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2001 Minnesota Business Assistance Form <br /> Econon'nc <br /> Devdopment <br /> <br /># The 2001 Minnesota Business Assistance Form (MBAF) is used to report each business subsidy and financial <br /> assistance agreement signed from January 1, 2000 through December 31, 2000 per Minn. Stat. § 116J.993 to <br /> § 116J.995. Please use a separate form to report each agreement; for agreements signed from August 1, 1999 <br /> though December 31, 1999, use the 2000 MBAF; and for agreements signed from July 1, 1995 through July 31, <br /> 1999 use the 1999 MBAF. <br /> <br /># The following govemment agencies must submit a 2001 MBAF even if an agreement was not signed during the <br /> period January 1, 2000 through December 31, 2000: I) any local government/agency that signed a business <br /> subsidy agreement since January 1, 1996, or represents a population of more than 2,500; 2) all state government <br /> agencies. If the local/state government agency does not have any subsidies or assistance to report, please answer <br /> questions 1 through 13 and questions 33 and 34. <br /> <br /># If a local or state government agency that is required to report has not done so by April 1, DTED will mail a <br /> warning. If it fails to report by June 1, it may not award any business subsidies until a report has been filed. <br /> # Questions? Call (651) 296-0580. Information on where to mail or fax your completed MBAF(s) is on page 4. <br /> Abo t Grantor <br /> <br />~ecllon · llllU[llliltl~/ll ti. ut/ut ut <br />I. Name o~ ~rantor ~nclin~ entity) 2. ~Name o£ person completing,this <br /> <br /> 3. S=ect ad.ess 4. Ci~ ~ 5. ZIP code <br /> 6. Coun~ 7. Phone number 8. Fax number 9. E-mail address <br /> <br /> I0. Please indicate who in your organization should receive the 2002 MB~ if different ~om the person in ~estion 2. <br /> Name/Title Phone number S=eet ad,ess Ci~ ZIP code <br /> 11. Classification of~antor (Mark one. If grantor is enti~ 12. Has yo~ org~ization held a public heating on ~d <br /> created by gov 't agency, please indicate affiliation. For adopted criteria for awarding business subsidies in <br /> example, a ci~ EDA would check "CiW government. '~ compliance with Minn. Stat. }116J.9947 (Mark one.) <br /> ~i* government ~Xes (Indicate hearing date an~criteri~ <br /> ~ Co~W government ~ No <br /> ~ Regional government ~ We held a public hearing but have not yet adopted <br /> ~ State government criteria Gndicate date of initial hearing - ) <br /> ~ Other (Please speci~.) ~ Other (Plebe attach explanation.) <br /> <br /> 13. Has your organization si~ed ~y a~eements to award a business subsidy or financial assistance ~om Januau 1, 2000 <br /> through December 31, 2000 that is required to be repoffed under Minn. Stat. ~ 116J.993 and ~ 116J.9947 (Mark one.) <br /> ~s (Complete the remainder of the form.) ~ No (Stop here, go to section 5 on page 4.) <br /> <br />Section 2 Information About Recipient <br /> <br />14. Name of business or organization <br /> receiving subsidy or financial assistance <br /> <br /> 15. Address where business subsidy or financial assistance <br /> will be used <br /> <br />1/357 z <br />IStreet address City State ZIP code <br /> <br />16. Does the recipient have a parent corporation? (Mark one.) <br />~ Yes (Indicate name and address of parent corporation below. If more than one, indicate ultimate owner.) <br /> <br />Name of parent corporation Street address City State <br /> <br />ZIP code <br /> <br />2001 Minnesota Business Assistance Form Page I of 4 Department of Trade and Economic Development <br /> <br /> <br />