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Last updated: 10/12/2023
Primary Personnel and Owner Attestation (Cannabis Regulation) {LIC-4004-FORM}
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Description
LIC-4004-FORM - PRIMARY PERSONNEL AND OWNER ATTESTATION. This attestation form is intended to support compliance with Los Angeles Municipal Code (LAMC) Sections 104.04(c) and 104.04(d), which set forth prohibitions on Owners and Primary Personnel if they have been convicted of certain criminal offenses, among other restrictions. Each Owner and Primary Personnel disclosed on the List of Primary Personnel and Owners (LIC-4003-FORM) must submit a signed, notarized version of this form. Please carefully review the definitions below to ensure you are either a Primary Personnel or Owner and that you understand the relevant restrictions. These restrictions apply to all Primary Personnel and Owners, including those who are verified Tier 1 or Tier 2 Social Equity Applicants. www.FormsWorkflow.com
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