OCR Micro Cultivation License Application

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Application CheckList

Application Fully Completed
Type or clearly print, in English, an answer to every question. If a question does not apply, indicate with an N/A. If the available space is insufficient, continue on a separate sheet and precede each answer with the appropriate title. An applicant is prohibited from operating a Regulated Cannabis Business prior to obtaining all necessary approvals or licenses from the Department of Licensing and Consumer Affairs, the Department of Agriculture, the Office of Cannabis Regulation, and any other relevant licensing or permitting offices.
Application Contents
o Disclosure Requirements o Main Application o Authorization Forms The disclosure requirements and the main application must be completed in full by all applicants.
All Forms Signed & Attached
The following must be completed, signed and returned by each individual owner and each representative for a business entity with the application: o Affirmation & Consent o Tax Check Authorization o Investigation Authorization / Authorization to Release Information o Applicant’s Request to Release Information
Application and Permit Fees
All applications and documentation must be submitted online via the OCR website at: ——–. See fee schedule on website: www.ocr.vi.gov/register/ Application fees remitted to the Office of Cannabis Regulation are non-refundable. (OCR Rules and Regulations §777-18.) o Submit complete original or scanned application packet. o Checks (in the name of the applicant or applicant’s attorney’s trust account) or money orders shall be made payable to: Government of the Virgin Islands. Credit cards (Visa and Mastercard) may be used when paying in-person (subject to service charge). NO Transfers/Changes of Ownership applications will be accepted for Micro Cultivation Permits in accordance with OCR Rules and Regulations §777-22.
Required Disclosures
See Application Required Disclosures Upon request by the OCR, an Applicant must provide additional information or documents required to process and investigate the application, within ten (10) days of the request. Please note: This deadline may be extended for a period of time commensurate with the scope of the request
Application Submittal
Applications can be submitted electronically, with all required attachments. Application fees must be remitted either in-person or by mail to: Office of Cannabis Regulation 8201 Subbase, Suite 1 St. Thomas, VI 00802 OR Office of Cannabis Regulation Department of Licensing & Consumer Affairs 3000 Golden Rock, Suite 9 Christiansted, VI 00820 Note: Incomplete applications will not be processed. An application is not considered complete until payment is received and processed on or before the application deadline.

User Information

Name

CANNABIS MICRO CULTIVATION APPLICATION

Business Ownership Information

(All persons holding Ownership must be listed)

Business Operation Information

(All persons holding major operational responsibility must be listed)

Business Financial Information

*All sources of revenue to operate the cultivation enterprise must be obtained from legal sources. Total amount of operating capital to start the enterprise (in dollars): $ The sources of all operating capital must be listed here
(Cash collateral credit etc.)
(Cash collateral credit etc.)
(Cash collateral credit etc.)
(Cash collateral credit etc.)

Attestations, Authorizations, and Releases

This section contains all pertinent Attestations, Authorizations, and Releases for the Office of Cannabis Regulation, its Board, Staff, and related contracted entities to perform all necessary checks and investigations to verify applicants’ eligibility to receive permit and operate a cannabis cultivation enterprise.

* All individuals listed by SSN in this application must initial each of the three (3) attestation/authorization/release sections and sign in the signature spaces for the application to be considered complete and evaluated.

Affirmation & Consent

I/We as an owner(s) for the applicant business, state under penalty for offering a false instrument for recording pursuant to 19 V.I.C. Pt. III, Ch. 34 that the entire Cannabis Micro Cultivation Permit Application statements, attachments, and supporting schedules are true and correct to the best of my/our knowledge and belief, and that this statement is executed with the knowledge that misrepresentation or failure to reveal information requested may be deemed sufficient cause for the refusal to issue a Cannabis Permit by the Office of Cannabis Regulation. Further, I/we am/are aware that later discovery of an omission or misrepresentation made in the above statements may be grounds for denial of the Cannabis Micro Cultivation Permit application. I/We am/are voluntarily submitting this application to the US Virgin Islands Office of Cannabis Regulation, under oath, with full knowledge that I/we may be charged with perjury or other crimes for intentional omissions and misrepresentations pursuant to US Virgin Islands law or for offering a false instrument for recording pursuant to 19 V.I.C. Pt. III, Ch. 34. I/We further consent to any background investigation necessary to determine my/our present and continuing suitability and that this consent continues as long as I/we hold a US Virgin Islands Cannabis Micro Cultivation Permit.

Note: If your check is rejected due to insufficient or uncollected funds, the application is considered incomplete.

