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Collective-Dispensary
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owner Name
owner Email
owner Phone
DatE of transition
owner Address
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District of Columbia
Zip code
Jurisdiction declaration & Address Format
Ecclesiastical
National
Adderss Format
Collective Name & Motto
Type of Entity
Cannabis Collective
Dispensary
Manufacturing
Cultivation
Delivery
Other
Registration ID
Collective state
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Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Another option
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
District of Columbia
Existing Assets to convert
converting Assesst
Agency Recipients
BUREAU
Health
Revenue
Bank Name
EIN
Purpose or Mission Statement
Where will the collective be based?
special rules or beliefs (Optional)
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508(c)(1)(A) Collective Declaration
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conversion notice
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Ecclesiastical Declaration
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Print
Religious Exemption Letter
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Banking Support Letter
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Commercial Rescission Letter
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Assignment of Ownership
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Conditional Acceptance Affidavit
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Final Notice of Default
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Print
Universal Declaration of Assignment
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508 Affidavit of Status
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Agency Jurisdiction Notice
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Follow-Up Confirmation
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