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EXHIBIT C <br /> • Minnesota Business Assistance Form <br /> (Minnesota Department Of Trade And Economic Development) <br /> ♦`►c.Tade�Q.. <br /> f <br /> • <br /> EC O <br /> n.; Minnesota Business Assistance Form* <br /> ti• N? 4 Minnesota Department of Trade and Economic Development <br /> A <br /> A,•OSd ap`• <br /> •p.♦ .n I� • <br /> 4 <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 TIF 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 /> Please send completed form annually by March 1 to: or fax report to: <br /> Minnesota Business Assistance Form (6I2)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 />