Medical Marijuana Establishment Registration Certificate ...

BRIAN SANDOVAL Governor JAMES DEVOLLD Chair, Nevada Tax Commission DEONNE E. CONTINE Executive Director

STATE OF NEVADA

DEPARTMENT OF TAXATION

Web Site:

1550 College Parkway, Suite 115 Carson City, Nevada 89706-7937 Phone: (775) 684-2000 Fax: (775) 684-2020

LAS VEGAS OFFICE Grant Sawyer Office Building, Suite1300

555 E. Washington Avenue Las Vegas, Nevada 89101 Phone: (702) 486-2300 Fax: (702) 486-2373

RENO OFFICE 4600 Kietzke Lane Building L, Suite 235 Reno, Nevada 89502 Phone: (775) 687-9999 Fax: (775) 688-1303

HENDERSON OFFICE 2550 Paseo Verde Parkway, Suite 180

Henderson, Nevada 89074 Phone: (702) 486-2300 Fax: (702) 486-3377

Medical Marijuana Establishment Registration Certificate

Request for Applications

Release Date: November 1, 2017 Accepting Applications Period: November 20, 2017 through December 4, 2017

(Business Days M-F, 8:00 A.M. - 5:00 P.M.)

For additional information, please contact: Medical Marijuana Establishment (MME) Program

State of Nevada Department of Taxation 1550 College Parkway, Suite 115 Carson City, NV 89706 Phone: 866-962-3707

Email address: marijuana@tax.state.nv.us

Version 5.1? 09/27/2017 Medical Marijuana Establishment Registration Certificate Application

Page 1 of 47

BRIAN SANDOVAL Governor JAMES DEVOLLD Chair, Nevada Tax Commission DEONNE E. CONTINE Executive Director

STATE OF NEVADA

DEPARTMENT OF TAXATION

Web Site:

1550 College Parkway, Suite 115 Carson City, Nevada 89706-7937 Phone: (775) 684-2000 Fax: (775) 684-2020

LAS VEGAS OFFICE Grant Sawyer Office Building, Suite1300

555 E. Washington Avenue Las Vegas, Nevada 89101 Phone: (702) 486-2300 Fax: (702) 486-2373

RENO OFFICE 4600 Kietzke Lane Building L, Suite 235 Reno, Nevada 89502 Phone: (775) 687-9999 Fax: (775) 688-1303

HENDERSON OFFICE 2550 Paseo Verde Parkway, Suite 180

Henderson, Nevada 89074 Phone: (702) 486-2300 Fax: (702) 486-3377

APPLICANT INFORMATION SHEET FOR MEDICAL MARIJUANA ESTABLISHMENT APPLICATION

Applicant Must: A) Provide all requested information in the space provided next to each numbered question. The information provided in Sections V1 through V10 will be used for application questions and updates; B) Type or print responses; and C) Include this Applicant Information Sheet in Tab III of the Identified Criteria Response.

V1

Company Name

V2

Street Address

V3

City, State, ZIP

V4

Area Code

Telephone Number Number

Extension

V5

Area Code

Facsimile Number Number

Extension

V6

Area Code

Toll Free Number Number

Extension

Contact Person for Providing Information, sign documents, or ensure actions are taken pursuant to NAC

453A.300

Name:

V7

Title:

Address:

Email Address:

V8 Area Code:

Telephone Number for Contact Person Number:

Extension:

V9 Area Code:

Facsimile Number for Contact Person Number:

Extension:

V10 Signature:

Signature

Date:

Version 5.2 ? 10/31/2017 Medical Marijuana Establishment Registration Certificate Application

Page 2 of 47

BRIAN SANDOVAL Governor JAMES DEVOLLD Chair, Nevada Tax Commission DEONNE E. CONTINE Executive Director

STATE OF NEVADA

DEPARTMENT OF TAXATION

Web Site:

1550 College Parkway, Suite 115 Carson City, Nevada 89706-7937 Phone: (775) 684-2000 Fax: (775) 684-2020

LAS VEGAS OFFICE Grant Sawyer Office Building, Suite1300

555 E. Washington Avenue Las Vegas, Nevada 89101 Phone: (702) 486-2300 Fax: (702) 486-2373

RENO OFFICE 4600 Kietzke Lane Building L, Suite 235 Reno, Nevada 89502 Phone: (775) 687-9999 Fax: (775) 688-1303

HENDERSON OFFICE 2550 Paseo Verde Parkway, Suite 180

Henderson, Nevada 89074 Phone: (702) 486-2300 Fax: (702) 486-3377

TABLE OF CONTENTS

1. TERMS AND DEFINITIONS ................................................................................................................ 4

2. APPLICATION OVERVIEW ................................................................................................................ 9 3. APPLICATION TIMELINE ................................................................................................................ 10 4. APPLICATION INSTRUCTIONS.......................................................................................................10

5. APPLICATION REQUIREMENTS, FORMAT AND CONTENT................................................... 11 6. APPLICATION EVALUATION AND AWARD PROCESS.............................................................22

ATTACHMENT A- MEDICAL MARIJUANA ESTABLISHMENT APPLICATION .............................. 26 ATTACHMENT B ? OWNER OFFICER AND BOARD MEMBER ATTESTATION FORM ............... 30

ATTACHMENT C ? OWNER, OFFICER AND BOARD MEMBER INFORMATION FORM ............. 32 ATTACHMENT D ? CHILD SUPPORT VERIFICATION FORM.............................................................34

ATTACHMENT E? REQUEST AND CONSENT TO RELEASE APPLICATION FORM ..................... 36 ATTACHMENT F ? PROPERTY OWNER APPROVAL FOR USE FORM ............................................. 38

