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• • • 17. Industry of recipient's facility (Mark one.): ^ Manufacturing ^ Services ^ Finance, Insurance, Real Estate ^ Retail Trade ^ Wholesale Trade ^ Construction ^ Other leases eci 18. Did the recipient relocate as a result of signing this agreement? (Mark one.) ^ Yes (Indicate city and state of previous address and reason recipient did not complete this project at that address.) City/State of previous address Reason project not completed at previous address ^ No (Go to Ouestion 19 ) 19. What would recipient have done without business subsidy or financial assistance? (Mark one): ^ Remain at previous location, but not expand ^ Remain at previous location but expand ^ Relocate to different Minnesota location ^ Relocated outside Minnesota ^ Other S ti n 3' A reement Information ec o 20. Total dollar value of business subsidy or financial assistance 21. Date agreement signed (In addition to the agreement date, (Please separate value by type in Questions 24 and 25.) indicate any dates the agreement was amended.) (Enter zero for JOBZ, Biozone and Agzone projects.) 22. Benefit date (Indicate the date the recipient receives the business subsidy or improvements were finished, equipment was placed into service, or the recipient occupied the property, whichever is earlier.) 23. Does the agreement provide a business subsidy or one of the four types of financial assistance (see Question 25) required to be reported? (Mark one.) ^ business subsid ^ financial assistance 24. If the agreement provided a business subsidy, please indicate the 25. If the assistance was one of the four types of financial assistance, type(s) and total dollar value for each type. please indicate the type(s). ^ not applicable, agreement provided financial assistance ^ not applicable, agreement provided a business subsidy ^ loan (only principal) $ ^ assistance for property ^ grant (i.e., forgivable loan) $ by contaminants $ ^ tax abatement $ ^ assistance for renovating building ^ Tff or other tax reduction or deferral $ stock or bringing it up to code, and D guarantee or payment $ assistance provided for designated ^ contribution of property or infrastructure $ historic preservation districts, when ^ preferential use of governmental facilities $ 50 percent or less of total cost $ ^ land contribution $ ^ assistance for pollution control or ^ Biozone $ 0 abatement $ ^ JOBZ (state tax exemptions/credits and sales tax) $ 0 ^ assistance for a TTF soils ^ JOBZ - Agzone $ 0 condition district $ ^ other (Sped subsidy type.) $ (Note: no dollar value for zone ro'ects 26. If the assistance included tax increment financing, please indicate 27. Are any other grantors providing a business subsidy or financial the type of TIF district? (Mark one.) assistance to the same project? (Mark one.) ^ not applicable, assistance was not in the form of TIF ^ Yes (Specify each grantor and flue value of their assistance below; attach an additional sheet if necessary. ^ redevelopment ^ renewal and renovation ^ soils condition Grantor Value ($) ^ economic deve]opment ^ mined underground space ^ hazardous substance subdistrict Grantor Value ($) ^ No Minnesota Business Assistance Foam (02/01/05) Page 2 of 5 Dept. of Employment and Economic Development