Tax Check Authorization and Request to Release Information

I am signing this waiver on behalf of (the “Applicant/Permittee”) to permit the US Virgin Islands Bureau of Internal Revenue and any other local taxing authority to release information and documents that would otherwise be confidential. If I am signing this waiver for someone other than myself, I certify that I have the authority to execute this waiver on behalf of the Applicant/Permittee. The information and documentation obtained pursuant to this waiver will be used in connection with the Applicant/Permittee’s application or permit with the US Virgin Islands Office of Cannabis Regulation, which requires proof of compliance with certain tax obligations pursuant to several statutory provisions and any other similar law or ordinance concerning the confidentiality of tax returns and return information. This waiver shall be valid while the application is pending and, if the application is approved, (1) for one year from the date of Permit Issuance. Applicant/Permittee requests that the US Virgin Islands Bureau of Internal Revenue release the following information and supporting documentation to the US Virgin Islands Office of Cannabis Regulation, which is acting as Applicant’s/Permittee’s duly authorized representative, solely to obtain the information specified below. 1. Whether the Applicant/Permittee has failed to file any tax return with the US Virgin Islands Bureau of Internal Revenue or any other state or local taxing authority by the required due date (determined with regard to any extension(s) of time for filing) for any tax year for which filing of a return might have been required. 2. Whether the Applicant/Permittee has failed to pay any tax, penalty, or interest liability within 30 days of the date on which the US Virgin Islands Bureau of Internal Revenue or any other state or local taxing authority gave notice of the amount due and requested payment. 3. Whether the Applicant/Permittee has entered into a payment plan with the US Virgin Islands Bureau of Internal Revenue or any other state or local taxing authority and whether Applicant/Permittee is current on any payments required by said payment plan.
Applicant/Permittee authorizes the US Virgin Islands Bureau of Internal Revenue and any other state or local taxing authority to release any additional information or documentation necessary to answer the questions above. Applicant/Permittee authorizes the US Virgin Islands Office of Cannabis Regulations and its legal representatives to use the information and documentation obtained from the US Virgin Islands Bureau of Internal Revenue and any other state or local taxing authority in any administrative action regarding the application or permit. To assist the US Virgin Islands Bureau of Internal Revenue and any other state or local taxing authority locate the tax records, Applicant/Permittee is voluntarily providing the following information (please type or print).

Investigation Authorization/Authorization to Release Information

I hereby authorize the US Virgin Islands Office of Cannabis Regulation (hereafter, the Investigatory Agencies) to conduct a complete investigation into my personal background (including the backgrounds for all persons listed in the application or who have a financial interest in the proposed Cannabis business regardless of ownership share or investment amount), using whatever legal means they deem appropriate. I hereby authorize any person or entity
contacted by the Investigatory Agencies to provide any and all such information deemed necessary by the Investigatory Agencies. I hereby waive any rights of confidentiality in this regard.
I understand that by signing this authorization, a financial record check will be performed. I authorize any financial institution to surrender to the Investigatory Agencies a complete and accurate record of such transactions that may have occurred with that institution, including, but not limited to, internal banking memoranda, past and present loan applications, financial statements and any other documents relating to my personal or business financial records (including those for all persons listed in the application or who have a financial interest in the proposed Cannabis business regardless of ownership share or investment amount) in whatever form and wherever located. I authorize the release of this type of information, even though such information may be designated as “confidential” or “nonpublic” under the provisions of local or federal laws.
I understand that by signing this authorization, a criminal history check will be performed. I authorize the Investigatory Agencies to obtain and use from any source, any information concerning me (inclusive of all persons listed in the application or who have a financial interest in the proposed Cannabis business regardless of ownership share or investment amount) contained in any type of criminal history record files, wherever located. I understand that the criminal history record files contain records of arrests which may have resulted in a disposition other than a finding of guilt (i.e., dismissed charges, or charges that resulted in a not guilty finding). I understand that the information may contain listings of charges that resulted in suspended imposition of sentence, even though I successfully completed the conditions of said sentence and was discharged pursuant to law. I authorize the release of this type of information, even though this record may be designated as “confidential” or “nonpublic” under the provisions of state or federal laws. The Investigatory Agencies reserve the right to investigate all relevant information and facts to their satisfaction. I understand that the Investigatory Agencies may conduct a complete and comprehensive investigation to determine the accuracy of all information gathered. However, the Government of the US Virgin Islands, Investigatory Agencies, and other agents or employees of the Government of the US Virgin Islands shall not be held liable for the receipt, use, or dissemination of inaccurate information. I, on behalf of the applicant, its legal representatives, and assigns, hereby release, waive, discharge, and agree to hold harmless, and otherwise waive liability as to the Government of the US Virgin Islands, Investigatory Agencies, and other agents or employees of the Government of the US Virgin Islands for any damages resulting from any use, disclosure, or publication in any manner, other than a willfully unlawful disclosure or publication, of any material or information acquired during inquiries, investigations, or hearings, and hereby authorize the lawful use, disclosure, or publication of this material or information. Any information contained within my application, contained within any financial or personnel record, or otherwise found, obtained, or maintained by the Investigatory Agencies, shall be accessible to law enforcement agents of this or any other state, the government of the United States, or any foreign country.

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