cannabis application PDF;

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Executive Summary

This document is an application form for businesses seeking a Cannabis Business License within the Borough of Barrington, New Jersey. It details the requirements for various license types, including Class 5 Retailer, and accommodates considerations for microbusinesses, social equity, and diversity-owned entities. Applicants are required to provide extensive business and financial information, proof of site control, and current state and local application statuses. Key submissions include detailed plans for odor mitigation, safety and security, and location descriptions, alongside comprehensive business and financial plans. A notarized Financial Interest Section, outlining all parties with financial stakes, and an Affidavit of Submission are mandatory components of the application package. A non-refundable application fee of $2,500, payable to the "Borough of Barrington," must accompany the submission. Applications can be emailed to the designated Borough Clerk, with the check submitted by mail or in person. Submissions lacking the application fee will not be accepted.

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--- Document: cannabis application PDF; Document ---
BARRINGTON
New Jersey
229 Trenton Avenue
Barrington, NJ 08007
Tel. (856) 547-0706
Fax: (856) 547-1392
Email: info@barringtonboro.com
Website: wwww.barringtonboro.com
BOROUGH OF BARRINGTON
CANNABIS BUSINESS APPLICATION
1.
LICENSE TYPE
INFORMATION
1.
LICENSE TYPE SOUGHT (mark below)
Class 5 - Retailer
2.
MICROBUSINESS
3.
SOCIAL EQUITY
4.
DIVERSITY OWNED
Yes
No
Yes
No
Yes
No
1.
Business Name:
2.
BUSINESS
(location in Barrington)
2.
Street Address:
3.
City:
4.
State:
5.
Zip Code:
6.
Phone:
1.
3.
Applicant Name:
2.
Street Address:
APPLICANT
3.
City:
4.
State:
5.
Zip Code:
6.
Phone:
7.
Email:
4.
1.
Primary Contact Name:
2.
Street Address:
PRIMARY
3.
CONTACT
City:
4.
State:
5.
Zip Code:
6.
Phone:
7.
Email:
1
5.
STATE APPLICATION STATUS
1.
APPLICATION
Submitted Application to State CRC
2.
Seeking Condition Application with State CRC
STATUS
3.
Has CRC Approved your application?
4.
Was your CRC Application denied?
5. State license number (if applicable)
YES
NO
LOCAL APPLICATION STATUS
6.
Does the Applicant have site control? (proof required)
Yes, we have a signed lease
7.
Yes, we own the site
Submitted Conditional Use Application to Planning Board?
8.
If yes, is the Planning Board application already approved?
LICENSE RENEWAL ONLY
9.
Has license type information changed?
10.
If applicable, are you still a Microbusiness?
6.
APPLICATION
SUBMITTED
YES
NO
N/A
CHECKLIST
1.
(An applicant shall
submit the following
documents or
information)
Complete and Notarized Financial Interest Section. See next
page. Names and residences of all persons financially interested
in the business, and the nature and extent of this interest; and,
if a corporation, the names, residences and citizenship of the
officers, directors and stockholders, and shall disclose whether
the applicant has been convicted of any criminal or quasi-
criminal offense, and if so, the date and place of such
conviction and the nature of the offense.
2.
Proof the cannabis establishment or cannabis distributor will be
operated pursuant to all local and state regulations
3.
Any necessary approvals by the Barrington Planning Board, or
other related boards
4.
Statement and/or plans of odor mitigating practices
5.
Safety and security plans and procedures
6.
A description of the proposed location, including the
surrounding area and the suitability or advantages of the
proposed location, along with a floor plan and optional
renderings or architectural or engineering plans
7.
A business and financial plan
2
7.
FINANCIAL
INTEREST
(Attach additional sheets
as necessary)
QUESTIONS TO BE ANSWERED BY CORPORATIONS ONLY
Any corporation that is reported to have an interest in the business to be licensed, whether the licensee company,
the parent corporation or the licensed company, holding company, or otherwise affiliated in the corporate chain
must answer the following using separate sheets for each corporation. Answer questions for both section 6 and 7 for
each corporation.
1.
Name or Corporation:
2.
Street address of home office:
Municipality:
State/Country:
Zip Code:
3.
NJ Sales Tax Certificate of Authority Number:
4.
If corporation address in number 2 above it out of state, report below the address of any
office location in New Jersey, insert n/a if none.
Street address:
Municipality:
State:
New Jersey
Zip Code:
5.
Is the corporation now an existing, valid corporation?
Yes
No
6.
Date chartered or incorporated (mm/dd/yyyy):
State chartered or incorporated:
7.
Certificate of incorporation number:
8.
9.
If not incorporated under the laws of New Jersey, has the
