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17. Industry of recipient's facility (Mark one.): <br />Q Manufacturing Q Services Q Finance, Insurance, Real Estate <br />Q Retail Trade Q Wholesale Trade Q Construction Q Other (please specify) <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 Question 19.) <br />19. What would recipient have done without business subsidy or financial assistance? (Mark one): <br />0 Remain at previous location, but not expand 0 Remain at previous location but expand at the location <br />Q Relocate to different Minnesota location 0 Relocated outside Minnesota <br />❑ Other <br />19A. Was the project a result of eminent domain? 0 Yes 0 No <br />reement Information <br />20. Total dollar value of business subsidy or financial assistance <br />(Please separate value by type in Questions 24 and 25.) <br />(Enter zero for JOBZ, Biozone and Agzone projects.) <br />21. Date agreement signed (In addition to the agreement date, <br />indicate any dates the agreement was amended.) <br />22. Benefit date (Indicate the date the recipient receives the business subsidy or improvements were finished, equipment was placed into <br />service, or the recipient occupied the property, whichever is earlier.) <br />23. Does the agreement provide a business subsidy or one of the four types of financial assistance (see Question 25) required <br />to be reported? (Mark one.) <br />Q business subsidy Q financial assistance <br />24. If the agreement provided a business subsidy, please indicate the <br />type(s) and total dollar value for each type. <br />Q not applicable, agreement provided financial assistance <br />Q loan (only principal) $ <br />25. If the assistance was one of the four types of financial assistance, <br />please indicate the type(s). <br />Q not applicable, agreement provided a business subsidy <br />Q assistance for property <br />by contaminants $ <br />Q grant (i.e., forgivable loan) $ <br />Q tax abatement $ <br />Q 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 />Q IW or other tax reduction or deferral* $ <br />Q guarantee or payment $ <br />Q contribution of property or infrastructure $ <br />Q preferential use of governmental facilities $ <br />Q land contribution $ <br />U assistance for pollution control or <br />abatement $ <br />Q Biozone $ 0 <br />Q JOBZ (state tax exemptions /credits and sales tax) $ 0 <br />Q assistance for a TIF soils <br />condition district $ <br />Q JOBZ - Agzone $ 0 <br />0 other (Specify subsidy type.) $ <br />(Note: no dollar value for zone projects) <br />26. If the assistance included tax increment financing, please indicate <br />the type of TIF district? (Mark one.) <br />Q not applicable, assistance was not in the form of TIF <br />Q redevelopment <br />Q renewal and renovation <br />Q soils condition <br />Q economic development <br />Q mined underground space <br />Q hazardous substance subdistrict <br />27. Are any other grantors providing a business subsidy or financial <br />assistance to the same project? (Mark one.) <br />Q Yes (Specify each grantor and the value of their assistance below; <br />attach an additional sheet if necessary. <br />Grantor Value ($) <br />Grantor Value ($) <br />Q No <br />*For questions about TIF reporting requirements contact Arlin Waelti (651) 296 -7676 at the Minnesota Office of the State Auditor. <br />Minnesota Business Assistance Form (12/19/06) <br />Page ^ 4 O <br />Dept. of Employment and Economic Development <br />