Marijuana Retailer Application

Form Instructions

Marijuana Retailer Application Instructions (Page 1 of 1) Revised 20230616

What is this form?

This document collects most of the necessary information that is required as part of your OLCC Retailer license

application. Read each page carefully. If you have already submitted your application in the online licensing system, send

the completed form to OLCC staff when it is requested. If you have not yet submitted an application in the online licensing

system, upload the completed packet as a supporting document to your recreational marijuana application online at:

https://apps.oregon.gov/OLCC/Marijuana/elicense/

In addition to the information included in this packet, you will also be required to provide the following documents as

uploads into the online licensing system:

•

A copy of a

completed

Land Use Compatibility Statement from the city or county that authorizes land use in t

city or county in which your proposed premises is located.

•

A map or sketch of the premises proposed for licensure, including the defined boundaries of the premises, the

ocation of any primary residence located on the same tax lot as the licensed premises, and a scaled floor or plot

plan sketch of all enclosed areas. See the Premises Map Instructions for detailed information about what t

include.

•

Information on the structure of the business proposed to be licensed:

A Marijuana Applicant Questionnaire containing a complete list of individuals and legal entities who

qualify as applicants for the license.

An Individual History form for each individual.

hat if I am buying an existing licensed business?

If you are buying an existing licensed business, you will still submit all the information listed above. Once you have

submitted your application, the current licensee will need to submit a Change of Ownership request.

Remember, you cannot begin operating the business until your license has been approved and issued by OLCC.

With the passage of House Bill 4016 (2022), the Commission is required to inactivate

applications for new recreational marijuana Producer, Processor, Retailer, or Wholesaler

licenses submitted on or after January 2, 2022, and until March 31, 2024. Unless you are

submitting this application as part of a Change of Ownership, other change to an existing

licensed premises, or as requested specifically by OLCC staff, your application will be

inactivated and a refund may not be issued for your application fee.

olis.oregonlegislature.gov/liz/2022R1/Downloads/MeasureDocument/HB4016/Enrolled

STOP

OREGON LIQUOR & CANNABIS COMMISSION

Marijuana Retailer Application

[FORM MJ 17-5020] mj_app_ret_packet (rev 20230616) Page 1 of 3

Section 1 – Business Information

Licensee Name:

Premises Address:

City: State:

ZIP:

Yes

Section 2 – Premises Information

☐ ☐

Is the proposed premises on any federal or public land?

☐ ☐

Is the proposed premises fully enclosed by permanent walls and doors?

☐ ☐

Is the proposed premises at the same address or physical location as a business with a liquor license or pending

application for a liquor license?

☐ ☐

Is the proposed premises on any reservation or tribal trust land of a federally recognized Indian tribe?

☐ ☐

Are there any recreational marijuana licenses at this premises or other license applications pending

for this premises?

☐ ☐

Is the proposed premises at the same address or physical location as a medical marijuana grow site, medical

marijuana processing site, or medical marijuana dispensary?

☐ ☐

Is the proposed premises at the same address or physical location as a business with a psilocybin product

manufacturer or service center license or pending application for a psilocybin manufacture or service center license?

☐ ☐

Have you ever had an ODA Hemp Grower registration or license?

Section 3 – Additional Privileges

A retailer may request the following additional privileges. Licensees are responsible for knowing and following all rules

applicable to their license, including the rules for any additional privileges they are granted. Please answer the following:

Yes

☐ ☐

I am seeking a Medical Purposes Registration (OAR 845-025-2900) in order to sell medical-grade cannabinoid

products (subject to concentrations of THC as described in OAR 333-007-0220) to OMMP cardholders or

designated primary caregivers, to allow OMMP cardholders age 18-20 on their premises, or to provide

marijuana to an OMMP cardholder or designated primary caregiver free of charge or at a discounted price.

☐ ☐

I am seeking a

Home Delivery

Registration (OAR 845-025-2880) to deliver marijuana items to a customer at

that customer’s place of residence.

Section 4 – Required Documents

Section 4.1 – Right to Occupy the Premises

Yes

☐ ☐

I have a legal right to occupy the proposed licensed premises and have uploaded a copy of my proof of legal

access to my license dashboard. I understand, at all times I must retain control of, or the right of access to all

or any part of the licensed premises. Except as provided in OAR 845-025-1160, failure to retain such control or

right of access is a Category III violation and may be grounds for immediate suspension or cancellation of the

lice

nse.

f there is no direct access to the property where the premises is located from a public right-of-way, this

means that I must have an easement to allow licensee representatives and Commission staff to access

the property. I understand that without such an easement, the property owner who is entitled to control

access to the premises has an ownership interest as described in OAR 845-025-1045 and must be a

applicant of the license.

