amount you
owe and send you a bill.
Complete Part III by totaling the “Number of Returns”
column and the “Amount Due” column. Make your check
or money order payable, in the amount due, to the
“Kansas Department of Revenue.”
PART IVSi
gnature and Date
This form must be signed and d
ated by the taxpayer,
officer for the taxpayer, or authorized tax preparer.
Enclose your check or money order with this form and
mail it to the following address:
Record Requests
Kansas Department of Revenue
PO Box 3506
Topeka KS 66625-3506
W
hen your returns/documents have been retrieved, a
copy of them will be mailed to the address you have
provided on this form.
If you prefer, you may use ai
r express as a method of
delivery, but you will be responsible for the charges.
Payment must be made directly to the delivery service
and you must provide the Kansas Department of
Revenue with a prepaid envelope or an account number
for such delivery.
NOTE: Tax records are considered confidential
documents and are held in strict confidence by law;
therefore, faxing them is not a delivery option.
FEE STRUCTURE FOR DOCUMENTS
NOT LISTED ON THIS FORM
Copy charge for each page is $0.25
Search charge (staff time per hour) $25.00
Computer time (staff time per hour) $60.00
Mail charge for first 5 pages is $0.40 and $0.25 for
each additional 5 page increments
Copy and Search Charge Fees: The 25-cent copy charge
is a per page charge which is principally assessed to
reimburse the agency for routine costs of retrieving records
which are requested with specificity and are held within the
agency's current file system. It does not include the cost of
more than one-tenth of an hour of research or access time
required to determine the location of records not readily
accessible, to determine what specific records meet
request criteria, to segregate public from non-public
information, to access records from archives and other
similar necessary services. For such services in providing
access or copies, the $25 per hour search charge may be
assessed, to be billed by the tenth of an hour.
Mail Charge Fee: The mail charge may be assessed in
addition to the copy charge when mail service is requested.
For up to and including the first five pages, 40 cents may
be charged, plus an additional 25 cents for up to and
including each additional five pages.