CCA Medical Marijuana Dispensary Application Redacted)

8/3/2019 CCA Medical Marijuana Dispensary Application Redacted)

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COMPASSION CENTERS OF AMERICA, LLCApplication for Medical Marijuana Dispensary

Submitted to:The District of Columbia Department of Health

Department of Health899n North Capitol Street, NE

2nd FloorWashington, DC 20002Tuesday, November 15~2011


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Compassion Centers of America, LLC

1. Question 1: Please provide the following:

For partnership or limited liability company:a) Legal name of the business or, if the business will be using a trade nameother than it's legal name, a copy of the trade name registration from tbeDepartment of Consumer and Regulatory Affairs.


b) Names and addresses of each member ofthe partnership or limited liabilitycompany.

Chris GardAlameda, CA 94501Just in J a rinAlameda, CA 94501Thomas LindenfeldWashington, DC 20015

Application for Medical Marijuana Dispensary 1


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c) Date of birth of cach member of the partnership or limited liability company

Chris GardDOB:Ju stin Ja re nDOB:Thomas LindenfeldDOB:

d) Certificate of Good Standing for the partnership or limited liability com-panyissued by the Department of Consumer and Regulatory Affairs within 30days of the application's submission.

Please see Appendix A for the Certificate of Good Standing, Basic BusinessLicense, Certificate of Registration, Basic Business Clean Hands Form, DCBusiness Tax Registration Number, Application for Certificate of ForeignLimited Liability Corporation, and Office of Tax and Revenue Sales and UseTax Certificate of Registration.



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2. Please provide the proposed physical address of the dispensary. In the case ofnew construction, provide the lot and square numbers of the ground upon which theestablishment will be located. Provide the size and design of the dispensary. Providethe proposed date on which the applicant plans to open the establishment.Proposed location of the dispensary:1539 7th Street, NWWashington, DC 20001


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3. Please provide evidence of compliance with the zoning requirements inSection 5201 of the Notice of Emergency and Fourth Proposed Rulemakingpublished in the D.C. Register on August 12, 2011, for the proposed physicaladdress to be utilized as a dispensary. You must also provide a certifiedsurveyor's report setting forth the proximity of the dispensary to the nearestpublic or private, preschool, primary or secondary scheol or recreation center,and the name ofthe school or recreation center.

Compassion Centers of America, LLC 's dispensary is located at 1539 7th Street, NW,Washington DC 2001 and is in compliance with the zoning requirements in Section 5201of the Notice of Emergency, and Fourth Proposed Rulemaking published in the D.C.Register on August 12,201 t for a dispensary.The Compassion Centers of America, LLC 's dispensary is not located within threehundred feet (300 ft.) of a preschool, primary or secondary school, or recreation center, asis shown on our certified surveyor's report. All measurements for the survey were madein accordance to 5000.1 of the Notice of Emergency, and Fourth Proposed Rulemakingpublished in the D.C. Register on August 12,20 II for a dispensary.

Please see the surveyor's report and zoning determination letter in Appendix C.



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GOVERNMENT OF THE DISTRICT OF COLUMBIADEPARTMENT OF CONSUMER AND REGULATORY AFFAIRS

CORPORA nONS DIVISION

* *CERTIFICATE

THIS IS TO CERTIFY THATCOMPASSION CENTERS OF AMERICA, LLC

A Limited Liability Company organized and existing under and by virtue of the laws of thestate of NV has been duly authorized to transact business as a foreign Limited LiabilityCompany in the District of Columbia by virtue of the Certificate of Registration issued by theDepartment of Consumer and Regulatory Affairs. Corporations Division on 09/07/201100:00:00.The above entitled Limited Liability Company is at the time of issuance of this Certificate inGood Standing according to the records of this office,

IN TESTIMONY WHEREOF I have hereunto set my hand and caused the sealof this office to be affixed as of 10/25/2011 18:20:29

Business and Professional Licensing Administration

PATRICIA E. GRAYSSuperintendent of CorporationsCorporations Division

Vincent C. GrayMayorTracking Ii: SCHAOV67YB


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GOVERNMENT OF THE DISTRICf OF COLUMBIADepartment of HealthHealth Regulation and Licensing Administration * * *

Medical Marijuana ProgramDispensaryAcknowledgement and Attestation FormThis form must be signed and notarized as part of the application process.

