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<br />17. Industry of recipient's facility (Mark one.): <br /> <br />o Manufacturing 0 Services 0 Finance, Insurance, Real Estate <br />o Retail Trade 0 Wholesale Trade 0 Construction <br />18. Did the recipientrelocate as a result of signing this agreement? (Mark one.) <br /> <br />o Yes (Indicate city and state of previous address and reason recipient did not complete this project at that acfth.ess.) <br /> <br /> <br />City/State of previous address <br /> <br />Reason project not completed at previous address' <br /> <br /># <br /> <br />Indicate total number of employees who ceased to be employed by recipient when the recipient relocated to become eligible for the <br />business subsidy. <br /> <br />CI No Go to uestion 19. <br />19. What would recipient have done without business subsidy or financial assistance? (Mark one): <br />o Remain at previous location, but not expand O' Remain at previous location but expand at the location <br />CI Relocate to different Minnesota location 0 Relocated outside Minnesota <br />C1.0ther <br /> <br />19A. Was the reject a result of eminent domain? <br /> <br />DYes ONo <br /> <br />Section 3: A reement Information. <br />20. Total dollar value of business subsidy or financial assistance <br />(Please separate value by type in Q,uestions 24 and 25.) <br /> <br />21. Date agreement signed (In addition to the agreement date, <br />indicate any dates the agreement was amended.) <br /> <br />22. Benefit date (Indicate the date the recipieni receives the business subsidy. lfthe subsidy involves physical equipment, then the benefit <br />date is the date the equipment is placed into service. lfthe business subsidy involves property improvements, the benefit date is when the <br />improvements are finished or when the business occupies the property).' .. <br /> <br />23. Does the agreement prQvide a business subsidy or one of the four types of financial assistance (see Question 25) required <br />to be reported? (Mark one.) . . <br /> <br />o business subsid <br />24. If the agreement provided a business subsidy, please indicate the <br />type(s) and total dollar value for each type. <br /> <br />o not applicable, agreement provided financial assistance <br /> <br />o loan (only principal) <br />o grant (Le., forgivable loan) <br />o tax abatement <br />o TIP or other tax reduction or deferral* <br />o guarantee or payment <br />o contribution of property or infrastructure <br />o preferential use of governmental facilities <br />o land contribution <br />o other (Specify subsidy type.) <br /> <br />$- <br />$- <br />$- <br />$- <br />$- <br />$- <br />$- <br />$- <br />$- <br /> <br />26. If the assistance included tax increment financing, please indicate <br />the type ofTIF district. (Mark one.) <br /> <br />o not applicable, assistance was not in the form of TIP <br /> <br />o redevelopment <br />o renewal and renovation <br />o soils condition <br />o economic development <br />o mined underground space <br />o haZardous substance subdistriCt <br /> <br />26 A. If assistance included JOBZ benefits, please indicate type of <br />assistance.' (Mark all that apply and please also submit the JOBZ <br />MBAFform.) <br /> <br />o JOBZ 0 JOBZ A one 0 Biozone <br /> <br />Oifinancial assistance <br />25. If the assistance was one of the four types of financial assistance, . <br />please indicate thetype(s). <br /> <br />o not applicable, agreement provided a business subsidy <br /> <br />o assistance for property. <br />by containinants $ <br />o assistance for renovating bui~ding <br />stock or bringing it up to code, and <br />assistance provided for designated <br />historic preservation districts, when <br />50 percent or less of total cost $ <br />o assistance for pollution control or <br />oo~m~ $ <br />o assistance for a TIF soils <br />condition district $ <br />27. Are any other grantors providing a business sUbsidy or finimcial <br />assistance to the same project? (Mark one.) <br /> <br />o Y~s (Specify each grantor a~d the value of their assistance below; <br />attach an additional sheet ifnecessary. <br /> <br />Grantor <br /> <br />Value ($) <br /> <br />Grantor <br /> <br />Value ($) <br /> <br />ONo <br /> <br />* For questions about TIF reporting requirements contact Arlin Waelti (651) 296-7676 at the Minnesota Office of the State Auditor. <br /> <br />Page 2 of5 <br /> <br />Dept. of Employment and Economic Development <br /> <br />Minnesota Business Assistance Form (3/25/08) <br /> <br />48 <br />