Instructions for Completing the Temporary Cannabis Retailer Application

INSTRUCTIONS FOR COMPLETING THE TEMPORARY CANNABIS RETAILER APPLICATION SECTION A – Applicant/Business Information

When completing the application, the applicant must select the appropriate license type and designation for the cannabis activity they will be conducting:

License Application Type
· Adult-Use (A-License) · Medicinal (M-License)

Non-Storefront Retailer (Delivery): Sells and delivers cannabis or cannabis products to consumers. A retailer non-storefront must have a licensed premises but is not open to the public, and conducts sales exclusively by delivery.

Retailer (Storefront Sales): Sells and delivers cannabis and cannabis products to consumers. A retailer must have a licensed premises which may be open to the public to sell cannabis and cannabis products to customers. Sales may also be conducted by delivery.

Business Organizational Structure

All applicants are required to identify their business organizational structure. (See Required Attachments)

Business Contact Information

If an individual, the first and last name of the applicant must be provided. If the applicant is a business entity, then the full legal business name is required. The applicant business name must be identical to the name listed on the business-formation documents submitted to the Bureau. The applicant must provide the physical address of the premises, and the mailing address if it is different. The applicant must also provide the business website address, email address, and telephone number.

Social Security Number/Individual Taxpayer Identification Number/Federal Employer Identification Number

Each applicant must provide a valid United States Social Security Number (SSN), an Individual Taxpayer Identification Number (ITIN), or a Federal Employer Identification Number (FEIN), before an application can be approved.

SECTION B – Primary Contact Person

The primary contact is the individual who is designated as the person the licensing authorities can contact for information regarding the business. The applicant must provide the primary contact’s name, title, telephone number, and email address.

SECTION C – Owner Information

An owner is defined as a person with an aggregate ownership interest in the commercial cannabis business of 20 percent or more, unless the interest is solely a security, lien or encumbrance. An owner includes:

▪ A person with an aggregate ownership interest of 20 percent or more in the person applying for a license or a licensee, unless the interest is solely a security, lien or encumbrance.

▪The chief executive officer of a nonprofit or other entity (i.e. corporation). ▪ A member of the board of directors of a nonprofit.

▪An individual who will be participating in the direction, control, or management of the person applying for a license.
▪ An owner who is an individual participating in the direction, control, or management of the commercial cannabis business

includes any of the following:
▫A partner of a commercial cannabis business that is organized as a partnership.
▫ A member of a limited liability company of a commercial cannabis business that is organized as a limited liability company. ▫ An officer or director of a commercial cannabis business that is organized as a corporation.

SECTION D – Required Attachments/Documents
Premises Diagram
Applicants are required to provide a diagram of the premises, which must be drawn to scale and clearly identify the items below:

· Boundaries of the property. If only a portion of the property is used for the cannabis business, the applicant must label the the other areas and state what they are being used for.

· Dimensions, entrances, and exits.
· Interior partitions, walls, rooms, windows, doorways, and common or shared entryways. · Breakrooms, changing facilities/bathrooms, which must be separate from storage areas. · Type of cannabis activity that will be conducted in each area.
· Numbering and location of all cameras.

BBC-LIC-002A (12/17)

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Documentation of Local Compliance

Applicants are required to submit a copy of valid license, permit, or other authorization from the local jurisdiction with the application for licensure.

Evidence of Legal Right to Occupy

If the applicant owns the property, a copy of title or deed must be provided. If the applicant does not own the property, a statement from the property owner that the applicant has the legal right to occupy the property to perform
commercial cannabis activities and a copy of the applicant’s rental agreement must be provided.

Additional Information Incomplete Application

If the application is incomplete, a notification will be sent to all owners listed on the application with details regarding the information still needed to process the application. Notification of incomplete information on an Owner Submittal will only be sent to the specific owner.

Withdrawal of Application

If applicant wishes to withdraw the submitted application, a written withdrawal request, including the date and signature of at least one owner must be submitted.

BBC-LIC-002A (12/17)

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