INSTRUCTIONS: KANSAS CERTIFICATE OF DISABILITY (Schedule DIS)

Any Kansas resident who completes a Form K-40H seeking a partial or total refund on property taxes paid on the basis of a permanent disability must also submit a certificate of disability along with their application. This Schedule DIS document is to be completed by a licensed physician. Alternately, you may attach a copy of a Social Security certificate of disability or a Veterans Disability Statement. Military veterans who do not have such a statement can request one from their regional Veterans Administration office. To receive this letter from this office, you must be 50% or more disabled. Note that spouses of deceased disabled military veterans may also file this claim. To qualify, your annual income cannot exceed $11,760 unless you are blind, in which case your maximum annual income is $19,680.

Kansas Certificate Of Disability Schedule DIS Step 1: The doctor should enter the name of the person they have examined.

Kansas Certificate Of Disability Schedule DIS Step 2: The doctor should enter the Social Security number of the person being examined.

Kansas Certificate Of Disability Schedule DIS Step 3: The doctor should enter the complete address of the person being examined, including their zip code.

Kansas Certificate Of Disability Schedule DIS Step 4: Question one asks whether the patient has a permanent physical or mental disability which prevents them from working which lasted the entire year and/or which can be expected to result in their death. The doctor should check either "yes" or "no."

Kansas Certificate Of Disability Schedule DIS Step 5: Question two requires the doctor to provide a written explanation of the disability.

Kansas Certificate Of Disability Schedule DIS Step 6: Question three requires the doctor to give the date on which the disability was originally diagnosed.

Kansas Certificate Of Disability Schedule DIS Step 7: The doctor should enter their name in the first blank under "Certificate Of Physician."

Kansas Certificate Of Disability Schedule DIS Step 8: The signature should sign and print their name where indicated, as well as entering their business address, phone number and the date.

Kansas Certificate Of Disability Schedule DIS Step 9: The document should be mailed to the address given on the back of form K-40H. The claim and certificate should be filed no later than April 15 of the following year.