Form MJ17-5020 "Marijuana Retailer Application" - Oregon

What Is Form MJ17-5020?

This is a legal form that was released by the Oregon Liquor Control Commission - a government authority operating within Oregon. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on November 6, 2020;
  • The latest edition provided by the Oregon Liquor Control Commission;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form MJ17-5020 by clicking the link below or browse more documents and templates provided by the Oregon Liquor Control Commission.

ADVERTISEMENT
ADVERTISEMENT

Download Form MJ17-5020 "Marijuana Retailer Application" - Oregon

336 times
Rate (4.7 / 5) 18 votes
Marijuana Retailer Application
Form Instructions
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 the
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
location 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 to
include.
Information on the structure of the business proposed to be licensed:
o
A
Marijuana Applicant Questionnaire
containing a complete list of individuals and legal entities who
qualify as applicants for the license.
o
An
Individual History form
for each individual.
What 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.
Marijuana Laboratory Application Instructions (Page 1 of 1)
Revised 20201106
Marijuana Retailer Application
Form Instructions
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 the
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
location 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 to
include.
Information on the structure of the business proposed to be licensed:
o
A
Marijuana Applicant Questionnaire
containing a complete list of individuals and legal entities who
qualify as applicants for the license.
o
An
Individual History form
for each individual.
What 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.
Marijuana Laboratory Application Instructions (Page 1 of 1)
Revised 20201106
OREGON LIQUOR CONTROL COMMISSION
Marijuana Retailer Application
Section 1 – Business Information
Licensee Name:
Premises Address:
City:
State:
OR
ZIP:
Section 2 – Premises Information
Yes
No
☐ ☐
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?
☐ ☐
Is there an existing recreational marijuana license or license application for this premises?
Is the proposed premises at the same address or physical location as a medical marijuana grow site, processing site,
☐ ☐
or dispensary?
Section 3 – Additional Privileges
A wholesaler 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 No
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 – Attestations
By signing this form, you attest that each of the following statements are true. I understand the Commission may require a
licensee to provide proof of any of the below or below referenced documents at any time.
Section 4.1 – Right to Occupy the Premises
I have a legal right to occupy the premises. I understand that 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(5), failure to retain such control or right of access is
a Category I violation and may be grounds for immediate suspension or cancellation of the license.
If 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 an applicant for the license.
Section 4.2 – Cannabis Tracking System (CTS)
As required by OAR 845-025-7500, prior to licensure, at least one licensee or licensee representative has completed or will
complete required CTS training through
https://www.metrc.com/oregon
using their true, legal name. 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.
[FORM MJ 17-5020] mj_app_ret_packet (rev 20201106) Page 1 of 2
OREGON LIQUOR CONTROL COMMISSION
Marijuana Retailer Application
Section 4.3 – Premises Map
By signing this form, I attest that 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 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 marijuana 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 ID of a customer
is invalid, the customer will be refused service and will be 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 minors 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 contacted.
Section 6
Acknowledgement
I understand that if my answers are not true and complete, OLCC may deny my license application.
Signature:
Date:
Name:
Title:
[FORM MJ 17-5020] mj_app_ret_packet (rev 20201106) Page 2 of 2
Page of 3