Form Sfn 59686 - Business Incentive Agreement - North Dakota Department Of Commerce

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BUSINESS INCENTIVE AGREEMENT
NORTH DAKOTA DEPARTMENT OF COMMERCE
SFN 59686 (04/2012)
The RECIPIENT specified below has been approved to receive a business incentive from the state of North Dakota.
Therefore, in fulfillment of the requirements of North Dakota Century Code § 54-60.1-03, the grantor of the business
incentive (GRANTOR) and the entity to receive the business incentive (RECIPIENT) must enter into a Business
Incentive Agreement. This Business Incentive Agreement provides project data and specifies the goals the
RECIPIENT has agreed to meet in order to receive the state business incentive.
Should the value of this incentive be less than $25,000, and should the RECIPIENT receive no additional incentives to
bring the total to $25,000 or more within one year, the reporting requirements outlined in North Dakota Century Code §
54 -60.1-05, and in this agreement, will not go into effect.
Grantor
Name of GRANTOR
On Behalf Of
Address
City
State
Zip Code
Recipient
Name of RECIPIENT Business
Also known as
Mailing Address
City
State
Zip Code
Street Address
City
State
Zip Code
Main Contact Person
Email Address
Business Classification of RECIPIENT (3 digit NAICS code)
Location of RECIPIENT prior to receiving this business incentive (if different from above)
Street Address
City
State
Zip Code
Parent Company of RECIPIENT (if any)
Street Address
City
State
Zip Code
Project Information
(For office use only) Project Number
File Number
Incentive Value
Benefit Date
Incentive Type
Incentive Description
Is this incentive tax increment financing? Yes
 No
If yes, describe the type of district:
Project Description:

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