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+NtiNESO,. 1999 Minnesota Business Assistance Form • (Please return by April 1,1999) Trade&- Economic Please complete lines 1 through 16 for all agreements. Development 1.Funding government agency name 2.Contact name 3.Agency street address 4.City 5.Zip code 6.Phone number(area code) 8.Type of government agency 7.Fax number(area code) -City _County Regional State -Other(Please indicate) 9.Name of business receiving assistance 10.Industry of recipient(SIC code) 11.Type of assistance(e.g.loan,TIF,grant,infrastructure,etc.) 12.Name of TIF district(if applicable) 13.Date of business 14.Date assistance first 15.Date project(building/ 16.Dollar value of business assistance agreement provided machinery/etc.)was assistance placed in service For assistance agreements signed between July 1,1995 and December 31,1997,complete lines 17 through 20.For agreements signed during 1998 and future years,please complete lines 21 through 24. • 17.Job creation goals for business receiving assistance 18.Average hourly wage level goals for business receiving assistance 19.Actual jobs created since business received assistance 20.Actual average hourly wage paid to employees hired since business received assistance Goals of business receiving assistance:(Please indicate Actual performance since project placed in service:(Please number of employees at each wage level and indicate the indicate number of employees at each wage level and indicate corresponding benefit level.) the corresponding benefit level.) 21.Job Creation Hourly Wage 22.Hourly Value 23.Job Creation Hourly Wage 24.Hourly Value Level of Voluntary Level of Voluntary Full-tine Part-time (excL benefits) Benefits($) Full-time Part-time (excl.benefits) Benefits($) less than$7.00 less than$7.00 $7.00 to$7.99 $7.00 to$7.99 $8.00 to$9.99 $8.00 to$9.99 $10.00 to$11.99 $10.00 to$11.99 $12.00 and higher $12.00 and higher If necessary,please attach additional documentation. If necessary,please attach additional documentation. Please complete lines 25 through 27 for all agreements. 25.Last date actual wage and job creation levels documented 26.Date this Minnesota Business Assistance Form completed 27.Have all wage and job goals been achieved? U Yes-do not submit future forms for this project. ❑No-please submit the 200011Tnnesota Business Assistance Form. • This form replaces all previous forms.Please complete one form for each business assistance agreement your agency signed between July 1,1995 and December 31,1998 which provided$25,000 or more in public funds or used tax increment financing.A form should be submitted annually for each assistance agreement until a submitted form indicates that all wage and job creation goals have been achieved Do not submit this form if your agency has not agreed to provide assistance to a business since July 1,1995. (over)