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Certilicate for P, eal Estate Tax Exemption For Farm Residences To: Assessor, City or Twp. Of (J{ fi. n/4 -/ , ND, County Auditor of Cass County I (We) hereby make application for real property tax exemption l[br Ihe year 2002 oll the properly described below and, in compliance with N.D.C.C. Section 57-02-14. l, or with N.D.C.C. Section 57-02-08(15), certify tile following information in support thereof: Name of Property Owner: [~C~. U i Ci Mailing Address: Z'/ I 0 ~ /0~2 '[Ix Address of Property Claim Exempt: Legall)escription(ifmo,'espaceis,,eeded, al~acha,,othersheet): 5/( ,A~,.,-- -ir.c.c. {- p { ~"-L//vtx.J~ Exemption Claimed Parsuant to 57-02-08(15) of the Norlh Dakota Ceotm-y Code: (Choose the on~ catego~ that applies) Active Farmer Catel~ory e Does Ihe tract upon which the residence is located contain 10 acres or more? Yes l~ No · Is the major portion of the occupant's time devoted to fainting activities? Yes ~1 No [..I · Does the annual net income from fainting constitute 50% or more of the total ncl income, including that net income ora spouse if married duriug any of the three preceding calendar years? Yes ~ No "Net income from fanning 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 fi-om farming activities which have been deducted in computing taxable income. * Did Ibc occupant engaged in fro'ming have non-farm income, including that ol'a spouse, of' more lhan $40,000 during each o f the three preceding calendar years? Yes L.I No,KJ IVacallt Residence Categury II ~ Is thc residence intended for use as a fm-m residcncc? Yes C.I No D Farm l,al~,~ror Residvnce (?alegory Il ~ Is the residence being used as part ora farm plant to provide housing tbr that farmer's workers? Yes ~ No ~ Retired Farmer Ca~egm'y ~ Did the retired occupant retire because of illness or age and who al the time of retirement owned and occupied as a farmer the residence in which the farmer lives and for which the exemption is claimed7 Yes ~ No Q Begimdng Farmer Category I, Ilas the individual begun occupancy and operation ora farm within the three preceding calendar years; who normally &voles the major portion of time to fainting activities: and who does not have a history of farm income fi'om farming for each of the three preceding calendar years'? Yes 121 No CI Note: N.D.C.(!. Section 12.1-11-02, provides that nmking false statement in a gove4-nm, enta] matter is punishable as a / (:lass A misdemeanor. ("]"~'" ? ' , ~ / e :~° c~ ' -L.. Sigoature of 3'pp!/,¢fint ~.~t, 'rhln cerlllleale shall h~ filed '*silh lhe ansessor and colmly amltlor befin'e February ! every year for which the exemplion Is claimed. Date For Office Use Only: Applicatinn is: Approved l)isapproved CI Assessor or Director of Tax Equalization Date K:\LETYERSL~pplications\2002farmapp.wpd