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Certificate for Real Estate Tax Exemption For Farm Residences To: Assessor, City or Twp. Of Ii"", r , t' ('\ , ND, County Auditor of Cass County I (We) hereby make application for real property tax exemption for the year 2004 on the property described below and, in compliance with N.D.C.C. Section 57-02-14.1, or with N.D.C.C. Section 57-02-08(15), certify the following information in support thereof: Name of Property Owner: L.R 1L Pd., n ~ Mailing Address: ').l.t'iLj '''''''+- h. Av~ St: Address of Property Claim Exempt: A ('5 uS u ~ \ I ~ ) JV 0 5 floc;] ~ crt oS- Legal Desyription'Ofmore space is needed, attach anotner sheet): -;) .11 II<-r + rllet 5~j.<-[ 3-1 41-cfJ 0 BAr I:" luJ e Exemption Claimed Pursuant to 57-02-08(15) of the North Dakota Century Code: (Ch~ose the one category that applies) Active Farmer Category . Does the tract upon which the residence is located contain 10 acres or more? . Is the major portion of the occupant's time devoted to farming activities? . Does the annual net income from farming constitute 50% or more of the total net income, including that net income of a spouse if married during any of the three preceding calendar years? Yes ~ No 0 "Net income from farming shall be as reported for state income tax purposes adjusted to include: i. The difference between gross sale price less expenses of sale and amount reported as a capital gain and, ii. The interest expenses from farming which have been deducted in computing taxable income. iii. Depreciation expenses from farming activities which have been deducted in computing taxable income. . Did the occupant engaged in farming have non.farm income, including that of a spouse, of more than $4G,000 during each of the three preceding calendar years? Yes" Yes)&} NoD NoD Yes 0 No~ Vacant Residence Category . Is the residence intended for use as a farm residence? Yes f4 NoD Farm Laborer Residence Category . Is the residence being used as part of a fann plant to provide housing for that farmer's workers? Yes D No~ Retired Farmer Category , . Did the retired occupant retire because of illness or age and who at the time of retirement owned and occupied as a fanner the residence in which the farmer lives and for which the exemption is claimed? Yes D NoD Beginning Farmer Category . Has the individual begun occupancy and operation of a farm within the three preceding calendar years; who normally devotes the major portion of time to fanning activities; and who does not have a history of fann income from farming for each of the three preceding calendar years? Yes D NoD Note: N.D.C.C. Section 12.1-11-02, provides that making false statement i A misdemeanor. atter is punishable as a. Class L.L - /- ot.f Date This certificate shall be filed with the assessor and county auditor before February 1 every year for which the exemption is claimed. For Office Use Only: Application is: Approved 0 Disapproved 0 Assessor or Director of Tax Equalization Date K:\LETTERS\Applications\2004 farmapp.wpd