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EXHIBIT D <br /> • Minnesota Business Assistance Form <br /> (Minnesota Department Of Trade And Economic Development) <br /> '.1;a4 <br /> a.4 <br /> . adte :'♦ <br /> C O ♦ <br /> ti <br /> . Minnesota Business Assistance Form* <br /> 4 01 c7 <br /> Minnesota Department of Trade and Economic Development <br /> ,. 411a%!:44 <br /> Please type or print in dark ink. <br /> 1.Funding government agency name <br /> 2.Agency street address <br /> 3.City 4.Zip Code 5.Phone number(area code) 6.Fax number(area code) <br /> 7.Contact name 8.Type of government agency <br /> • _City _County _Regional _State <br /> —Other(Please indicate) <br /> 9.Name of TIP district(if applicable) <br /> 10.Name of business receiving assistance 11.Date business received assistance <br /> 12.Job creation goals for business receiving assistance 13.Hourly wage level goals for business receiving assistance <br /> 14.Actual jobs created since business received assistance 15.Actual average hourly wage paid to employees hired since <br /> business received assistance <br /> 16.Last date actual wage and job creation levels documented <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: or fax report to: <br /> Minnesota Business Assistance Form (612)296-1290 <br /> Minnesota Department of Trade and Economic Development <br /> 500 Metro Square For information,call: <br /> 121 East 7th Place (612) 297-1291 or 1-800-657-3858 <br /> St. Paul,Minnesota 55101 <br />