Grain Storage Facility Safety Cost-Share Application | Minnesota Department of Agriculture

To apply for the Grain Storage Facility Safety Cost-Share, please fill in and submit this form. If you have questions, contact Allison at Allison.Beauregard@state.mn.us.

* indicates required field

First name

Last name

Farm or company name

Mailing address

City

State

Zip

County

Farm location, if different than mailing address

Phone

Total number of bins and silos on the farm

Number of bins and silos where equipment was installed

Tell us what kind of equipment you installed

List your eligible purchases

Purchased from	Item(s) bought	Where item will be used	Total cost	Operations
Purchased from	Item(s) bought	Where item will be used	Total cost

Is there anything else you'd like us to know about your application?

Upload proof(s) of purchase

Choose files

Upload requirements

Provide your W-9 (required)

I completed the W-9 in DocuSign

If you don’t have an electronic version of your W-9, go to this PowerForm Signer Information page, enter your name and email address, and click “Begin Signing” to go to the W-9 in DocuSign.

I am uploading a photo or scan of my signed W-9

Choose file to upload

Upload your W-9

Application agreement

I acknowledge that I have read and agreed to the Privacy Notice and attest that the information I am submitting is true, complete, and accurate.

Privacy notice

Privacy Notice: Some data provided in this application may be classified by the Minnesota Data Practices Act or other law as private or nonpublic. Access to private or nonpublic data is limited by law to MDA staff and contractors with a valid work assignment to access the data, parties authorized by the applicant or by a valid court order, Minnesota Management and Budget, Minnesota Department of Administration, the state auditor, the legislative auditor and any other entity or person authorized by state law, federal law, or federal subpoena. If necessary, the MDA may also share the data with law enforcement or the office of the Minnesota Attorney General. The information provided will be used to assess if an applicant is eligible to receive payment under this program. Applicants are not legally required to provide the information requested in this application, but only completed applications will be considered.

Internal Revenue Service Code Section 6109 requires applicants to provide their correct taxpayer identification number to payers who must file information returns with the IRS. The MDA will use the information provided on the applicant’s W-9 form to report payments received as part of the Loan Origination Fee Grant Program to the IRS. The IRS uses the numbers for identification purposes and to help verify the accuracy of the applicant’s tax return. For more information on how the information provided on a W-9 may be used, refer to the Privacy Act Notice on page 6 of the W-9 form.