Form MJ17-6025 "Marijuana Laboratory Renewal Application" - Oregon

What Is Form MJ17-6025?

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 11, 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 MJ17-6025 by clicking the link below or browse more documents and templates provided by the Oregon Liquor Control Commission.

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Download Form MJ17-6025 "Marijuana Laboratory Renewal Application" - Oregon

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Marijuana Laboratory Renewal Application
Form Instructions
What is this form?
Marijuana licensees are required to renew their licenses annually. Submitting a renewal application is a two-
step process:
1. Fill out this renewal application form.
2. Submit your renewal, including uploading this form and paying the application fee and license fee
through the online portal at https://apps.oregon.gov/OLCC/Marijuana/elicense/. When you log into your
license dashboard, there will be a “Renew” button if you are within 90 days of license expiration.
Who needs to sign this form?
Each licensee whose name appears on the license certificate must sign the renewal application. If any named
licensee is a legal entity (corporation, LLC, or limited partnership) one person who is an applicant for the
license under OAR 845-025-1030(4) or has an ownership interest as defined in OAR 845-025-1045(3) may
sign on behalf of the entity. Common examples include:
For LLCs: A member of the LLC or a manager of a manager-managed LLC
For Corporations: An officer of the corporation
For Limited Partnerships: A general partner of the partnership
Making changes to a licensed business
This form asks several questions to identify whether you have made any changes to your licensed business.
Please bear in mind that most changes will require prior approval from OLCC before you make the change. If
you have made or are requesting to make changes that have not yet been approved by OLCC, please submit
that request separate from your renewal application.
Our change request forms can be found on the
Marijuana Forms and Publications
Page, under the section
titled “Notification/Change Forms.”
If you only disclose or request the changes on your renewal application but do not submit a separate change
request form, staff will not consider the request until your renewal application is assigned for investigation.
Federal Employer Identification Number and Business Identification Number
All businesses in Oregon that do not offer an employer-sponsored retirement plan will be required to register
for OregonSaves. In order to serve legal marijuana businesses in Oregon, the OLCC and Oregon State
Treasury need to collect your business' Federal Employer Identification Number (FEIN) and your Business
Identification Number (BIN). Please fill in these fields on the renewal application form.
ORELAP certification
Before renewing your license, you will need to provide OLCC with a copy of your ORELAP certificate and
documentation of which types of testing you have been accredited to perform.
Marijuana Laboratory Renewal Instructions
Revised 20190111
Marijuana Laboratory Renewal Application
Form Instructions
What is this form?
Marijuana licensees are required to renew their licenses annually. Submitting a renewal application is a two-
step process:
1. Fill out this renewal application form.
2. Submit your renewal, including uploading this form and paying the application fee and license fee
through the online portal at https://apps.oregon.gov/OLCC/Marijuana/elicense/. When you log into your
license dashboard, there will be a “Renew” button if you are within 90 days of license expiration.
Who needs to sign this form?
Each licensee whose name appears on the license certificate must sign the renewal application. If any named
licensee is a legal entity (corporation, LLC, or limited partnership) one person who is an applicant for the
license under OAR 845-025-1030(4) or has an ownership interest as defined in OAR 845-025-1045(3) may
sign on behalf of the entity. Common examples include:
For LLCs: A member of the LLC or a manager of a manager-managed LLC
For Corporations: An officer of the corporation
For Limited Partnerships: A general partner of the partnership
Making changes to a licensed business
This form asks several questions to identify whether you have made any changes to your licensed business.
Please bear in mind that most changes will require prior approval from OLCC before you make the change. If
you have made or are requesting to make changes that have not yet been approved by OLCC, please submit
that request separate from your renewal application.
Our change request forms can be found on the
Marijuana Forms and Publications
Page, under the section
titled “Notification/Change Forms.”
If you only disclose or request the changes on your renewal application but do not submit a separate change
request form, staff will not consider the request until your renewal application is assigned for investigation.
Federal Employer Identification Number and Business Identification Number
All businesses in Oregon that do not offer an employer-sponsored retirement plan will be required to register
for OregonSaves. In order to serve legal marijuana businesses in Oregon, the OLCC and Oregon State
Treasury need to collect your business' Federal Employer Identification Number (FEIN) and your Business
Identification Number (BIN). Please fill in these fields on the renewal application form.
ORELAP certification
Before renewing your license, you will need to provide OLCC with a copy of your ORELAP certificate and
documentation of which types of testing you have been accredited to perform.
Marijuana Laboratory Renewal Instructions
Revised 20190111
OREGON LIQUOR CONTROL COMMISSION
Marijuana Laboratory Renewal Application
Please answer all questions completely. Failure to disclose any information requested, or providing
false or misleading information on this form is grounds to deny the renewal application
.
(OAR 845-025-1115)
Section 1 – Business Information
Licensee Name:
License ID Number:
Contact Name:
BIN*:
Contact Email:
FEIN*:
Section 2 – Renewal Questions
YES
NO
1.
☐ ☐
Has your approved business structure changed in ANY way?*
(This may include, but is not limited to: employees or landlords receiving a percentage of revenue or profits, any new
investors, new owners, added or removed partners, or any changes in membership percentages, stockholders, directors, or
corporate officers.)
If yes, attach a written statement of the change(s) and submit a change request separate from this renewal*
2.
☐ ☐
Have you made any significant changes to your premises or changes in the operation of
your business that have not previously been reported to OLCC?*
(This may include, but is not limited to: Moving or removing cameras, remodeling the premises to move walls or doors, or
changing your operating and security plan)
If yes, attach a written statement of the change(s) and submit a change request separate from this renewal*
3.
☐ ☐
Were you previously approved for any security waivers?
If yes, attach a copy your approved waiver request.
4.
Acknowledge that you have provided a copy of your ORELAP certificate with this packet.*
Section 3
Acknowledgement
The Oregon Liquor Control Commission requires the licensee* to read and affirm the following with a signature:
I have reviewed all information being submitted as part of my renewal application. All
information submitted is true and correct to the best of my knowledge.
Licensee’s Name
Signature
Date
*See the instruction page for additional information.
[FORM MJ 17-6025] mj_app_lab_renewal (rev 20190111) Page 1 of 1
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