1. The undersigned applicant has not been convicted of any felony before filing theapp l i ca t ion .

2. The undersigned applicant has not been convicted of a misdemeanor for a drug-relatedoffense before filing the application.

3. The undersigned applicant is not a person whose authority to be a caregiver or qualifiedpatient has been revoked by the Department.

4. The undersigned applicant certifies that I do not owe more than $100.00 to the District ofColumbia government as a result of:

A. Fines, penalties or interest assessed pursuant to the Litter Control AdministrationAction of 1985, effective March 25, 1986 (D.C. Code 6-2901 et seq.);

8. Fines, penalties or interest assessed pursuant to the Illegal Dumping EnforcementAct of 1994, effective May 20,1994 (D.C. Law 10-117; D.C. Code 6-2911 etseq.);

C. Fines, penalties or interest assessed pursuant to the Department of Consumer andRegulatory Affair Civil Infractions Act of 1985, effective October 5, 1986 (D.C.Law 6-42; D.C. Code 6-2701 et seq.); or

D. Past due taxes.The undersigned applicant understands that if he/she knowingly falsifies thisCertification, the Department will move to revoke the license or permit for which he/sheis applying, and to fine me $1 ,000.00. He/she further understand that the Department mayconduct an investigation to ascertain the veracity of this certification. The undersignedapplicant understands that this Certification is now required as documentation toaccompany my application for a license or permit, and that by completing thisCertification, he/she is not guaranteed that my license or permit will be approved. Pleaseread carefully and completely before signing, A false statement on this certificationrequires that the Department proceed immediately to revoke the license or permit forwhich the undersigned applicant is now applying and fine him/her $1000.00. This

899 North Capitol Street. NE, : t I < I Floor, Washington, D.C. 20002 Email : [email protected] Webpage: http://hrta.doh.dc.govlmmp
mailto:[email protected]://hrta.doh.dc.govlmmp/http://hrta.doh.dc.govlmmp/mailto:[email protected]


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certificate is required by the "CLEAN HANDS BEFORE RECEIVING A LICENSE ORPERMIT ACT OF 1996". (Effective May ll, 1996, D.C. Law t 1-118, D.C. Code 47-2861 et seq.)

5. The undersigned applicant attests that he/she has read the Legalization of Marijuana forMedical Treatment Initiative of 1999 (Act), effective July 27,2010, the Emergency andthe Fourth Proposed Rulernaking published, August 12,2011 in the D.C. Register, andhas knowledge of District and federal laws and regulations relating to marijuana andmedical marijuana.6. The undersigned applicant assumes any and all risk or liability that may result underDistrict of Columbia and federal laws and regulations from the operation of a medicalmarijuana dispensary.7. The undersigned applicant acknowledges that he/she understands that the medical

marijuana laws and enforcement thereof of the District of Columbia and the Federalgovernment are subject to change at any time and that the District of Columbia shall notbe liable as a result of these changes;8. The undersigned applicant attests to the fact that the applicant is the true and actualowner of the business for which the registration is sought; the applicant intends to carryon the business for the entity identified in the application and not as the agent of anyother individual, partnership, association, or corporation not identified in the application;and the registered establishment will be managed by the applicant in person or by aregistered manager approved by the Director;9. The undersigned attests that the applicant understands and is aware that a dispensary's

registration may be revoked at any time for the convenience of the District pursuant tothe regulations.10. The undersigned applicant understands that the Department is not required to issue all ofthe available registrations to operate a dispensary.11. The undersigned specifically acknowledges receipt and advisement of the notices below.The undersigned agrees to and accepts the limitation of liability against the District, andthe requirement to indemnify, hold harmless, and defend the District.

