MINNESOTA MANAGEMENT & BUDGET TREASURY DIVISION PUBLIC PURPOSE SCORING WORKSHEET FOR MANUFACTURING PROJECTS AND ENTERPRISE ZONE FACILITY PROJECTS Pursuant to Minnesota Statutes, Chapter 474A, as amended Form W Scoring Worksheet Revised March 2009 Page 1 of 1 Name of Issuer: Name of Business: Address of Business: Amount of Allocation Requested: The following criteria will be used to award an allocation if competing applications are received. 1. Direct new jobs created in the state within the next 2 years: $100,000 � Allocation requested = 2. X Direct new jobs X 15 = Points Scored Direct existing jobs retained in the state within the next 2 years: $100,000 � Allocation requested = X Direct existing jobs X .625 X 15 = 3. Average hourly wage paid to employees by the proposed project within the next 2 years (exclusive of benefits mandated by law) Average Wages Paid Per Hour Non-metro area points awarded Seven county metro area points awarded $8 10 0 $10 15 10 $12 20 15 $15 20 20 4. Net property tax increase in first full year of operation Estimated net increase in property tax: $ � Allocation requested = X 500 = 5. Community unemployment rate Seasonally unadjusted unemployment rate for the city or county: % � State average unemployment %= X 10 = 6. 7. Project is located in an incorporated area or a planned urban growth area as defined by M.S. 462.352, subdivision 18. If yes, add 20 points. If no, add 0 points. Project is a brownfield project located in a state or federal Superfund site, a voluntary investigation and cleanup site, or a brownfield site, all as defined by the Minnesota pollution control agency. If yes, add 20 points. If no, add 0 points. Project demonstrates favorable environmental citizenship as evidenced by no nonforgivable or combination administrative penalty orders, stipulation agreements, consent decrees, or other enforcement orders containing a monetary penalty by the Minnesota Pollution Control Agency over the past three years or pending at the time of application. If yes, add 20 points. If no, add 0 points. TOTAL POINTS SCORED 8. Certification: The issuer certifies that the above information is true and correct to the best knowledge of the undersigned. Name/Title/Issuer: Signature: Send one original to: Minnesota Management & Budget, Treasury Division Attn: Susan Gurrola 400 Centennial Building, 658 Cedar Street St. Paul, Minnesota 55155-1489 Date: American LegalNet, Inc. www.FormsWorkFlow.com