Form MJ17-2210 "Micro Tier Producer Lucs Exemption" - Oregon

What Is Form MJ17-2210?

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 January 3, 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 MJ17-2210 by clicking the link below or browse more documents and templates provided by the Oregon Liquor Control Commission.

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Download Form MJ17-2210 "Micro Tier Producer Lucs Exemption" - Oregon

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OREGON LIQUOR CONTROL COMMISSION
Micro Tier Producer LUCS Exemption
Section 1 – Business Information
Applicant Name:
Application ID:
Premises Address:
City:
ZIP:
Section 2 – License Tier
Micro Tier I Producer license
This application is for a:
Micro Tier II Producer license
Section 3 – Jurisdiction
My proposed premises is located in unincorporated ______________________ County.
Section 4 – Persons Responsible for a Marijuana Grow Site
The following individuals are currently persons responsible for a marijuana grow site (PRMG) registered at the
proposed licensed premises:
Date PRMG first registered
PRMG Name
with OHA at this site
I attest that there are no other PRMGs registered at the proposed licensed premises other than the individuals
listed above.
Note that in order to qualify for the LUCS exemption, at least one PRMG must have been continuously
registered at the site since before January 1, 2015, and all PRMGs must have been continuously registered at
the site since before February 1, 2016.
Section 5 – Acknowledgement
I affirm that my answers are true and correct. I understand that if my answers are not true and correct that the
OLCC may deny my application.
Signature:
Date:
Name:
Title:
[FORM MJ 17-2210] mj_opt_pro_lucsexempt (20190103) Page 1 of 1
OREGON LIQUOR CONTROL COMMISSION
Micro Tier Producer LUCS Exemption
Section 1 – Business Information
Applicant Name:
Application ID:
Premises Address:
City:
ZIP:
Section 2 – License Tier
Micro Tier I Producer license
This application is for a:
Micro Tier II Producer license
Section 3 – Jurisdiction
My proposed premises is located in unincorporated ______________________ County.
Section 4 – Persons Responsible for a Marijuana Grow Site
The following individuals are currently persons responsible for a marijuana grow site (PRMG) registered at the
proposed licensed premises:
Date PRMG first registered
PRMG Name
with OHA at this site
I attest that there are no other PRMGs registered at the proposed licensed premises other than the individuals
listed above.
Note that in order to qualify for the LUCS exemption, at least one PRMG must have been continuously
registered at the site since before January 1, 2015, and all PRMGs must have been continuously registered at
the site since before February 1, 2016.
Section 5 – Acknowledgement
I affirm that my answers are true and correct. I understand that if my answers are not true and correct that the
OLCC may deny my application.
Signature:
Date:
Name:
Title:
[FORM MJ 17-2210] mj_opt_pro_lucsexempt (20190103) Page 1 of 1