[City of Shoreview] Cannabis Business License Application

Cannabis Business License Application

Registration information

Select application type:

Retailer (initial & first renewal) - $500

Retailer (renewals) - $250

Low potency hemp edible retail (initial & first renewal) - $125

Low potency hemp edible retail (renewals) - $125

Payment options:

Pay online with this application by credit card (a service fee will eb added)
Call 651-490-4600 to pay with credit card
Send check to city hall

Amount due

Enter MN tax ID or Federal tax ID (FEIN):

Office of Cannabis Management ID:

Applicant information

Other names (maiden name, names from previous marriages, or aliases):

Phone number

Driver's license number

Issuing state

Property owner information

Phone number

Business information

Business name

Business email

Business phone number

Legal description of property

Describe the following: type of business to be conducted, services to be offered, and the items to be sold on the licensed premises.

Partnership information

Is there a partnership?

Yes

Partnership name

Business phone number

Partner information (attach additional sheet if needed)

Partner phone number

If additional partners exist, upload additional partner information at end of this form. Be sure to include partner name, address, phone number and date of birth for every partner in the partnership.

Corporation information

Is this a corporation applying?

Yes

Corporation name

Business phone number

Date of incorporation

Corporate officer

Corporation officer name

Corporation officer date of birth

Corporation officer phone number

Is the corporation authorized to do business in Minnesota? If you check no, you cannot proceed with this application.

Yes

Document Checklist

The following items must be uploaded with this application:

Copy of valid state license or written notice of OCM license preapproval.
Certificate of liability insurance
Certificate of compliance for worker's compensation
Floor plan of premises to be licensed, drawn to scale (for new applications)
Filed copy of articles of organization or incorporation (if applicable)
Executed copy of partnership agreement (for partnership applicant's only)
Any additional partner or corporation officer information.

Copy of state license or written notice of OCM license preapproval

Click Here to Upload

Certificate of liability insurance

Click Here to Upload

Certificate of compliance for Minnesota workers’ compensation law

Click Here to Upload

Floor plan of the licensed premises (must be drawn to scale)

Click Here to Upload

Signature Required

By signing this application, I swear:

All the information above is true and to the best of my knowledge
I am at least 21 years old
I am not prohibited from holding a cannabis license
I have read chapter 10, article IV of the Shoreview city code. Link: Chapter 10
I understand the conditions set forth for cannabis licenses
I am consenting to release of information about myself

Consent For Information

Consent for the release of information in accordance with MSA 13.05, aubd. 4(d):

I authorize the Ramsey County Sheriff’s Office to release criminal history data, as defined by Minnesota Statute 13.87, subd. 1 and driver’s license and traffic record data to the Deputy Clerk for the City of Shoreview. I understand that some of this data may be classified as private data under Minnesota statutes and I hereby give my informed consent to the release of that private data by the Ramsey County Sheriff’s Office to the deputy clerk for the City of Shoreview. This consent for the release of data is for the purpose of obtaining a permit or license with the City of Shoreview. This information cannot be used for any other purposes. This authorization may be revoked in writing by me at any time and in no event will it be valid for more than one year from the date below.

Yes

Other names used (maiden name, name change, alias, etc.)

Sex

Driver license number

State Issued

PRIVACY NOTICE/TENNESSEN WARNING:
In connection with your request for a license, the City has asked that you provide information about yourself which may be classified as private, confidential, nonpublic, or protected nonpublic under the Minnesota Government Data Practices Act.

This means that this data is not ordinarily available to the general public. Accordingly, the City is required to inform you of the following:

The purpose and intended use of the information requested is to determine if you are eligible for a cannabis registration from the City of Shoreview.
The known consequences of supplying the requested information is that the information or further investigation could disclose information which could cause your application to be denied.
You are not legally obligated to supply the requested information. The known consequences of refusing to supply the requested information is that your request for a registration cannot be processed.
A criminal charge, arrest, or conviction will not necessarily bar you from obtaining a license with the City, unless the conviction is related to the matter for which the license is sought, according to Minn Stat. 364.03. However, failure to reveal the requested criminal information will be considered falsification of the application and may be used as grounds for the denial of the application.
Other governmental agencies necessary to process your application are authorized by law to receive the information provided.
The city is required by law to furnish some of this information to the Department of Labor and Industry and the Minnesota Commissioner of Revenue.

The undersigned, by signing this notice, acknowledges that they have read and understood the contents of this notice and has received a copy of this notice.

My signature constitutes agreement of the Tennessen Warning and this entire application.

I certify that all statements by me on this form are true and complete. I understand that any false statements or omissions on this form shall be sufficient cause for rejecting my license.

I hereby authorize the City of Shoreview to use this information to determine my suitability for obtaining a license.

Signature of applicant & individual authorizing release

First Name

Last Name

Choose how to sign

Draw Type

I agree to electronically sign and to create a legally binding contract between the other party and myself, or the entity I am authorized to represent.