Fillable Hemp Program Consent to Grow/Process Hemp on Leased (State of Connecticut/Department of Administrative Services)

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Hemp Program Consent to Grow/Process Hemp on Leased (State of Connecticut/Department of Administrative Services)

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The Hemp Program Consent to Grow/Process Hemp on Leased (State of Connecticut/Department of Administrative Services) form is 1 page long and contains:

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File type: PDF

U.S.A. forms for State of Connecticut/Department of Administrative Services

BROWSE STATE OF CONNECTICUT/DEPARTMENT OF ADMINISTRATIVE SERVICES (CT) FORMS

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This form will only be accepted through the DOAG E-License portal. Paper applications
will not be accepted.
STATE OF CONNECTICUT
DEPARTMENT OF AGRICULTURE
Office of the Commissioner
Bryan P. Hurlburt
Commissioner
(860) 713-2502
agr.hemp@ct.gov
Hemp Program
Consent to Grow/Process Hemp on Leased Land
(rev. 7.25.19)
Grower CT License #:
Dates Agreement is Applicable:
Grower
(tenant)
Information
Last Name:
First:
M.I.:
Business Legal Name:
Street
Address:
Town/ City:
State:
Zip:
Name of
landowner
listed on deed
Last Name or
Business
Name:
First:
M.I.:
Location of
property
Full Address
Latitude/Longitude (at center, DECIMAL
DEGREES to at least 4 decimal places)
No. of Acres/
sq. ft.
_ _._ _ _ _ _
-_ _._ _ _ _
_
_ _._ _ _ _ _
-_ _._ _ _ _
_
_ _._ _ _ _ _
-_ _._ _ _ _
_
I know and understand the boundaries of the above
listed properties, and that this form is valid only during
the time period specified above.
I hereby grant the person/business named above
permission to grow and/or process hemp on my
property at the address(s) listed above and during the
time period specified above. I acknowledge that and
consent to, representatives of the Connecticut
Department of Agriculture and any law enforcement
agency having the right to inspect all buildings,
equipment, supplies, vehicles and records located on
this real property, during the time period specified
above.
Signature of Signing Authority for Tenant Date
Signature of Landowner Date
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Hemp Program Consent to GrowProcess Hemp on Leased (State of ConnecticutDepartment of Administrative Services)

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Completed 20 July 2020

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