6.2 EDSR 12-16-2013 - Laserfiche WebLink

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p_asitively = tnnes(tc( 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 fromAuaust 1� 1999 through December 31,2012 unless goals have been achieved and reported on a MBAF per Minn.Stat.§1161993 to§1167.995. 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 1,2008,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 maynot 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): 2.Name of person completing this form: 3.Street address: 4.City: 5.Zip Code: 6.County: 7.Phone number: 8.Fax number: 9.E-mail address: 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 • by gov't agency,please indicate affiliation. For example,a city government) criteria for awarding business subsidies in compliance with ..DA would cheek°City Minn.Stat.§1161994? (Mark one.) ❑City government ❑ .Yes,in 2013(attach criteria) f0 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 ❑ ::o ❑Other(Please specify): I 0 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.01167.993 and§116..994.) • Section 2: Recipient Information _ 14.Name of business or organization I5.Address where business subsidy or financial assistance receiving subsidy or financial assistance: will be used Street address. City,State,Zip Code: 16.Does the recipient have a parent corporation? (Mark one) ❑Yes(Indicate name and address ofparent corporation below. If more than one,indicate ultimate owner.) 0 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