6.2 EDSR 12-16-2013 - Laserfiche WebLink

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p s• �v t, Department et Employment f aadEconominDevalopmant F nI G oseta Please fill in date agreement signed(same as question 21) 2013 Minnesota Business Assistance Form for Non-JOBZ Projects • • Use the Minnesota Business Assistance Form to report each business subsidy and financial assistance agreement signed from August 1, 1999 through December 31,2012 unless goals have been achieved and reported on a MBAF per Minn.Stat.§116J.993 to§116J.995. You may complete and submit this form online,instead of submitting a paper version. ■ The following government agencies must submit a MBAF: 1)any local government/agency that signed a business subsidy agreement since January I,2008,or represents a population of more than 2,500;2)all state government agencies authorized to provide business subsidies;3)business assistance that exceeds$150,000. • DEED will contact any local or state government agency that is required to report but has not done so by April 1. Business assistance may not be awarded after June 1 of each year until a report has been submitted. • Questions? Call(651)259-7179. Information on where to mail or fax your completed MBAF(s)is on page 5. Section 1: (Grantor Information) 1.Name of grantor (funding entity): City of Elk River 2.Name of person completing this form: Clay Wilfahrt 3.Street address: 13065 Orono Parkway 4.City: Elk River 5.Zip Code: 55330 6.County: Sherburne 7.Phone number: 763.635.1000 8.Fax number: 763.635.1090 9.E-mail address: cwi ifahrt @elkri vetmn.gov 10.Please indicate who in your organization should receive the MBAF if different from the person in Question 2. Name: Title: Street Address: City: I Zip Code: Phone Number: Email Address: 11.Classification of grantor(Mark one.If grantor is entity created 12.Has your organization held a public hearing on and adopted S by gov't agency,please indicate affiliation. For example,a city EDA would check"City government.') criteria for awarding business subsidies in compliance with Minn.Stat.§ 116J.994? (Mark one.) City government ❑ Yes,in 2013(attach criteria) ❑ Yes,in 2013 but have not yet adopted criteria ❑County government ❑ Yes,prior to 2013 ❑Regional government If Yes: Hearing Date: Year Criteria Submitted: ❑State government ❑ No ❑Other(Please specify): ❑ Other(Please attach explanation.) 13.Has your organization signed any agreements to award a business subsidy or financial assistance from August 1, 1999 through December 31,2012 unless goals have been achieved and reported in a previously filed MBAF? (Mark one.) ®Yes(Complete the remainder of the form unless goals have been achieved and ❑No(Stop here,go to section 5 on page 4.) reported in a previously filed MBAF per Minn.Stat.§116J.993 and§116J.994) Section 2: Recipient Information 14.Name of business or organization 15.Address where business subsidy or financial assistance receiving subsidy or financial assistance: Bank of Elk River will be used Street address:630 Main St NW City,State,Zip Code:Elk River,MN 55330 16.Does the recipient have a parent corporation? (Mark one.) ❑Yes(Indicate name and address of parent corporation below. If more than one,indicate ultimate owner.) ®No Name of parent corporation: Street address: City,State,Zip Code: • Minnesota Business Assistance Form(12/10/12) Page 1 of 5 Dept.of Employment and Economic Development