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<br />17. Industry ofrecipient's facility (Mark one.): <br /> . -Manufacturing . -Services . -Finance, Insurance, Real Estate <br /> . -Retail Trade . -Wholesale Trade . -Construction . -Other (please specify) <br />18. Did the recipient relocate as a result of signing this agreement? (Mark one.) <br />. .Yes (Indicate city and state a/previous address and reason recipient did not complete this project at that address.) <br />. -No (Go to Question 19.) <br />City/State of previous address Reason project not completed at previous address <br />19. Would the recipient have remained in previous location or relocated elsewhere if not awarded this business subsidy or <br />financial assistance? (Mark one.) <br /> . -Remained at previous location . -Relocated to different Minnesota location . -Relocated outside Minnesota <br /> <br />Section 3 A"reement Information <br />20. Total dollar value of business subsidy or financial 21. Date agreement signed (In addition to the agreement <br /> assistance (Please separate value by type in Questions 24 date, indicate any dates the agreement Will amended.) <br /> and 25.) <br />22. Benefit date (Indicate the date the recipient wil/ benefitfrom the business subsidy or financial assistance. For example, <br />indicate the date improvements were finished, equipment was placed into service, or the recipient occupied the property, <br />whichever is earlier.) <br />23. Does the agreement provide a business subsidy or one of the four types of financial assistance (see Question 25) required to <br />be reported? (Mark one.) <br /> . "business subsidy . -financial assistance <br />24. If the agreement provided a business subsidy, please 25. If the assistance was one of the four types of financial <br />indicate the type(s) and total dollar value for each type. assistance, please indicate the type(s). <br />- 'flat applicable, agreement provided financial assistance - "I1ot applicable, agreement provided a business subsidy <br />- -loan (only principal) $ - -assistance for property polluted $ <br />- "grant (i.e., forgivable loan) $ by contaminants <br />- "tax abatement $ - oassistance for renovating building $ <br />- -TIF or other tax reduction or deferral $ stock or bringing it up to code, and <br />- "guarantee of payment $ assistance provided for designated <br />- "Contribution of property or infrastructure $ historic preservation districts, when <br />- "preferential use of governmental facilities $ 50% or less of total cost <br />- -land contribution $ - -assistance for pollution control or $ <br />. ,,'her (Specify subsidy type.) $ abatement <br /> - -assistance for a TIF soils condition district $ <br />26. If the assistance included tax increment financing, please 27. Are any other grantors providing a business subsidy or <br />indicate the type of TIF district? (Mark one.) financial assistance to the same project? (Mark one.) <br />- 'flot applicable, assistance was not in the form ofTIF - -Yes (Specify each grantor and the value of their <br /> assistance below; attach an additional sheet ifnecessary) <br />- 'redevelopment <br />- -renewal and renovation - -No <br />- "Soils condition <br />- -economic development Grantor(s) and value of the agreement(s): <br />- mined underground space <br />- -hazardous substance subdistrict <br /> Grantor Value ($) <br /> Grantor Value ($) <br /> <br />Minnesota Business Assistance Fonn (1/14/04) <br /> <br />Page2of4 <br /> <br />Dept. of Employrrent & Economic Development <br />