(a) Limitation of Liability - The District of Columbia shai] not be liable toregistrant, its employees, agents, business invitees, licensees, customers, clients,family members or guests for any damage, injury, accident, loss, compensation orclaim, based on, arising out of or resulting from registrant's participation in theDistrict of Columbia's medical marijuana program, including but not limited tothe follow ing: arrest and seizure of persons and/or property, prosecution pursuantto federal laws by federal prosecutors, interruption in registrant's ability to operateits medical marijuana cultivation center and/or dispensary; any fire, robbery, theft,mysterious disappearance or any other casualty; the actions of any other

Page2 of 49/30/2011


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registrants or persons within the cultivation center and/or dispensary. ThisLimitation of Liability provision shall survive expiration or the earlier terminationof this registration if such registration is granted.(b) Indemnification, Hold Harmless and Defense Obligations - Registranthereby indemnifies and holds the District of Columbia, its officers, directors,employees, affiliates and agents ("Indemnified Parties") harmless and shalldefend the Indemnified Parties (with counsel satisfactory to District of Columbia)from and against any and all losses, costs, damages, liabilities, expenses. claimsand judgments (including. without limitation, attorneys fees and court costs)suffered by or claimed against the Indemnified Parties, directly or indirectly,based on, arising out of or resulting from (i) registrant's establishment andoperation of a cultivation center and/or dispensary in the District's medicalmarijuana program. (ii) the negligence or willful misconduct of registrant or itsemployees, contractors. agents. licensees, guests or invitees, (iii) any breach ordefault by registrant in the performance or observance of its covenants orobligations under this registration, or (iv) any violations of law by of registrant orits employees, contractors, agents, licensees, guests or invitees.(c) Federal Prosecution - The United States Congress has determined thatmarijuana is a controlled substance and has placed marijuana in Schedule I of theControlled Substance Act. Growing. distributing, and possessing marijuana inany capacity, other than as a part of a federally authorized research program, is aviolation of federal laws. The District of Columbia's law authorizing theDistrict's medical marijuana program will not excuse any registrant from anyviolation of the federal laws governing marijuana or authorize amy registrant toviolate federal laws.

12. The undersigned applicant certifies that the application is complete and accurate.

Any person who knowingly makes a false statement on an application. or in anyaccompanying statement under oath that the Department may require. shall be guilty ofthe offense of making false statements. The making of a false statement. whether madewith or without the knowledge or consent of the applicant, shall, in the discretion of theDirector, constitute sufficient cause for denial of the application or revocation of theregistration. The making of false statements shall also constitute the basis for a criminaloffense under D.C. Official Code 22-2514.

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13. The undersigned chooses to sign this attestation willingly and without reservation and isfully aware of its meaning and effect.

Signature of APPJicant:--:~f-I_~~~' _ x _ . : . t, - - - - = - ~ _ _ _ _ _ : . " ~ / ~ ~ ! L ~ _. .~f~ G . . t . \ e . n 1 / n r a & - - - I_Lc.

Title: - . ! . . O \ ~ ~ : . : . . . . . . . = . - ~ : : . . . . .. : - - . - - - - - - - - -Date: ~ _ J . . ~ - y Q / { : ! : . . : . : . . . . . . . . - - - j , - L { . : . . . . - - - , ! " z . : : : . . : : c ) : : : - \ ~ \ . : - - - - - - - -

Company Name:

Subscribed and sworn to before me this ,20 .r.C h a n g H o C h o lMy com mission exp ires__ ~ I \ I I l J ( ) t l a a ' i - C p : 1 . l l l l b w : l I l lO . C . u D l l lt s t f ! l : ll c t ~ Q ! l . f ~CoI~u!!!mb~la~_M y C o m m is s io n E x p ir e s 6114 /14

Notary Signature and Seal: __ -,~.. = ~ = - - = = =:;;_---:;o.'P=!...


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GOVERNMENT OF THE DISTRICT OF COLUMBIADepartment of Health

lIcHlth Rcguilltion and Licenslng Administration * * *Medical Marijuana ProgramDispensaryAcknowledgement and Attestation Form

This form must be signed and notarized as part of the application process.

I. The undersigned applicant has not been convicted of any felony before filing theapp 1 ication.

2. The undersigned applicant has not been convicted ofa misdemeanor for a drug-relatedoffense before filing the application.


