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d a2. at Bene e is the date the date he equ i p (Indicate <br />me te n e date the re is placed i nto service. If the business subsidy the subsidy involves <br />improvements,` the benefit date is the when the <br />dthe equpnt. <br />improvements are finished or when the business occupies the property). <br />23. Does the agreement provide a business subsidy or one of the four types of fmancial assistance (see Question 25) required <br />to be reported? (Mark one.) <br />❑ business subsid 0 financial assistance <br />25. If the assistance was one of the four types of financial assistance, <br />24 If the agreement please indicate the type(s). <br />❑ not applicable, agreement provided a business subsidy <br />provided a business subsidy, please indicate the <br />type(s) and total dollar value for each type. <br />O not applicable, agreement provided financial assistance <br />O loan (only principal) $ <br />O grant (i.e., forgivable loan) $ <br />O tax abatement <br />0 TIF or other tax reduction or deferral* $ <br />O guarantee or payment $ <br />0 contribution of property or infrastructure $ <br />0 preferential use of governmental facilities $ <br />O land contribution $ <br />0 other (Specify subsidy type.) <br />26. If the assistance included tax increment financing, please indicate <br />the type of TIF district. (Mark one.) <br />❑ not applicable, assistance was not in the form of TIF <br />21. Date agreement signed (In addition to the agreement date, <br />indicate any dates the agreement was amended.) <br />0 assistance for property. <br />by contaminants <br />0 assistance for renovating building <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 />0 assistance for pollution control or <br />abatement <br />0 assistance for a TIF soils <br />condition district <br />27. Are any other grantors providing a business subsidy or financial <br />assistance to the same project? (Mark one.) <br />❑ Yes (Specify each grantor and the value of their assistance below; <br />attach an additional sheet if necessary. <br />Grantor <br />Grantor <br />0 No <br />Value ($) <br />Value ($) <br />Section 3: A:reement Information <br />20. Total dollar value of business subsidy or financial n and 2 assistance <br />(Plase separate value by type <br />17. Industry of recipient's facility (Mark one.): <br />0 Manufacturing 0 Services 0 Finance, Insurance, Real Estate ❑Other lease s•ect� <br />0 Retail Trade 0 Wholesale Trade 0 Construction <br />18. Did the recipient relocate as a result of signing this agreement? (Mark one.) <br />0 Yes (Indicate city and state of previous address and reason recipient did not complete this project at that address.) <br />City/State of previous address Reason project not completed at previous address <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 />0 No Go to ,uestion 19 <br />19. What would recipient have done without business subsidy or financial assistance? (Mark one ❑ Remain at previous location but expand at the location <br />❑ Remain at previous location, but not expand ❑Relocated outside Minnesota <br />0 Relocate to different Minnesota location <br />0 Other <br />19A. Was the <br />o'ect a result of eminent domain? <br />O Yes O No <br />Cl redevelopment <br />0 renewal and renovation <br />0 soils condition <br />❑ economic development <br />0 mined underground space <br />0 hazardous substance subdistrict <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 />MBAF form.) <br />❑ JOBZ O JOBZ A• one 0 Biozone <br />*For questions about TIF reporting requirements contact Arlin Waelti (651) 296 -7676 at the Minnesota Office of the State Auditor. <br />ygnesota Business Assistance Form (3/25108) <br />Page 2 of 5 Dept. of Employment and Economic Development <br />-Z <br />