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Forms for Dispensaries and Agents / 15-36 Application Packet
Forms for Dispensary Agents
- BLS Region Waiver Request Form
- Notice of Proper Zoning Form
- Adult Use Dispensing Organization License Surety Bond
- Adult Use Dispensing Organization License Escrow Account Agreement
- Example of Pre- and Post- Transaction Charts for Ownership Changes
- Tips for First Time Registration to renew a Professional License
- Application for Proposed Principal Officer of an Adult Use Dispensing Organization
- Fingerprint Instructions
- Fingerprint Vendor List
- Adult Use Fingerprint Consent Form
- Affidavit of No Subsequent Convictions
- Adult Use Dispensary Agent Attestation Form
- Petition for Restoration From Discipline
Forms for Dispensary Use
- Video Surveillance Failure Report Form
- Change of Ownership Guidance for Current License Holders (Updated February 8, 2023)
- Change of Ownership/Management Service Agreement Authorization Form
- Application for Proposed Principal Officer of an Adult Use Dispensing Organization
- Adult Use Out-of-State Fingerprint Instructions
- Request for Relocation - Form 1
- Request for Proposed Buidling and Site Conditional Approval - Form 2
- Request for Inspection of Relocation - Form 3
- IDFPR / Biotrack Inventory Adjustment Request Form
- Cannabis Control Section / Medical Cannabis Section Contact List
- Authorization for Third Party Contact
- Medical and Adult Use Cannabis Dispensing Organization Agent Termination Notification Form
15-36 Application Packet
- "15-36 License" Application
- Exhibit A - Table of Organization and Principal Officer Applications
- Exhibit B - Notice of Proper Zoning Form and Addenda
- Exhibit C - Proposed Floor Plan
- Exhibit D - Surety Bond
- Exhibit D - Escrow Account
- Exhibit E - Material Changes Attestation
- Exhibit F - Surety Bond / Escrow Account Waiver Form (Optional)
- Application for Extension of Conditional License