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2. Registration Type:*
   -- Select One --First Time/NewAnnual RenewalReporting Changes
4. The fiscal year for this registration:*
   -- Select One --July 1, 2020 - June 30, 2021July 1, 2021 - June 30, 2022July 1, 2022 - June 30, 2023July 1, 2023 - June 30, 2024
6. The total sq. footage of the site for the fiscal year listed:*
8. County Permit Number:*
10. State License Number:*
12. License/ Permit Type *
    -- Select One --Cultivation (Indoor)Cultivation (Mixed Light Tier 1)Cultivation (Mixed Light Tier 2)Cultivation (Outdoor)Nursery Retailer Distributor Distribution Facility Testing LaboratoryTransporterManufacturing Facility Dispensary Microbusiness Combination (Please describe below)Other (Please describe below)
14. If you selected "Combination" or "Other" above please provide detailed answer*
16. Legal Business Name & DBA:*
18. Business Physical Address:*
20. Business Mailing Address:*
22. Business Contact Person:*
24. Phone Number:*
26. Email:*
28. Business Website:
30. List the number of growing cycles that will be harvested during the fiscal year listed above:*
32. List the sq. footage of each growing cycle that will be harvested during the fiscal year listed above:*
34. Full Name:*
36. Title:*
38. Confirmation:*

    1. I declare under penalty of perjury that the information contained in this form is true and correct and that I am signing as an authorized agent of the business listed on this form.

    I understand that storage of contact information, including but not limited to names, telephone numbers, and email addresses in the TTC's request database may constitute a public record which may be subject to disclosure under the California Public Records Act, Government Code Section 6250.

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39. 1. Receive an email copy of this form.
40. Email address

    This field is not part of the form submission.

41. Submit

* indicates a required field