4. The undersigned applicant certifies that Io not owe more than $100.00 to the District ofColumbia government as a result of:

A. Fines, penalties or interest assessed pursuant to the litter Control AdministrationAction of 1985, effective Marcil 25, 1986 (D.C. Code 6~2901 et seq.);

8. Fines, penalties or interest assessed pursuant to the Illegal Dumping EnforcementAct of 1994, effective May 20, 1994 (D.C. Law 10-117; D.C. Code 6-2911etseq.):

C. Fines, penalties or interest assessed pursuant to the Department of Consumer andRegulatory Affair Civil Infractions Act of 1985, effective October 5, 1986 (D.C.Law 6~42;D.C. Code 6~2701et seq.); or

D. Past due taxes.The undersigned applicant understands that ifhe/she knowingly falsifies thisCertification, the Department will move to revoke the license or permit for which he/sheis applying, an d to fine m e $1,000.00. He/she further understand th at th e Department mayconduct an investigation to ascertain the veracity of this certification. The undersignedapplicant understands that this Certification is now required as documentation toaccompany my application for a license or permit. a nd th at by completing thisCertification. he/she is not guaranteed that my license or permit will be approved. Pleaseread carefully and completely before signing. A false statement on this certificationrequires that the Department proceed immediately to revoke the license or permit forwhich the undersigned applicant is now applying and fine himfher $1000.00. This

899 North Capitol Streel. NE. 2nd Floor, Washington. D.C. 20002 Email; [email protected]: hHp:/lhrla.doh.dc.gov/mmp
mailto:[email protected]:mailto:[email protected]:


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certificate is required by the "CLEAN HANDS BEFORE RECEIVING A LICENSE ORPERMIT ACT OF 1996". (Effective May 11, 1996, D.C. Law 11-1I8, D.C. Code 47-2861 et seq.)

5. The undersigned applicant attests that he/she has read the Legalization of Marijuana forMedical Treatment Initiative of 1999 (Act), effective July 27,2010, the Emergency andthe Fourth Proposed Rulemaking published, August ]2,2011 in the D.C. Register, andhas knowledge of District and federal laws and regulations relating to marijuana andmedical marijuana.

6. The undersigned applicant assumes any and all risk or liability that may result underDistrict of Columbia and federal laws and regulations from the operation of a medicalmarijuana dispensary.

7. The undersigned applicant acknowledges that he/she understands that the medicalmarijuana laws and enforcement thereof of the District of Columbia and the Federalgovernment are subject to change at any time and that the District of Columbia shall notbe liable as a result of these changes;

8. The undersigned applicant attests to the fact that the applicant is the true and actualowner of the bus iness for wh ich the registration is sought; the app Iicant intends 10 carryon the business for the entity identified in the application and not as the agent of anyother individual, partnership, association, or corporation not identified in the application;and the registered establishment will be managed by the applicant in person or by aregistered manager approved by the Director,

9. The undersigned attests that the applicant understands and is aware that a dispensary'sregistration may be revoked at any time for the convenience of the District pursuant tothe regulations.

10. The undersigned applicant understands that the Department is not required to issue all ofthe available registrations to operate a dispensary.

II. The undersigned specifically acknowledges receipt and advisement of the notices below.The undersigned agrees to and accepts the limitation of liability against the District, andthe requirement to indemnify, hold harmless, and defend the District.

(a) Limitation of Liability - The District of Columbia shall not be liable toregistrant, its employees, agents, business invitees, licensees, customers, clients,family members or guests for any damage, injury, accident, loss, compensation orclaim, based on, arising out of or resulting from registrant's participation in theDistrict of Columbia's medical marijuana program, including but not limited tothe following: arrest and seizure of persons and/or property, prosecution pursuantto federal laws by federal prosecutors, interruption in registrant's ability to operateits medical marijuana cultivation center and/or dispensary; any fire, robbery, theft,mysterious disappearance or any other casualty; the actions of any other

Page 20f4913012011


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registrants or persons within the cultivation center andlor dispensary. ThisLimitation of Liability provision shall survive expiration or the earlier terminationof this registration ifsuch registration is granted.(b) Indemnification, Hold Harmless and Defense Obligations - Registranthereby indemnifies and holds the District of Columbia, its officers, directors,employees, affiliates and agents ("Indemnified Parties") harmless and shalldefend the Indemnified Parties (with counsel satisfactory to District of Columbia)from and against any and all losses, costs, damages. liabilities. expenses, claimsand judgments (including, without limitation, attorneys fees and court costs)suffered by or claimed against the Indemnified Parties, directly or indirectly,based on, arising out of or resulting from (i) registrant's establishment andoperation of a cultivation center andlor dispensary in the District's medicalmarijuana program. (ii) the negligence or willful misconduct of registrant or itsemployees, contractors, agents, licensees, guests or invitees, (iii) any breach ordefault by registrant in the performance or observance of its covenants orobligations under this registration, or (iv) any violations of law by of registrant orits employees, contractors, agents, licensees, guests or invitees.(c) Federal Prosecution - The United States Congress has determined thatmarijuana is a controlled substance and has placed marijuana in Schedule r of theControlled Substance Act. Growing, distributing. and possessing marijuana inany capacity, other than as a part of a federally authorized research program, is aviolation of federal laws. The District of Columbia's law authorizing theDistrict's medical marijuana program will not excuse any registrant from anyviolation of the federal laws governing marijuana or authorize any registrant toviolate federal laws.

l2. The undersigned applicant certifies that the application is complete and accurate.

