5.1. HRSR 10-04-2004 - Laserfiche WebLink

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17. Industry of recipient's facility(Mark one.): • • •Manufacturing • •Services • Finance,Insurance,Real Estate • Retail Trade Wholesale Trade • • •Construction • *Other(please specify) 18. Did the recipient relocate as a result of signing this agreement?(Mark one.) • Yes(Indicate city and state of previous address and reason recipient did not complete this project at that address.) • No(Go to Question 19.) City/State of previous address Reason project not completed at previous address 19. Would the recipient have remained in previous location or relocated elsewhere if not awarded this business subsidy or financial assistance?(Mark one.) • Remained at previous location • *Relocated to different Minnesota location • Relocated outside Minnesota Section 3 Agreement Information 20. Total dollar value of business subsidy or financial 21. Date agreement signed(In addition to the agreement assistance(Please separate value by type in Questions 24 date, indicate any dates the agreement was amended.) and 25.) 22. Benefit date(Indicate the date the recipient will benefit from the business subsidy or financial assistance. For example, indicate the date improvements were finished,equipment was placed into service,or the recipient occupied the property, whichever is earlier.) 23. Does the agreement provide a business subsidy or one of the four types of financial assistance(see Question 25)required to be reported? (Mark one.) • *business subsidy • •financial assistance • 24.If the agreement provided a business subsidy,please 25. If the assistance was one of the four types of financial indicate the type(s)and total dollar value for each type. assistance,please indicate the type(s). • •not applicable,agreement provided financial assistance • •not applicable,agreement provided a business subsidy • loan(only principal) $ • -assistance for property polluted $ • grant(i.e.,forgivable loan) $ by contaminants • lax abatement $ • assistance for renovating building $ • •TIF or other tax reduction or deferral $ stock or bringing it up to code,and • guarantee of payment $ assistance provided for designated • *contribution of property or infrastructure $ historic preservation districts,when • preferential use of governmental facilities $ 50%or less of total cost • land contribution $ • •assistance for pollution control or $ • *other(Specify subsidy type.) $ abatement • *assistance for a TIF soils condition district $ 26. If the assistance included tax increment financing,please 27. Are any other grantors providing a business subsidy or indicate the type of TIF district?(Mark one.) financial assistance to the same project? (Mark one.) • •not applicable,assistance was not in the form of TIF • •Yes(Specify each grantor and the value of their assistance below;attach an additional sheet if necessary.) • •redevelopment • *renewal and renovation • No • soils condition • *economic development Grantor(s)and value of the agreement(s): • mined underground space • •hazardous substance subdistrict Grantor Value($) • Grantor Value($) Minnesota Business Assistance Form(1/14/04) Page 2 of 4 Dept.of Employment &Economic Development