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17. Industry of recipient’s facility (Mark one.): Manufacturing Services Finance, Insurance, Real Estate Retail Trade Wholesale Trade Construction Other (please specify) ___________________ 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 Question 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__________________________________________________________________________________________ Section 3: Agreement Information 20. Total dollar value of business subsidy or financial assistance (Please separate value by type in Questions 24 and 25.) (Enter zero for JOBZ, Biozone and Agzone projects.) 21. Date agreement signed (In addition to the agreement date, indicate any dates the agreement was amended.) 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 subsidy financial assistance 24. If the agreement provided a business subsidy, please indicate the type(s) and total dollar value for each type. not applicable, agreement provided financial assistance loan (only principal) $_______ grant (i.e., forgivable loan) $_______ tax abatement $_______ TIF or other tax reduction or deferral $_______ guarantee or payment $_______ contribution of property or infrastructure $_______ preferential use of governmental facilities $_______ land contribution $_______ Biozone $ 0 JOBZ (state tax exemptions/credits and sales tax) $ 0 JOBZ - Agzone $ 0 other (Specify subsidy type.) _________________ $_______ (Note: no dollar value for zone projects) 25. If the assistance was one of the four types of financial assistance, please indicate the type(s). not applicable, agreement provided a business subsidy assistance for property by contaminants $________ assistance for renovating building stock or bringing it up to code, and assistance provided for designated historic preservation districts, when 50 percent or less of total cost $________ assistance for pollution control or abatement $________ assistance for a TIF soils condition district $________ 26. If the assistance included tax increment financing, please indicate the type of TIF district? (Mark one.) not applicable, assistance was not in the form of TIF redevelopment renewal and renovation soils condition economic development mined underground space hazardous substance subdistrict 27. Are any other grantors providing a business subsidy or financial assistance to the same project? (Mark one.) Yes (Specify each grantor and the value of their assistance below; attach an additional sheet if necessary. ______________________________ _____________________ Grantor Value ($) ______________________________ _____________________ Grantor Value ($) No Minnesota Business Assistance Form (02/01/05) Page 2 of 5 Dept. of Employment and Economic Development