ATTACHMENT G ? MULTI-ESTABLISHMENT LIMITATIONS FORM............................................... 40 ATTACHMENT H ? NAME, SIGNAGE, AND ADVERTISING PLAN FORM ........................................ 42 ATTACHMENT I ? IDENTIFIER LEGEND FORM ................................................................................... 44 ATTACHMENT J ? FEDERAL LAWS AND AUTHORITIES ................................................................... 46

Version 5.2 ? 10/31/2017 Medical Marijuana Establishment Registration Certificate Application

Page 3 of 47

BRIAN SANDOVAL Governor JAMES DEVOLLD Chair, Nevada Tax Commission DEONNE E. CONTINE Executive Director

STATE OF NEVADA

DEPARTMENT OF TAXATION

Web Site:

1550 College Parkway, Suite 115 Carson City, Nevada 89706-7937 Phone: (775) 684-2000 Fax: (775) 684-2020

LAS VEGAS OFFICE Grant Sawyer Office Building, Suite1300

555 E. Washington Avenue Las Vegas, Nevada 89101 Phone: (702) 486-2300 Fax: (702) 486-2373

RENO OFFICE 4600 Kietzke Lane Building L, Suite 235 Reno, Nevada 89502 Phone: (775) 687-9999 Fax: (775) 688-1303

HENDERSON OFFICE 2550 Paseo Verde Parkway, Suite 180

Henderson, Nevada 89074 Phone: (702) 486-2300 Fax: (702) 486-3377

1. TERMS AND DEFINITIONS

For the purposes of this Application, the following acronyms/definitions will be used:

TERMS

DEFINITIONS

Applicant

Organization/individual submitting an application in

response to this request for application.

Awarded applicant

The organization/individual that is awarded and has an

approved provisional certificate with the State of Nevada

for the establishment type identified in this application.

Confidential information Department

Any information relating to the building or product security submitted in support of a medical marijuana establishment certificate. The Department of Taxation.

Designated primary caregiver

Edible marijuana products Electronic verification system Enclosed, locked facility Establishment certificate approval to operate date

A person who is 18 years of age or older, has significant responsibility for managing the well-being of a person diagnosed with a chronic or debilitating medical condition and is designated as such in the manner required pursuant to NRS 453A.250. *The term does not include the attending physician of a person diagnosed with a chronic or debilitating medical condition.

Products that contain marijuana or an extract thereof and are intended for human consumption by oral ingestion and are presented in the form of foodstuffs, extracts, oils, tinctures and other similar products. An electronic database that keeps track of data in real time and is accessible by the Department and by registered medical marijuana establishments. A closet, display case, room, greenhouse, or other enclosed area and is equipped with locks or other security devices which allow access only by a medical marijuana establishment agent and the holder of a valid registry identification card. The date the State Department of Taxation officially gives the approval to operate based on approval of the local jurisdiction and successful fulfillment of all approval to operate instructions between the Department and the successful applicant.

Version 5.2 ? 10/31/2017 Medical Marijuana Establishment Registration Certificate Application

Page 4 of 47

BRIAN SANDOVAL Governor JAMES DEVOLLD Chair, Nevada Tax Commission DEONNE E. CONTINE Executive Director

STATE OF NEVADA

DEPARTMENT OF TAXATION

Web Site:

1550 College Parkway, Suite 115 Carson City, Nevada 89706-7937 Phone: (775) 684-2000 Fax: (775) 684-2020

LAS VEGAS OFFICE Grant Sawyer Office Building, Suite1300

555 E. Washington Avenue Las Vegas, Nevada 89101 Phone: (702) 486-2300 Fax: (702) 486-2373

RENO OFFICE 4600 Kietzke Lane Building L, Suite 235 Reno, Nevada 89502 Phone: (775) 687-9999 Fax: (775) 688-1303

HENDERSON OFFICE 2550 Paseo Verde Parkway, Suite 180

Henderson, Nevada 89074 Phone: (702) 486-2300 Fax: (702) 486-3377

Establishment certificate award date Evaluation committee Excluded felony offense

Facility for the production of edible marijuana products or marijuana infused products Identifiers

Independent testing laboratory

The date when applicants are notified that a medical marijuana establishment provisional certificate has been successfully awarded and is awaiting approval of the local jurisdiction and successful fulfillment of all approval to operate instructions.

An independent committee comprised of State officers or employees and temporary professionals established to evaluate and score applications submitted in response to this request for applications. A crime of violence or a violation of a state or federal law pertaining to controlled substances, if the law was punishable as a felony in the jurisdiction where the person was convicted. The term does not include a criminal offense for which the sentence, including any term of probation, incarceration or supervised release, was completed more than 10 years before or an offense involving conduct that would be immune from arrest, prosecution or penalty, except that the conduct occurred before April 1, 2014, or was prosecuted by an authority other than the State of Nevada. A business that is registered with the Department and acquires, possesses, manufactures, delivers, transfers, transports, supplies, or sells edible marijuana products or marijuana-infused products to medical marijuana dispensaries. In a non-identified response, as assignment of letters, numbers, job title or generic business type to assure the identity of a person or business remains unidentifiable. Assignment of identifiers will be application specific and will be communicated in the application in the identifier legend. A business that is registered with the Department to test marijuana, edible marijuana products and marijuanainfused products. Such an independent testing laboratory must be able to determine accurately, with respect to marijuana, edible marijuana products and marijuanainfused products, the concentration therein of THC, and cannabidiol, the presence and identification of molds and fungus and the presence and concentration of fertilizers and other nutrients.

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