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Section JZ: JOZ Information Complete Questions 28-31 if the financial assistance was awarded to a JOBZ qualified business recipient receiving JOBZ benefits. (If not, go directly to Question 32.) JZ1. What was the amount of private capital investment of the business in the JOBZ zone prior to December 31, 2004? Real (land and buildings) $________________ Personal (equipment) $________________ JZ2. What was the property tax assessment which was not collected for the property where the JOBZ qualified business was operating during the period of January 1, 2004 and December 31, 2004? (Please specify each additional parcel identification number and the value of the property tax assessment that was not collected during the period of January 1, 2004 and December 31, 2004; attach an additional sheet if necessary – obtain information from county tax assessor's office.) $____________________ for Parcel Identification Number: ____________________ JZ3. What was the value of Wind Energy Production Tax, if any, for the JOBZ qualified business that was operating during the period of January 1, 2004 and December 31, 2004? $_____________________ Section 4: Goals and Public Purpose Identified in the Agreement 28. Minn. Stat. §116J.994 requires that business subsidy and financial assistance agreements state a public purpose. Which of the following public purposes were stated in the agreement? (Mark all that apply.) Enhancing economic diversity Increasing tax base (cannot be only purpose) Creating high-quality job growth Job retention Other (please specify) ________________________________________ Stabilizing the community 29. Indicate whether the agreement included the following types of goals, and whether the recipient had attained those goals at the time of this report. (Fill in the boxes and attainment date(s) for each goal.) Goals Target attainment All goals established? dates (month & year) attained? A) Specific wage and job goals to be attained within 2 years Yes No _________________ Yes No B) Other job-creation and/or retention goals Yes No _________________ Yes No C) Other wage goals Yes No _________________ Yes No D) Goals other than wage and job goals Yes No _________________ Yes No (Please attach description of goals and progress toward attainment (if not documented in Questions 30 and 31.) 30. For each of the following wage categories, indicate the job creation and/or retention goals stated in the agreement and the average hourly value of any employer-provided health insurance goals for those jobs. (Only indicate job creation goals in full-time equivalents if you are unable to separate goals by full- and part-time positions.) Full-time Part-time/ FTE (only if unable to Hourly Wage Job Seasonal/Temp. stated as FT/PT) Hourly Value of (excluding benefits) Creation Job Creation Job Creation Job Retention Health Insurance no hourly wage-level goal ________ ________ ________ ________ $________ less than $7.00 ________ ________ ________ ________ $________ $7.00 to $8.99 ________ ________ ________ ________ $________ $9.00 to $10.99 ________ ________ ________ ________ $________ $11.00 to $12.99 ________ ________ ________ ________ $________ $13.00 to $14.99 ________ ________ ________ ________ $________ $15.00 and higher ________ ________ ________ ________ $________ Minnesota Business Assistance Form (02/01/05) Page 3 of 5 Dept. of Employment and Economic Development