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Minnesota Bus ness Assistance Form* <br />?.o~o,~,.~ Minnesota Department of Trade and Economic Development <br /> <br />1. Funding government agency name <br /> <br />Please type or print in dark ink. <br /> <br />2. Agency street address <br /> <br />3. City <br /> <br />7. Contact name <br /> <br />9. Name of TIF district (ff applicable) <br /> <br />4. Zip Code <br /> <br />5. Phone number (area code) I 6. Fax number (area code) <br />8, Type of government agency <br /> ~ City ~County ~Regional ~Stnte <br /> <br /> ~ Oth~' (Please indic~_t.e) <br /> <br />10. Name of business receiving assistance <br /> <br />12. Job creation goals for business receiving assistance <br /> <br />14. Actual jobs created since business received assistance <br /> <br />16. Last tlat_e actual wage and job creation levels documented <br /> <br />11. Date business received assistance <br /> <br />13. Hourly wage level goals for business receiving assistance <br /> <br />15. Actual average hourly wage paid to employees hired since <br /> business received assistance <br /> <br />* Please complete one form for each business project your agency assisted with $25,000 or more in public funds. <br /> <br />Please send completed form annually by March 1 to: <br />Minnesota Business Assistance Form <br />Minnesota Department of Trade and Economic Development <br />500 Metro Square <br />121 East 7th Place <br />St. Paul, Minnesota 55101 <br /> <br />or fax report to: <br />(612) 296-1290 <br /> <br />For information, call: <br />(612) 297-1291 or 1~800-657-3858 <br /> <br /> <br />