Any person who knowingly makes a false statement on an application, or in anyaccompanying statement under oath that the Department may require, shall be guilty ofthe offense of making false statements. The making of a false statement, whether madewith or without the knowledge or consent of the applicant. shall, in the discretion of theDirector, constitute sufficient cause for denial of the application or revocation of theregistration. The making of false statements shall also constitute the basis for a criminaloffense under D.C. Official Code 22-2514.

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13 . Theundersignedchoosesto s ig n t hi s attestationwillingly andwithout reservationand isfuUy aw are of its m eaning and effect.

SignatureofApplicant:----........f.6F'I.--AK=-:=;....------------

_Jfn2..INrintName: .~JVs=\IN

Company Name : - -itle: _ ' \ } , . _ \ _ ( . _ e _ _ . ( ? - - ' ~ _ ' e s . = \ ~ ' O : : . . . ! : e N : : : . . : . . . . : : _ _ ' , _Date: to \ . ? - t 2 . . \ '>V \I~ - - - - - - - - ~ ~ - - ~ - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -Subscribed and sw orn to before me th is _

My comm ission expires ~- ~ . . . - - >.>:ota~ature and Seal: _r:_~

[fthe applicant is a sole proprietor. the individual must sign. If the applicant is a partnership, each partner must sign a copy of this document and submit a copy of the

partnership agreement. [fthe applicant is a corporation, the President or Vice President must sign. If the applicant is an LtC, each of the managing member(s) must sign a copy ofthis document. [fthe applicant is a Limited Partnership, each of the general partner(s) must sign a copy of this document.

E Z E Q U I E L V I L L A LO B O Sf. Commluion I I 1 86 1 45 6~ . N otary Public C alifornia 2

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GOVERNMENT OF THE DISTRICT OF COLUMBIADepartment of HealthHealth Regul.ation and Licensing Administration * * *

Medical Marijuana ProgramDispensaryAcknowledgement and Attestation Form

This form must be signed and notarized as part of the application process.

I. The undersigned applicant has not been convicted ofany felony before filing theappJ ication.

2 . The undersigned applicant has not been convicted of a misdemeanor for a drug-relatedoffense before fi ling the application.


4. The undersigned applicant certifies that I do not owe more than $100.00 to the District ofColumbia government as a result of:

A. Fines, penalties or interest assessed pursuant to the Liner Control AdministrationAction of 1985, effective March 25, 1986 (D.C. Code 6-2901 et seq.);

B. Fines, penalties or interest assessed pursuant to the Illegal Dumping EnforcementAct of 1994, effective May 20, 1994 (D.C. Law 10-117; D.C. Code 6-2911 etseq.);

C. Fines, penalties or interest assessed pursuant to the Department of Consumer andRegulatory Affair Civil Infractions Act of 1985, effective October 5, 1986 (D.C.Law 6-42; D.C. Code 6-2701 et seq.); or

D. Past due taxes.The undersigned applicant understands that if he/she knowingly falsifies thisCertification, the Department will move to revoke the license or permit for which he/sheis applying, and to fine me $1,000.00. He/she further understand that the Department mayconduct an investigation to ascertain the veracity of this certification. The undersignedapplicant understands that this Certification is ROW required as documentation toaccompany my application for a license or permit, and that by completing thisCertification, he/she is not guaranteed that my license or permit will be approved. Pleaseread carefully and completely before signing. A false statement on this certificationrequires that the Department proceed immediately to revoke the license or permit forwhich the undersigned applicant is now applying and fine him/her $1000.00. This

8 99 No rthC apilo l Stre et, NE , 2M F loo r. W ashing to n, D .C . 20 002 Email: doh ,[email protected] : ht lp: l fhr la.doh.dc.govlmmp
mailto:doh,[email protected]:mailto:doh,[email protected]:


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certificate is required by the "CLEAN HANDS BEFORE RECEIVING A LICENSE ORPERMIT ACT OF 1996". (Effective May 11, 1996, D.C. Law 11-118, D,C. Code 47-2861 et seq.)

