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Get Marijuana Collective Certificate Form

Must hold one of the positions identified in number 3 below and provide a copy of government issued identification for verification purposes I am filing a renewal for Business Tax Registration Certificate BTRC No. for the medical marijuana collective MMC. MEDICAL MARIJUANA COLLECTIVE ANNUAL BUSINESS TAX AFFIDAVIT Los Angeles Municipal Code Section 21. 50 Legal name of person filing medical marijuana collective s annual Business Tax renewal. My position at the MMC is Individual owner Manager of the LLC Member of the LLC Partner Officer of the corporation specify office held I have reviewed and am familiar with Proposition D and have personal knowledge of the history and operations of the MMC referenced in Answer 2. This MMC is qualified for limited immunity under Proposition D to establish and operate a medical marijuana collective in the City of Los Angeles. This MMC Operates at only one location Has a BTRC issued before November 14 2007 No* Registered with the City Clerk pursuant to Ordinance 179027 Filed an Intent to Register with the City Clerk pursuant to Ordinance 181069 as amended by Ordinance 181530 Did not cease operation as provided in LAMC 45. 19. 6. 3. D Obtained a 21. 50 BTRC in 2011 or 2012 and renewed it as provided in LAMC 45. 19. 6. 3. E BTRC No* Paid all taxes as provided by LAMC 45. 19. 6. 3. F Is open only between the hours of 10 00 a*m* and 8 00 p*m Complies with the site requirements of LAMC 45. 19. 6. 3. L and O Has identified the MMC managers to the City Clerk and had its managers complete Livescans pursuant to LAMC 45. 19. 6. 3. M annually since 2013 Has managers who are compliant with LAMC 45. 19. 6. 3. M. Note The above generally summarizes immunity requirements. Please consult Proposition D for further details. I understand that this Tax Registration Certificate is not a license to operate an MMC and its issuance does not indicate compliance with LAMC Section 45. 19. 6/Proposition D. a fully completed and signed affidavit is submitted to the Office of Finance. I declare under penalty of law LAMC Section 21. 50 g that to the best of my knowledge the foregoing is true correct and complete. Executed this day of at Los Angeles California* Signed SUBJECT TO PUBLIC DISCLOSURE. My position at the MMC is Individual owner Manager of the LLC Member of the LLC Partner Officer of the corporation specify office held I have reviewed and am familiar with Proposition D and have personal knowledge of the history and operations of the MMC referenced in Answer 2. This MMC is qualified for limited immunity under Proposition D to establish and operate a medical marijuana collective in the City of Los Angeles. This MMC is qualified for limited immunity under Proposition D to establish and operate a medical marijuana collective in the City of Los Angeles. This MMC Operates at only one location Has a BTRC issued before November 14 2007 No* Registered with the City Clerk pursuant to Ordinance 179027 Filed an Intent to Register with the City Clerk pursuant to Ordinance 181069 as amended by Ordinance 181530 Did not cease operation as provided in LAMC 45.

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