HomeMy WebLinkAboutLocal Verification from Colorado MMEDDR 8592 (05!28/11) -
COLORADO DEPARTMENT OF REVENUE
Medical Marijuana Enforcement Division
455 Sherman Street Suite 390
Denver CO 80203-4404 ,
303-205-8421
Colorado Medical Marijuana Licensing Authority
Local Verification Form
The below mentioned company has applied for a Optional Premises license with the State of Colorado, Department of
Revenue, Medical Marijuana Enforcement Division (MMED). The location for this premise to be licensed, resides in your
jurisdiction, MMED is requesting that an authorized person from your jurisdiction complete this form and advise MMED
that the below company and location is approved for a Optional Premises license in your jurisdiction and that said
approval was made from an application that was received by your jurisdiction prior to July 1, 2010.
License Type
Optional Premises
Applicant's BusIness Name
NUTRITIONAL SUPPLEMENTS LLC .
Medical Marijuana License Number
403-00932
Trade Name (DBA)
6Pte nC 4,4"0 ss iVee- ..,
Website Address
www.buddinghealth.net
€ hysical Adciress
Street Address of Medical Marijuana Business
38150 River Frontage Roast, Units 1-8, 2-A, 2-B,
, 2-D,3-C'
City
New Castle
State - :
CO
Zip
81647
Business Phone Number
•
Home Phone Number
Email Address
gratefulstanley@gmail.com
Mailing Amiress Of diftereni from
Business Address)
Address
2647 W 38th Avenue
City
Denver
State
CO
Zip
80211.
Primary. Contact Person for Business
Wt.") ► n . 1-- ct rvl a r
Title
• CrD 4. CEO
Primary Contact Phone Number
30 3 -- 7 i 7 — I 174 Y-2--
Primary Contact Address (City, State, Zip) /.,.d
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Repori and Approval of I.ocal Licensing Authcrity (CitylCo:unty)
Date application filed with local authority d
Pr,, ",-1( es0•
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Date of local authority (If held, far
date of application 21-43.3-302
Primary Contact Phone Number
new license applicants; cannot be less than 30 days from
(1) C.R.S.
THE LOCAL LICENSING
❑ It has adopted an ordinance
IA Give citation of ordinance
AUTHORITY
or
or resolution
HEREBY AFFIRMS:
resolution containing specific standards for license Issuance pribr to July 1, 2012
/2-60-1.4.4-(0-o- 1 2- ` 4,-a--
•
YES NO
0 Cif
gi ❑
or resolution and will be using mininiirm licensing requirements
in 12-43.3-Part 3 C.R.S.
• Has not adopted an ordinance
M This application is approved,
This application is not
We do report that:
provisions of Title 12, Article 43.3, C.R.S.
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and that such license, If granted, will comply with the
eligible or is denied. (circle one)
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