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to be attained by the time otreporting. (tt rtacn aaanlona' pugea v «r�...u <br />35. Information on recipient and agreement: <br />Name of recipient in default Type of subsidy or assistance Initial value of subsidy or assistance <br />Street address of recipient City/Zip code of recipient Outstanding value of subsidy <br />or assistance <br />36. Reason(s) for default (Mark all that apply.): <br />❑ recipient ceased operation 0 recipient relocated to a different community <br />0 recipient was unable to fill vacant positions 0 other (Speck reason.) <br />37. To date, has the recipient fulfilled its repayment obligation? (Mark one.) <br />0 Yes 0 No, recipient has begun to repay the assistance. 0 No, recipient has not begun to repay the assistance. <br />38. Has the agreement been amended to extend the recipient's deadline for fulfilling its obligations? (Mark one.) <br />❑Yes CI No <br />39. Describe the steps being taken to bring recipient into compliance or recoup the subsidy: <br />For questions 35 -39: Provide the following information for each recipient failing to fulfill goals or any other terms of an agreement that were <br />Minnesota Business Assistance Form (3/25/08) <br />Return your completed MBAF(s) by Mav 1, 2008 <br />Ell HER <br />Mail To: <br />Minnesota Business Assistance Report <br />Minnesota Department of Employment and Economic Development — Analysis and Evaluation <br />1' National Bank Building <br />332 Minnesota Street, Suite E200 <br />St. Paul, Minnesota 55101 -1351 <br />OR <br />Fax To: <br />(651) 215 -3841 <br />(Next year, please use the online version of this form. It can be found at <br />www.deed.state.mn.us/Community/subsidies/MBAFForm.htm.) <br />Page 5 of 5 Dept. of Employment and Economic Development <br />