5. The undersigned applicant attests that he/she has read the Legalization of Marijuana forMedical Treatment Initiative of 1999 (Act), effective July 27, 2010, the Emergency andthe Fourth Proposed Rulernaking published, August 12,2011 in the D.C. Register, andhas knowledge of District and federal laws and regulations relating to marijuana andmedical marijuana.

6. The undersigned applicant assumes any and all risk or liability that may result underDistrict of Columbia and federal laws and regulations from the operation ofa medicalmarijuana dispensary.

7. The undersigned applicant acknowledges that he/she understands that the medicalmarijuana laws and enforcement thereof of the District of Columbia and the Federalgovernment are subject to change at any time and that the District of Columbia shall notbe liable as a result of these changes;

8. The undersigned applicant attests to the fact that the applicant is the true and actualowner of tho business for which the registration is sought; the applicant intends to carryon the business for the entity identified in the application and not as the agent of anyother individual, partnership, association, or corporation not identified in the application;and the registered establishment will be managed by the applicant in person or by aregistered manager approved by the Director;

9. The undersigned attests that the applicant understands and is aware that a dispensary'sregistration may be revoked at any time for the convenience of the District pursuant tothe regulations.

10. The undersigned applicant understands that the Department is not required to issue all ofthe available registrations to operate a dispensary.

11. The undersigned specifically acknowledges receipt and advisement of the notices below.The undersigned agrees to and accepts the limitation of liability against the District, andthe requirement to indemnify, hold harmless, and defend the District.

(a) Limitation of Liability - The District of Columbia shall not be liable toregistrant. its employees, agents. business invitees. licensees, customers, clients,family members or guests for any damage. injury. accident, loss, compensation orclaim, based on, arising out of or resulting from registrant's participation in theDistrict of Columbia's medical marijuana program, including but not limited tothe following: arrest and seizure of persons and/or property, prosecution pursuantto federal laws by federal prosecutors, interruption in registrant's ability to operateits medical marijuana cultivation center and/or dispensary; any fire, robbery, theft,mysterious disappearance or any other casualty; the actions of an y other

Page 2 of49130/2011


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registrants or persons within tile cultivation center and/or dispensary. ThisLimitation of Liability provision shall survive expiration or the earlier terminationof th is registration if sue h registration is granted.(b) Indemnification, Hold Harmless and Defense Obligations ~ Registranthereby indemnifies and holds the District of Columbia, its officers, directors,employees, affiliates and agents ("Indemnified Parties") harmless and shalldefend the Indemnified Parties (with counsel satisfactory to District of Columbia)from and against any and all losses, costs, damages, liabilities, expenses, claimsand judgments (including, without limitation, attorneys fees and court costs)suffered by or claimed against the Indemnified Parties, directly or indirectly.based on, arising out of or resulting from (i) registrant's establishment andoperation of a cultivation center andlor dispensary in the District's medicalmarijuana program. (ii) the negligence or willful misconduct of registrant or it semployees, contractors, agents, licensees, guests or invitees, (iii) any breach ordefault by registrant in the performance or observance of its covenants orobligations under this registration, or (iv) any violations of law by of registrant orits employees, contractors, agents, licensees, guests or 'invitees.(c) Federal Prosecution - The United States Congress has determined thatmarijuana is a controlled substance and has placed marijuana in Schedule I of theControlled Substance Act. Growing, distributing, and possessing marijuana inany capacity, other than as a part of a federally authorized research program, is aviolation of federal laws. The District of Columbia's law authorizing theDistrict's medical marijuana program will not excuse any registrant from anyviolation of the federal laws governing marijuana or authorize any registrant toviolate federal laws.

12. The undersigned applicant certifies that the application is complete and accurate.

Any person who knowingly makes a false statement on an application, or in anyaccompanying statement under oath that the Department may requite, shall be guilty ofthe offense of making false statements. The making of a false statement, whether madewith or without the knowledge or consent of the applicant, shall, if! the discretion of theDirector, constitute sufficient cause for denial of the application or revocation of theregistration. The making of false statements shall also constitute the basis for a criminaloffense under D.C. Official Code 22-2514.

