Form K-139 - Corporate Application For Refund From Carry Back Of Net Operating Loss

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K-139
KANSAS
CORPORATE APPLICATION FOR REFUND FROM
(Rev. 8/11)
CARRY BACK OF NET OPERATING LOSS
Name
Employer Identification Number (EIN)
Address (number and street of principal office)
Enter the taxable year and amount of Net Operating Loss carry back.
Year ended
Net Operating Loss
Date loss year filed
City, State, Zip Code
_____________
________________
______________
‰
‰
Was the “Year ended” return a FINAL for Kansas?
Yes
No
COMPUTATION OF DECREASE IN TAX
3rd preceding taxable year ended
2nd preceding taxable year ended
1st preceding taxable year ended
NO REFUND WILL BE ISSUED without Federal
___ ___ ___ ___
___ ___ ___ ___
___ ___ ___ ___
Supporting Schedules (Forms 1139 or 1120X).
(b)
(c)
(d)
(e)
(f)
(a)
If Federal Forms 1139 OR 1120X were not filed,
Liability after
Return as filed
Liability after
Return as filed
Liability after
Return as filed
explain the reason in detail on the back of
or liability as last
application of
or liability as last
application of
or liability as last
application of
this form.
determined
carry back
determined
carry back
determined
carry back
1. Kansas net taxable income before deducting
line 2 of this form.
2. Net operating loss deduction resulting from
carry back.
3. Net taxable income as adjusted (subtract
line 2 from line 1).
4.
For tax years commencing before 1-1-92.
4a. Normal tax (4.5% of line 3).
4b. Surtax (2.25% of amount of line 3 in excess
of $25,000).
5.
For tax years commencing after 12-31-91.
5a. Normal tax (4% of line 3).
5b. Surtax (3% of amount of line 3 in excess of
$50,000).
6. Total tax (add lines 4a and 4b or 5a and 5b).
7. Total refundable credits (enter total of any tax
credits for which you are eligible). You must
complete and enclose applicable schedules.
8. Tax liability after credits (subtract line 7 from
line 6)
9. Enter amounts from line 8, columns b, d and f.
10. Overpayment (subtract line 9 from line 8).
I declare under the penalties of perjury that to the best of my knowledge and belief this is a true, correct and complete application.
sign
_______________________________________________________________________________________________________________________________________
Signature of officer
T i t l e
Date
here
_______________________________________________________________________________________________________________________________________
Signature of preparer (individual or firm)
Address
Date
Mail this application to: Kansas Corporate Income Tax, Kansas Department of Revenue, 915 SW Harrison St., Topeka, KS 66699-4000
File this application separately from your income tax return.
–– FOR OFFICE USE ONLY ––
Auditor ______________________________________________________________________________
Date _________________________
Tax
Interest
Total Refund

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