OREGON LIQUOR & CANNABIS COMMISSION

Marijuana Retailer Application

[FORM MJ 17-5020] mj_app_ret_packet (rev 20230616) Page 2 of 3

Yes

☐ ☐

As required by OAR 845-025-7500, prior to licensure, at least one licensee or applicant has completed or

will complete required CTS training through https://www.metrc.com/partner/oregon/ using their true, legal

name. The designated individual will submit a Certificate of Achievement of completion of the class and

passage of required exam.

Once licensed and for as long as the license remains active, at least one licensee will keep an active CTS

administrator account in their name for the premises. If the licensee designates a licensee representative

to complete training on their behalf, that representative must also keep an active CTS administrator

account in their name for the premises.

Section 4.3 – Premises Map

Yes

☐ ☐

I have provided OLCC with maps or sketches of the premises that clearly show:

• The location of my proposed premises on the property;

• The boundaries of my proposed premises;

• The boundaries of my limited access area(s) and consumer sales area;

• For each indoor area, a scaled floor plan that identifies all walls and all areas of ingress and egress; and

• The location of any primary residences on the tax lot, if applicable.

I understand that, if the Commission approves my license, the Commission’s approval relies in part upon the

completeness and accuracy of the information that I provide. If I have not completely and accurately identified my

licensed premises, or if my premises is not located at the address identified in Section 1 of this form and on my signed

Land Use Compatibility Statement, that may constitute grounds to revoke my license.

I understand that I will only be entitled to exercise my license privileges within the boundaries of my licensed

premises. I understand that marijuana may never enter any part of my premises that is not designated as a limited

access area, and that if I have failed to designate my limited access area, I will not have the privilege to allow

marijuana to enter the premises.

I attest that my proposed premises does not include a primary residence.

Section 4.3 – Certificate of Tax Compliance with Department of Revenue

Section 4.2 – Cannabis Tracking System (CTS)

Yes

☐ ☐

As required for licensure, under OAR 845-025-1030(3)(g), each applicant (natural person(s) and legal entities) for a

retailer license must provide a certificate issued by the Oregon Department of Revenue (DOR) verifying tax

compliance as described in OAR 845-025-1045(3) and (4). The certificate of compliance needs to be issued within 90

days of date the application was submitted. Failure to submit a certificate of compliance for each applicant for this

license will be considered an incomplete application and the OLCC will not process the application.

Will each applicant be able to provide a DOR certificate of tax compliance?

OREGON LIQUOR & CANNABIS COMMISSION

Marijuana Retailer Application

[FORM MJ 17-5020] mj_app_ret_packet (rev 20230616) Page 3 of 3

Section 5 – Operating and Security Plan

An Operating Plan and Security Plan are required for all license types. The Commission has set minimum standards for the security of

a licensed recreational marijuana premises. Licensees are responsible for the security of all marijuana items on the premises and those

in transit on behalf of the licensee. Adherence to the minimum requirements does not release a licensee from this responsibility.

OAR 845-025-1405 allows any licensee or applicant to request a waiver of any of the security requirements described in OAR 845-025-

1400 to 845-025-1470. A request for a security waiver must document the specific rule to be waived and document a proposed

alternative method to meet the objective of the rule. Waiver requests are subject to approval by the Commission and may be denied.

Broad requests to waive all of the security requests will be denied.

By signing this form, you agree to comply with all security and operational requirements specified in rule for which you do not have a

waiver specifically approved by the Commission. You can find the full text of the OLCC’s recreational marijuana administrative rules in

the Oregon Secretary of State Oregon Administrative Rule Database: Oregon Administrative Rules Chapter 845 Division 25.

Section 5.1 – Minor Control Plan

A minor control plan is required for all operations. By signing this form, you agree to comply with the following plan unless you have an

alternate plan explicitly approved by the Commission:

Standard retailer minor control plan:

During non

-business hours, all exterior doors will be locked. During business hours, ID will be checked both when a customer enters the

business and at time of sale. Any person under 21 who does not have a medical mar

ijuana card will be refused access. Any person under 18

will be refused access even if they have a medical marijuana card. If an employee checking ID has any reason to believe the I

D of a customer

is invalid, the customer will be refused service and will b

e asked to leave the premises.

Employee identification will be checked prior to hiring and no person will be employed who is not 21 and who does not have a

valid marijuana

worker permit. Signs will be clearly posted at all entry points indicating that mino

rs are not permitted on any portion of the premises. If a minor

attempts to gain access to the premises, they will be immediately told to leave and if they do not, law enforcement will be c

ontacted.

I understand that if my answers are not true and complete, OLCC may deny my license application.

Signature:

Date:

Name:

Title:

Section 6 – Acknowledgement