CHANGE OF LOCATION APPLICATION

Legal Name *

MCA License/Registration # *

Trade Name (If none enter N/A) *

Are you a Licensee or Registrant?

Per COMAR 14.17.06.03 A licensee may apply to change the location of their operation by submitting this application along with the $500 fee per COMAR 14.17.21. Please note that a licensee may not begin cultivation, processing, or dispensing of cannabis at a new location until the Administration approved the change. A dispensary may only change location within the county that the dispensary was awarded a license.

Dispensary

Grower

Processor

Independent Testing Laboratory

Security Guard Agency

Secure Transport Company

Waste Disposal Company

Business Contact Information

CURRENT Contact Information

Email *

Telephone *

Fax *

CURRENT Physical Address

Address or Location

Senatorial District of current address

NEW Contact Information

Email *

Telephone *

Fax *

NEW Proposed Physical Address

Address or Location

Senatorial District of proposed address

Written formal request outlining the: (1) change of location request, (2) projected timeline of change of location, if approved, and (3) business necessity to support change of location request (e.g., zoning, community opposition, damage or destruction to facility, or significant economic factors).

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Letter(s) from all requisite local and planning authorities that the entity is: Lawfully authorized to operate at the proposed premises; and if applicable, conforms to the location requirements in Alcoholic Beverages and Cannabis Article, Sec. 36-410(B).

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IS YOUR PHYSICAL ADDRESS THE SAME AS YOUR MAILING ADDRESS?

Yes - our Physical Address is also our Mailing Address

No - our Mailing Address is different

Fee Payment Confirmation

Date Paid *

Cashier's Check # or Money Order # *

The below authorized representative of the licensee or registrant acknowledges and affirms that the (1) information included in this application is accurate and complete, and (2) licensee or registrant may only operate at one licensed or registered premises.

Enter your email address here if you would like a copy of this submission.

First Name

Last Name

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I agree to electronically sign and to create a legally binding contract between the other party and myself, or the entity I am authorized to represent.