l to: Kansas Income Tax, Kansas Dept. of Revenu 2023 KANSAS INDIVIDUAL INCOME TAX K- (Rev. 7-23) 40 DO NOT STAPLE K-40 Page 1 114523 Name (please print) Date of Birth (MMDDYY) Relationship Social Security Number Your First Name Initial Last Name Spouse’s First Name Initial Last Name Mailing Address (Number and Street, including Rural Route) School District No. City, Town, or Post Office State Zip Code County Abbreviation If taxpayer (or spouse if filing joint) died during this tax year, mark an “X” in this box. ___

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YE . . ............................................................................... .......... If your name or address has changed since last year, mark an “X” in this box. Enter the first four letters of your last name. Use ALL CAPITAL letters. Your Social Security Number Enter the first four letters of your spouse’s last name. Use ALL CAPITAL letters. Spouse’s Social Security Number Daytime Telephone Number Amended Return (Mark ONE) If this is an AMENDED 2023 Kansas return mark one of the following boxes: Amended affects Kansas only Amended Federal tax return Adjustment by the IRS Filing Status (Mark ONE) Single Married filing joint (Even if only one had income) Married filing separate Head of household (Do not mark if filing a joint return) Residency Status (Mark ONE) Resident Part-year resident from (Complete Sch. S, Part B) Nonresident (Complete Sch. S, Part B) Exemptions and Dependents Enter the total exemptions for you, your spouse (if applicable), and each person you claim as a dependent. If filing status above is Head of household, add one exemption. If claiming the Disabled Veteran Personal Exemption allowance, enter the total here. (See instructions for qualifications). Total Kansas exemptions. Enter the requested information for all persons claimed as dependents. Do NOT include you or your spouse. Enclose separate schedule if necessary. Food Sales Tax Credit You must have been a Kansas resident for ALL of 2023. Complete this section to determine your qualifications and credit. A. Had a dependent child who lived with you all year and was under the age of 18 all of 2023? S NO B. Were you (or spouse) 55 years of age or older all of 2023 (born before January 1, 1968)? S NO C. Were you (or spouse) totally and permanently disabled or blind all of 2023, regardless of age? S NO If you answered “No” to A, B and C, STOP HERE; you do not qualify for this credit. D. If you answered “Yes” to A, B, or C, enter your federal adjusted gross income from line 1 of this return. If line “D” is more than $30,615, STOP HERE; you do not qualify for this credit. E. Number of exemptions claimed. F. Number of dependents that are 18 years of age or older (born before January 1, 2006) G. Total qualifying exemptions (subtract line F from line E H. Food Sales Tax Credit (multiply line G by $125). Enter the result here and on line 18 of this form Mai e PO Box 750260, Topeka, KS 66699-0260

ENTER AMOUNTS IN WHOLE DOLLARS ONLY Income Shade the box for negative amounts. Example: . ........................................................................................................... ) . ) ....... ) ..... tation 1. Federal adjusted gross income (as reported on your federal income tax return) ................. 1 . ........................ 3

. ...................................... 2 ) 4 7 0 2 6 1 9 1 8 ................................................................ ) 5 .............................................. ) 11 ............................. . 6 27 2 0 21 24 23 2 25 22 .......................................................................................... . 35 36 37 38 0 42 43 41 44 34 39 4 .........................................................................

1 ......................... ......... ) 7 8 19 16 1 3 14 1 15 ................................................................ ..................................................................................... ) ..... ........................................................................ .. ................................................................................ .................................................................. ) .......... ) ......................................................................... .................... ) .......................................................... ............................................................. ) .............................................................. ) ..................................... ) ................................................................................................

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.................................................................................. .. .. ) .... ) 28 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 . . ....................................... ) . ) ...................... ................... ) ) .......... . .................................

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.......................................................................................................... . . ............................ ) K-40 Page 2 114223 I declare under the penalties of perjury that to the best of my knowledge this is a true, correct, and complete return.

00 00 00 2. Modifications (from Schedule S, line A25; 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 Compu 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 14. 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. Total tax balance (subtract lines 17 and 18 from line 16; cannot be less than zero Withholding and Payments If this is an AMENDED return, complete lines 25, 26 and 27 20. Kansas income tax withheld from W-2s and/or 1099 21. Estimated tax paid 22. Amount paid with Kansas extension 23. Refundable portion of earned income tax credit (from worksheet, page 8 of instructions 24. Refundable portion of tax credits 25. Payments remitted with original return 26. Credit for tax paid on the K-120S (enclose K-9) 27. Overpayment from original return (this figure is a subtraction; see instructions 28. Total refundable credits (add lines 20 through 26; then subtract line 27 Balance Due 29. Underpayment (if line 19 is greater than line 28, enter the difference here 30. Interest (see instructions 31. Penalty (see instructions 32. Estimated Tax Penalty Mark box if engaged in commercial farming or fishing in 2023 33. AMOUNT YOU OWE (add lines 29 through 32 and any entries on lines 36 through 43 Overpayment You may donate to any of the programs on lines 36 through 43. The amount you enter will reduce your refund or increase the amount you owe. 34. Overpayment (if line 19 is less than line 28, enter the difference here 35. CREDIT FORWARD (enter amount you wish to be applied to your 2024 estimated tax 36. CHICKADEE CHECKOFF (Kansas Nongame Wildlife Improvement Program 37. SENIOR CITIZENS MEALS ON WHEELS CONTRIBUTION PROGRAM 38. BREAST CANCER RESEARCH FUND 39. MILITARY EMERGENCY RELIEF FUND 40. KANSAS HOMETOWN HEROES FUND 41. KANSAS CREATIVE ARTS INDUSTRY FUND 42. LOCAL SCHOOL DISTRICT CONTRIBUTION FUND School District Number 43. KANSAS HISTORIC SITE CONTRIBUTION FUND Historic Site Number 44. REFUND (subtract lines 35 through 43 from line 34) Signature(s) I authorize the Director of Taxation or the Director’s designee to discuss my return and enclosures with my preparer. Taxpayer Signature DATE Spouse Signature (If married filing joint) DATE SIGNATURE OF PREPARER OTHER THAN TAXPAYER Phone number of preparer Tax Preparer’s PTIN, EIN or SSN ENCLOSE any necessary documents with this form. DO NOT STAPLE.