Schedule Rnt - Kansas Certification Of Rent Paid - 2012

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RNT
2012
KANSAS
CERTIFICATION OF RENT PAID
(Rev. 7/12)
First Name
Last Name
Social Security Number
RENTAL PERIOD: From ________________________ , 2012 to ______________________ , 2012.
Month
Day
Month
Day
Complete a Schedule RNT for each place you resided in 2012, even if you paid no rent. See instructions on reverse side.
ADDRESS OF RENTAL PROPERTY
Number and Street or Rural Route
for the above time period.
NOTE: If this rental is an apartment complex,
City
State
Zip Code
enter the name of the complex below.
Landlord/Property Owner Name
LANDLORD or PROPERTY OWNER:
Enter ALL requested information. Your
Mailing Address
claim for refund cannot be processed if
this information is missing or incomplete.
City
State
Zip Code
(
)
(
)
Landlord/Property Owner Telephone Number
Fax Number (if applicable)
TYPE OF RENTAL PROPERTY
(Check all that apply):
‰
‰
‰
Low income housing
Nursing, boarding, group home
Mobile home
‰
‰
or assisted living facility
Section eight housing
Mobile home lot
‰
‰
‰
Apartment
Hotel
Manufactured home
‰
‰
‰
House
Housing authority
Other (Explain)
‰
‰
Duplex or similar facility
Live with landlord
Follow the instructions on the back of this form to accurately complete Lines 1 through 5.
‰
‰
1. Is the rental property above subject to property tax?
YES
NO
2. Total rent you paid for the 2012 rental period shown above. See instructions on back. Do not
include deposits or rent that is owed the landlord. Section 8 residents: Do not enter gross rent,
2
only the amount you paid ...........................................................................................................
3. Value of utilities, furnishings, or services included in your rent (from schedule below). If you live
in a nursing home or a boarding home, multiply line 2 by 25% (.25), and enter the result on line
3
4. See the instructions for Special Rental Situations on the back of this form ...........................
4
4. Subtract line 3 from line 2. This is your rent paid for occupancy ...............................................
5
00
5. Multiply line 4 by 15% (.15). Enter on line 12, front of Form K-40H ..........................................
MONTHLY
NO. OF MONTHS
ITEMS
CHARGE
RENTED
AMOUNT
A.
Furniture (other than appliances) ................................
$20.00
X
_____________
$
_____________
B.
Stove ............................................................................
10.00
X
_____________
_____________
C. Refrigerator ..................................................................
10.00
X
_____________
_____________
D. Dishwasher ..................................................................
6.00
X
_____________
_____________
E.
Washer and Dryer .......................................................
10.00
X
_____________
_____________
F.
Heat (for months used) ................................................
46.00
X
_____________
_____________
G.
Electricity (other than heat) ..........................................
40.00
X
_____________
_____________
H. Gas (other than heat) ..................................................
18.00
X
_____________
_____________
I.
Air Conditioning (for months used) ..............................
20.00
X
_____________
_____________
J.
Cable ...........................................................................
30.00
X
_____________
_____________
K.
Water and Sewer .........................................................
20.00
X
_____________
_____________
L.
Trash ............................................................................
10.00
X
_____________
_____________
M. Laundry ........................................................................
25.00
X
_____________
_____________
N. Meals ...........................................................................
300.00
X
_____________
_____________
O. Other (specify and estimate) .......................................
________
X
_____________
_____________
P.
TOTAL EXPENSES (Add items A through O. Enter the result here and on line 3 above.) ....................... $
_____________
(ENCLOSE SCHEDULE RNT WITH YOUR HOMESTEAD CLAIM, FORM K-40H)
Page 11

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