Form MJ19-2101 "Producer Property Owner Informed Consent" - Oregon

What Is Form MJ19-2101?

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 21, 2019;
  • 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 MJ19-2101 by clicking the link below or browse more documents and templates provided by the Oregon Liquor Control Commission.

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Download Form MJ19-2101 "Producer Property Owner Informed Consent" - Oregon

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OREGON LIQUOR CONTROL COMMISSION
Supplemental Form:
Producer Property Owner Informed Consent
What is this form?
In 2019, the Oregon legislature passed
House Bill
3200. Effective January 1, 2020, this bill requires that applicants for a
Producer license provide signed informed consent from the property owner giving permission to produce marijuana at the
premises, unless the applicant is the owner of the property. This form provides a template for that signed informed
consent.
This form is not needed if the applicant leases the property directly from the property owner and the lease contains explicit
permission to produce marijuana at the premises.
Who fills out this form?
Section 1 of the form may be filled out by either the applicant or the owner of the real property that comprises the
premises. The informed consent must be signed by the property owner. If the property is owned by a legal entity such as
an LLC or corporation, the form must be signed by someone who has authority to sign on behalf of that legal entity.
What if I own the property?
If the property is owned solely by a person or entity who is an applicant for the license, this form is not needed. If the
property is owned either wholly or in part by any person or entity that is not an applicant for the license, the Commission
requires signed informed consent from each owner of record.
Section 1 – Property Information
1
Property Owner
:
2
Premises Address
:
City:
State: OR
ZIP:
Section 2 – Informed Consent
Check one:
I own the property identified above as an individual.
The property identified above is owned by a legal entity and I am entitled to act on that legal entity’s behalf.
By signing below, I give consent for the premises identified above to be used for the production of marijuana.
Signature:
Date:
3
Name:
Title
:
The information entered on this line should match the information on file at your county assessor’s office. If it does not, please attach an explanation
1
and any necessary supporting documentation to account for the discrepancy. If the property is owned by a legal entity such as an LLC or corporation,
please list that legal entity on this line.
2
If the premises does not have a street address, you may list the Tax Lot Map Number (Township, Section, and Range) and Tax Lot number to identify
the property where the premises is located.
3
If the property is owned by a legal entity, use this line to identify the title or role of the person signing the form within the entity. If the property is owned
individually by the person signing this form, you may write “N/A” on this line.
[FORM MJ 19-2101] mj_pro_informed_consent (rev 20191121) Page 1 of 1
OREGON LIQUOR CONTROL COMMISSION
Supplemental Form:
Producer Property Owner Informed Consent
What is this form?
In 2019, the Oregon legislature passed
House Bill
3200. Effective January 1, 2020, this bill requires that applicants for a
Producer license provide signed informed consent from the property owner giving permission to produce marijuana at the
premises, unless the applicant is the owner of the property. This form provides a template for that signed informed
consent.
This form is not needed if the applicant leases the property directly from the property owner and the lease contains explicit
permission to produce marijuana at the premises.
Who fills out this form?
Section 1 of the form may be filled out by either the applicant or the owner of the real property that comprises the
premises. The informed consent must be signed by the property owner. If the property is owned by a legal entity such as
an LLC or corporation, the form must be signed by someone who has authority to sign on behalf of that legal entity.
What if I own the property?
If the property is owned solely by a person or entity who is an applicant for the license, this form is not needed. If the
property is owned either wholly or in part by any person or entity that is not an applicant for the license, the Commission
requires signed informed consent from each owner of record.
Section 1 – Property Information
1
Property Owner
:
2
Premises Address
:
City:
State: OR
ZIP:
Section 2 – Informed Consent
Check one:
I own the property identified above as an individual.
The property identified above is owned by a legal entity and I am entitled to act on that legal entity’s behalf.
By signing below, I give consent for the premises identified above to be used for the production of marijuana.
Signature:
Date:
3
Name:
Title
:
The information entered on this line should match the information on file at your county assessor’s office. If it does not, please attach an explanation
1
and any necessary supporting documentation to account for the discrepancy. If the property is owned by a legal entity such as an LLC or corporation,
please list that legal entity on this line.
2
If the premises does not have a street address, you may list the Tax Lot Map Number (Township, Section, and Range) and Tax Lot number to identify
the property where the premises is located.
3
If the property is owned by a legal entity, use this line to identify the title or role of the person signing the form within the entity. If the property is owned
individually by the person signing this form, you may write “N/A” on this line.
[FORM MJ 19-2101] mj_pro_informed_consent (rev 20191121) Page 1 of 1