Fillable Business License Application - Marijuana License (CITY OF ST HELENS)

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Business License Application - Marijuana License (CITY OF ST HELENS)

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The Business License Application - Marijuana License (CITY OF ST HELENS) form is 1 page long and contains:

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  • 14 check-boxes
  • 18 other fields

Country of origin: US
File type: PDF

U.S.A. forms for CITY OF ST HELENS

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Business License Application - Marijuana License
265 Strand
St, St. Helens, OR 97051 | 503-397-6272 office | www.sthelensoregon.gov
______________________________________________________________________________________________
Business Name:
__________________________ Business DBA: __________________________ Phone: __________________________
PRODUCTION SIZE (SQUARE FEET)
Indoor
Outdoor
TYPE OF BUSINESS
Producers
Micro Tier I
Medical Canopy
Processors
Wholesalers
Retailers
1 - 625
626 - 1,250
1,251 - 5,000
5,001 - 10,000
1 - 2,500
2,500 - 5,000
5,001 - 20,000
20,001 - 40,000
Applicant & Business Information
Micro Tier I
I
Tier I
Tier II
All Names, Addresses, and Title
s of Officer/Partner/Agents MUST BE LISTED
Name:_____________________ Title:_______________
Address:_________________________________________
Name:_____________________ Title:_______________
Address:_________________________________________
Name:_____________________ Title:_______________
Address:_________________________________________
Name:_____________________ Title:_______________
Address:_________________________________________
Is your business a:
Sole Proprietorship
Partnership
Corporation
Association
Other: ___________________
Provide a detailed description of the proposed accounting and inventory systems for your business as well as a description of the
type, nature, and extent of your proposed business:
Business License Information: (Please include copies)
OLCC License or OHA Certificate No: _____________________
St. Helens Business License No: _________________________
Secretary of State Registration No: _______________________
I hereby certify under penalty of perjury and false swearing that the information I have provided is true and correct.
__________________________________________________
_____________________________
Applicant Signature
Date of Signature
FOR OFFICE USE ONLY
Received By: _____________________________________________________ Date: _______________
City Administrator Approval: _________________________________________ Date: _______________
Amount Paid: ______________ Receipt Number: ______________ Date: _______________
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Business License Application - Marijuana License (CITY OF ST HELENS)

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Completed 24 January 2021

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