Agenda - Council - 01/13/2009 - Laserfiche WebLink

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1. Name of grantor (funding entity) 2. Name of person completing this form 3. Street address - 4. City 5. Zip Code 6: County ' 7. Phone number 8. Fax number 9. E -mail address 10. Please indicate who in your organization should receive the MBAF if different from the person in Question 2. • Name/Title Phone number Street address City . - Zip Code 11: Classification of grantor (Mark one. If grantor is entity created . by govt agency, please indicate affiliation. For example, a city EDA would check "City government. '9 ❑ City government ❑ County government ❑ Regional government ❑ State govemment • ❑ Other (Please specify) . 12. Has your organization held a public hearing on and adopted criteria for awarding business subsidies in compliance with Minn. Stat. § 116J.994? (Mark one) ❑ Yes, in 2008 (attach criteria) ❑ Yes, in 2008 but have not yet adopted criteria ❑ Yes, prior to 2008 If Yes: Hearing Date: Year Criteria Submitted: ❑ No ❑ Other (Please attach explanation.) 13. Has your organization signed any agreements to award a business subsidy December 31, 2007 unless goals have been achieved and reported in ❑ Yes (Complete the remainder of the form unless goals have been reported in a previously filed MBAF per Minn. Stat. §116J.993 or financial assistance from August 1, 1999 through a previously filed MBAF? . (Mark one.) achieved and ❑ No (Stop here, go to section 5 on page 4.) and §116J.994) Y Department et Employment and Economic Development Innose tc may not be awarded after June 1 of each year until a report has been submitted. ■ Questions? Call (651) 259 -7179. Information on where to mail or fax your completed MBAF(s) is on page 5. • Section 2: Recipient Information 2008 Minnesota Business Assistance Form for Non -JOBZ Projects • The Minnesota Business Assistance Form (MBAF) online is available at www. deed. state. mn. us / Community /subsidies/MBAFForm.htm to report each business subsidy and financial assistance agreement signed fromAugust 1, 1999 throne: December 31, 2007 unless goals have been achieved and reported on a MBAF per Minn. Stat. §1161993 to § 116J.995. ■ The following government agencies must submit a MBAF: 1) any local government/agency that signed a business subsidy agreement since January 1, 2003, or represents a population of more than 2,500; 2) all state government agencies authorized to provide business subsidies. • • Executive Order 08 -01 at http: // www.governor.state.nm.us/ priorities/ governorsorders/ executiveorders /PROD008598.httnl requires that recipients for all business subsidy agreements signed on or after January 29, 2008, to comply with the Immigration Act of 1986, as amended. The recipient of business assistance must certify that it is currently participating in the E- Verify program located at http://www.uscis.gov and that all newly hired employees hired on or after January 29, 2008 are eligible for employment in the United States throughout the term of the business assistance. Minnesota Business Assistance Form (3/25/08) Page I of 5 Please fill in date agreement signed (same as question 21) • DEED will contact any local or state government agency that is required to report but has not done so by May 1. Business assistance 14. Name of business or organization receiving subsidy or financial assistance 15. Address where business subsidy or financial assistance . will be used Street address City State ZIP Code 16. Does the recipient have a parent corporation? (Mark one.) ❑ Yes (Indicate name and address of parent corporation below: If more than one, indicate ultimate owner.) ❑ No Name of parent corporation Street address City State ZIP Code Dept. of Employment and Economic Development