Phase 2 (LAMC 104.08) Tier 3 Applicant Attestation {LIC-4023-FORM}

LIC-4023-FORM - PHASE 2 (LAMC 104.08) TIER 3 APPLICANT ATTESTATION. This form is the Tier 3 Applicant Attestation form used by the City of Los Angeles Department of Cannabis Regulation (DCR). It is designed to ensure compliance with the requirements outlined in the Los Angeles Municipal Code (LAMC) Section 104.20 regarding Tier 3 Social Equity Program requirements for cannabis businesses. The form collects information about the Tier 3 Applicant Entity, including its name and business premises location. It also requires the applicant to attest that they have read and understand the requirements outlined in LAMC Section 104.20 and agree to comply with them for a minimum of three years. These requirements include providing ancillary business costs, education and training, and property assistance to Social Equity Individual Applicants. The applicant must indicate whether they have started compliance with the Tier 3 Program Requirements or if they have a plan to begin compliance before the issuance of an Annual License. The form also includes a section for the applicant to attest that the information provided is true, correct, and complete, with a notarized signature required. The form provides contact information for the Department of Cannabis Regulation and includes a notary acknowledgment section for verification of signatures. www.FormsWorkflow.com