Marijuana Dispensary License Application
- SECTION 1 - OWNER'S INFORMATION
- 1.1 First name: Herbert
1.2 Surname: Hinkleton
1.3 Middle name:
1.4 Age: 51
1.5 Date of birth: 01/01/1970
1.6 Place of birth: Fort Carson, Bone County, San Andreas
1.7 Nationality: American
1.8 Current address: 19 Hempshire Park, Fort Carson
1.9 Cellphone number: 1119111
1.10 Email address: [email protected]
1.11 Do you have any criminal convictions?: No
1.12 Have you ever been arrested?: No
1.13 Have you ever been placed on probation?: No
1.14 If answered yes to any of the above, please detail here: N/A
*Note that all applicants will receive a background check confirming their criminal charges if any are present.
- SECTION 2 - BUSINESS INFORMATION - RETAIL SALE OF MARIJUANA
- 2.1 Retail business name: Smokers Paradise
2.2 Retail business address: Smokers Paradise, Blue Road, Blueberry
2.3 Approximate customer capacity: 40
2.4 Will allow marijuana consumption on-site?: [✓]
- SECTION 3 - BUSINESS INFORMATION - GROWING OF MARIJUANA
- 3.1 Wholesaler business name: Hinkleton Industries
3.2 Wholesaler business address: 19 Hempshire Park
3.3 Address of the location where the marijuana is going to be grown: 19 Hempshire Park
3.4 Approximate number of marijuana plants: 15 at full capacity.
- SECTION 4 - CONDITIONS OF ACCEPTANCE
- I, the undersigned, certify that all of the information that I have provided on this application is true and completed to the best of my knowledge. I understand that falsifying any information or omitting information may result in referral to law enforcement for Fraud and will result in an immediate rejection of the application; if already issued - it will be revoked immediately. I promise to obey all regulations laid out in the Controlled Substances Act of 2020. I know I am obliged to restrict access to persons younger than 21 to all premises where marijuana is grown, stored, handled, sold and consumed and to ensure that growing and consuming marijuana is done in a location not in view of the public. I am also not permitted to sell or furnish alcohol or tobacco, or host gambling games on the premises. I cannot have been convicted for substance violations or offences under the Controlled Substances Act and it is my responsibility to ensure that none of my employees have not been convicted either. I understand that my retail business may be inspected by licensing officials at any time during its opening hours and that a licensing official may request and gain access to the location I grow marijuana at any time and for any reason.
- Name [PRINTED]: HERBERT HINKLETON
- Signature: Hinkle
- Date: 01/01/2021