corporation received an authorization to conduct business in New
Jersey from the New Jersey Office off the Secretary of State?
Has the corporation charter ever been revoked by the Office of
the Secretary of State in New Jersey?
Yes
No
Yes
No
If the Answer if "Yes", insert the date of revocation, or if suspended, the beginning and
ending date of the suspension.
Date of revocation (mm/dd/yyyy):
Beginning date (mm/dd/yyyy):
Ending date (mm/dd/yyyy):
10.
Insert the name and address of registered or authorized agent in New Jersey upon whom
service of process in any proceedings against the Applicant, pursuant to the New Jersey
Cannabis Regulatory, Enforcement Assistance, and Marketplace Modernization Act, or
proceedings in a State of U.S. District Court, may be made:
Name (last, first, MI or Corporate Name):
Street Address:
Municipality:
State:
Zip Code:
Phone Number:
New Jersey
Email:
11.
If the licensed company is owned by other corporation(s) or in a corporate chain, attached a
diagram depicting the corporate relationships and the percentage of stock interest, in the
company to be licensed, owned by other corporations or other non-corporate entities
(individuals, partnerships, associations).
3
8.
FINANCIAL
INTEREST A
(Attach additional
sheets as necessary)
ALL APPLICANTS ANSWER THE FOLLOWING (ADD PAGES AS NECESSARY)
SOLE OWNERS AND PARTNERSHIPS: Complete this page in full
LIMITED PARTNERSHIP: All information about a general partner or partners of a limited partnership must be reported, whether the
general partner is an individual or a corporation. A list of the names and addresses of all limited partners must be submitted as an
attachment to this application with an identification of the percentage of each limited partner as it relates to total ownership of
the business entity to be licensed.
CORPORATIONS: All corporation applicants or licensees and any corporation that has an ownership interest in the corporation under
license or to be licensed must have been reported in section 6. Information on this page will identify all officers, directors, and
stockholders holding one percent or more of the shares of the respective company.
Name of corporation by this page (complete ONLY if applicant or stockholder is a corporation or a partnership)
1.
Name of individual (last name first),
stockholder, partner, officer or director:
2.
Home Street address:
P.O. Box:
Municipality:
State/Country:
Zip Code:
3.
Social Security Number:
4.
Date of Birth (MM/DD/YYYY):
5.
Home Telephone Number:
6.
Office Telephone Number:
7.
Percent of business owned or controlled:
8.
Number of shares:
9.
Check position that applies:
Sole Owner
Partner
Stockholder
President
Vice-President
Secretary
Treasurer
Manager
Director
Agent
Trustee
Receiver
Executor/Administrator
Beneficiary
Other:
1.
2.
Name of individual (last name first),
stockholder, partner, officer or director:
Home Street address:
P.O. Box:
Municipality:
State/Country:
Zip Code:
3.
Social Security Number:
4.
Date of Birth (MM/DD/YYYY):
5.
Home Telephone Number:
6.
Office Telephone Number:
7.
8.
9.
Percent of business owned or controlled:
Number of shares:
Check position that applies:
Sole Owner
Partner
Stockholder
President
Vice-President
Secretary
Treasurer
Manager
Director
Agent
Trustee
Receiver
Executor/Administrator
Beneficiary
Other:
4
9.
SUBMISSION
CHECKLIST
Please attach the required affidavits and supplemental forms, reports, and
other documents needed to process your application, see section 5.
Check for $2,500 payable to "Borough of Barrington". A submission
without the $2,500 application fee will NOT be accepted. Submit
the check by mail or in person.
Please fill out an Affidavit of Submission. A Cannabis Business
Application will not be accepted if one is NOT submitted.
Initials of the Applicant/Preparer:
(Must match Affidavit of Submission)
Once you have completed all of the Submission Checklist items above, you
can email you application to tshannon@barringtonboro.com
CONTACT:
Terry Shannon, Borough Clerk
229 Trenton Avenue
Barrington, NJ 08007
tshannon@barringtonboro.com
856-547-0706 ext. 201
5
AFFIDAVIT OF SUBMISSION
I, the Applicant, certify that the statements and information on the submitted Cannabis Business Application and the
attached materials submitted are true. I further certify that I am the individual applicant or that I am an Officer of the
Corporate Applicant and that I am authorized to sign the Affidavit of Submission for the Corporation or that I am a
General Partner of the Partnership Applicant. I hereby permit authorized Borough official(s) to inspect the subject
property in con-junction with this application.
Address (Subject Property):
Block(s)/Lot(s):
Initials of Applicant (must match GDA)
Applicant Signature
Property Owner Signature Authorizing Submission of the Application if other than Applicant
Sworn to and subscribed before me this date
Notary Public
6