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<br />Section 5 Recipients Failing to Fulfill Obligations <br /> <br />Do not com/Jlete this section if you com/Jleted it on another MBAF submitted to DEED.) <br />33. During the period January 1, 2003 through December 31, 2003, did your organization have any recipients who failed to <br /> report asrequired by Minn. Stat. * 1161.993 and * 1161.994? (Mark one.) <br />. .Yes (Indicate the name of each recipienJ failing to report and the value of subsidy or financial assistance awarded to that <br /> recipient. Attach additional pages ifnecessary.) <br />. -No <br />Name of recipient Type of subsidy or assistance (See Questions 24 and 25.) Value of subsidy or assistance <br />34. Did your organization have any recipients who failed to achieve any goals or fulfill any other obligations under an <br /> agreement signed on or after August 1, 1999, that were required to be fulfilled by the time of this report? (Mark one.) <br /> . .Yes (Complete the remainder of this section.) - -No (Stop here and submit form to DEED .) <br />35. . 39. Provide the following information for each recipient failing to fulfill goals or any other terms of an agreement that <br /> were to be attained by the time of reporting. (Attach additional pages ifnecessary.) <br />35. Information on recipient and agreement: <br />Name of recipient in default Type of subsidy or assistance Initial value of <br /> subsidy or assistance <br />Street address of recipient City/ZIP code of recipient Outstanding value of <br /> subsidy or assistance <br />36. Reason(s) for default (Mark all that apply.): <br />- -recipient ceased operation - -recipient relocated to a different community <br />- -recipient was unable to fill vacant positions - ~ther (Specify reason.) <br />37. To date, has the recipient fulfilled its repayment obligation? (Mark one.) <br />- -Yes - -No, recipient has begun to repay the assistance. - -No, recipient has not beeun to repay the assistance. <br />38. Has the agreem::nt been amended to extend the recipient's deadline for fulfilling its obligations? (Mark one.) <br /> - -Yes - -No <br />39. Describe the steps being taken to bring recipient into compliance or recoup the subsidy: <br /> <br />Return your completed MBAF(s) by April I, 2004, to: <br />Minnesota Business Assistance Form <br />Minnesota Department of Employment and Economic Development - AEO <br />500 Metro Square, 121 East 7'" Place <br />St. Paul, MN 55101-2146 <br /> <br />Or fax to: (651) 215-3841 <br /> <br />Minnesota Business Assistance Fonn (1/14/04) <br /> <br />Page 4 of4 <br /> <br />Dept. of Employment & Economic Development <br />