Page 3 of49/30/2011


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13. The undersigned chooses to sign this attestation willingly and without reservation and isfully aware of its meaning and effect.

Signature of APPlicant: C _ : : . . . _ _ ~ : : : . . . . ~" : ? _ _ _ ~ . . . . . . : _ _ ) _Print Name: C _ " . _ H _ f 2 - _ \ S - = - - . - - - - l . G . " t . ! . . _ t A - _ R . . . . . : : . . , ; . . Q L _ _C o m p a n y N a m e : _C _ ; _O _ t __ :m '- -- -L f "'p t a S '- = '- -" ', "" "' '- -< - ,. . . . . , e ( l L - L . . _ _ , L _ . J '. . . = - , Y ) ; . . , L . - I c . . ; . . : . = - v . _ _ " S _ ~ t t P ~ _. . . b 1 f r M ~ _ H t e L I L - L c . .

Date: (0 z . . . - z . . . . . L " ' . . : ; ) i

Subscribed and sworn to before me this L ' 2 . . . ~ dayof OL~'VW ,2olL.M y c o m m i s s i o n expires S '" \ '( ' 2 . -L \ \ 2 .0 \ ' S "Notary Signature and Seal: /'?z__- ~

[fthe applicant is a sole proprietor, the individual must sign. If'the applicant is a partnership, each partner must sign a copy of this document and submit a copy of the

partnership agreement. lfthe applicant is a corporation, the President or Vice President must sign. I f'the applicant is an LLC , each of the managing member(s) must sign a copy of this document. If the applicant is a Limited Partnership, each of the general partnens) must sign a copy of this document.

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GOVERNMENT OF THE DISTRICf OF COLUMBIAD EPAR TMEN T OF C ON SUMER AN D R EGULATOR Y AFFAIR SOFFICE OF THE WNING ADMINISTRATOR* * *VIA EMAILED PDPW r A J _ m c ~~.~te.t!\e-~,~RE: J 5 . 3~]fh st N W sSL:044~ 0179 [Subject Property]Dear m; .y y 1C~ll.Y f h:9 :This letter confirms my review of your client's proposed medical marijuana dispensary to be locatedat the Subject Property in Washington, D C . My analysis included applying the zoning regulations setforth in Title II of the District of Columbia Municipal Regulations (DCMR) and the medicalmarijuana regulations set forth in Title 22, Subtitle C of the DCMR (these regulations were adopted,on emergency basis, by the Mayor on August 10, 20 II, and were published in the D. C. Regis ter onAugust 1,2011 (58 D.C.R. 7207.After reviewing the District's zoning map. I found that the Property is zoned e - . 2 - A Under theD .C . zoning regulations, specifically II DCMR 721.1, any use permitted in a C-l District shall bepermitted in any C- prefixed District as a matter of right. Pursuant to 701.4 of the ZoningRegulations, a drug store or pharmacy is permitted as a matter of right in a C-I District; and,therefore. would be permitted on property zoned in a C- prefixed district, The presence of anOverlay does not affect this use. As the Zoning Administrator, I interpret the zoning regulations on acase-by-case basis. As such, I have determined that a medical marijuana dispensary is permitted onthe subject property.Under 22C DCMR 5201.1 and 5403.2, a medical marijuana dispensary shall not be located"within three hundred feet (300 ft) ofa preschool, primary or secondary school, or recreation center."Based on the information you provided, the Property complies with these distance requirements. Myoffice independently researched the District 's Geographic Information System and found noidentified preschools, prim ary or secondary schools, or recreation centers within a 300-foot radius ofthe Property's lot lines.

Therefore, based on the medica] marijuana and zoning regulations, your representations, and myoffice's independent research, I conclude that your proposed medical marijuana dispensary at theProperty is allowed as a matter of right use. As you are aware, this use is subject to the licensingrequirements of the D.C. Department of Health, which administers and regulations the medicalmarijuana program. Please feel free to contact me at matthew.legrant@ dc.gov if you have an yquestions.Sincerely.

1100 4thStreet, S.W" 3tdFloor. Washington, DC 20024
mailto:[email protected]:[email protected]

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CCA Medical Marijuana Dispensary Application Redacted)

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