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CHAPTER 13 - ECONOMIC DEVELOPMENT AND SPECIAL PROGRAMS Form 13.013 CONFIRMATION OF DECERTIFIED TIF DISTRICT The auditors from the TIF, Investment & Finance Division of the Office of the Office of the State Auditor (OSA) are reviewing our compliance with the requirements of the TIF Act relating to decertification of the following TIF district, Please complete the following information requested below in Part A and then forward the form to the County Auditor to be certified in Part B, Once the information has been completed by both the authorized TIF representative and the County Auditor, please return the form to the TIF Division of the OSA at the address listed below: Office of the State Auditor -- TIF, Investment & Finance Division 525 Park Street, Suite 500 St, Paul, MN 55103 PART A. To be completed by the TIF authorized representative: County Auditor/Treasurer's Name: Date: County Name: County Address: TIF Authority Name: TIF District # and Name: TIF District Type: TIF Plan Approval Date: Certification Request Date: Certification Date: Required Decertification Date: ❑ TIF Plan ❑ Statutory Maximum (Information to be confirmed by the County Auditor:) 1, Actual decertification date: 2, Date of first tax increment received: 3, Final tax increment distribution date: and amount $ 4, Amount of excess tax increment returned to the county, if any $ and date Signature: Date: Name and title of TIF authorized representative; PART B: To be completed by the County Auditor or representative: On behalf of the County Auditor/Treasurer, I certify that the above information, specifically information provided in questions 1-4, is correct with the following exceptions, if any: Signature: Date: Name and title of the County representative: Phone: Exceptions? ❑ No ❑ Yes If yes, please describe below: TAX INCREMENT FINANCING 13.01 -31 REVISION DATE► NOVEMBER, 2010