Required Forms & Documents

1. Legal Business Entity Record (LBER) Record [LA-B-0000000000]

Required For All Applicants

• LIC-4004-FORM(PDF, 331KB) - Owner / Primary Personnel Attestation
• LIC-4008-FORM(PDF, 858KB) - Legal Business Entity Record Disclosure Form
  Must include an organizational chart
• State Registration Documents
  Articles of Incorporation and/or Statement of Information
• Business Formation Documents (if applicable: For SEIA’s)
  Examples: Operating Agreement, Bylaws, etc.

Only Required If Applicable

• LIC-4009-FORM(PDF, 315KB) - Authorized Agent Acknowledgement
  Only required if you have an authorized agent
• SEP-6001-FORM(PDF, 324KB) - Owner Compliance Attestation
  Only required for Social Equity Individual Applicants

2. Pre-Application Record [LA-X-YY-000000-PREAPP]

Required For All Applicants

LIC-4016-FORM(PDF, 354KB) - Landowner Attestation Location Eligibility

3. Initial Inspection

Required For All Applicants

• LIC-4021-FORM(PDF, 306KB) - Initial Inspection Attestation
• Lease Agreement
• LIC-4024-FORM(PDF, 387KB) - Business Premises Diagram Checklist
  Note: This document is a checklist. The applicant must submit the actual Business Premises Diagram.

Only Required If Applicable

• Security Procedures: Please reference the Department of Cannabis Control (DCC) Security Plan Form

4. Annual Application Record [LA-X-YY-000000-ANN]

Required For All Applicants

• LIC-4021-FORM(PDF, 306KB) - Initial Inspection Attestation
• LIC-4020-FORM(PDF, 269KB) - No Alcohol or Tobacco Applicant Attestation
• LIC-4005-FORM(PDF, 301KB) - Indemnification Agreement
• LIC-4010-FORM(PDF, 322KB) - Temporary Approval Attestation
• LIC-4013-FORM(PDF, 778KB) - Project Specific Information
• LIC-4024-FORM(PDF, 387KB) - Business Premises Diagram Checklist
  Note: This document is a checklist. The applicant must submit the actual Business Premises Diagram.
• Lease Agreement

5. License Record [LA-X-000000-LIC]

All documents would already be received.

6. Modification Records [LA-X-000000-MOD]

Address Modification

Required For All Applicants

• LIC-4001-MOD(PDF, 850KB) - Modification Request Cover Page
• LIC-4002-MOD(PDF, 3MB) - Business Premises Relocation
• LIC-4016-FORM(PDF, 354KB) - Landowner Attestation

Only Required If Applicable

• LIC-4019-FORM(PDF, 279KB) - Business Premises Surrender Form
  Only required for a loss of site control

Entity Substitute Modification

Required For All Applicants

• LIC-4001-MOD(PDF, 850KB) - Modification Request Cover Page
• LIC-4004-FORM(PDF, 331KB) - Owner Primary Personnel Attestation
• LIC-4006-MOD(PDF, 3MB) - General Applicant Entity Substitution Form
• LIC-4008-FORM(PDF, 858KB) - Legal Business Entity Record Disclosure Form
  (Must include an organizational chart)

Only Required If Applicable

• None

Ownership Modification

Required For All Applicants

• LIC-4001-MOD(PDF, 850KB) - Modification Request Cover Page
• LIC-4004-MOD(PDF, 3MB) - Ownership Structure Change
• LIC-4005-MOD(PDF, 2MB) - Removal of Owners
• LIC-4008-FORM(PDF, 858KB) - Legal Business Entity Record Disclosure Form
  (Must include an organizational chart)

Only Required If Applicable

None

7. Renewal Records (2025) [LA-X-YY-000000-DOC] [LA-X-YY-000000-REN]

Required For All Applicants

• LIC-4005-FORM(PDF, 301KB) - Indemnification Agreement
• LIC-4008-FORM(PDF, 858KB) - Legal Business Entity Record Disclosure Form
• LIC-4024-FORM(PDF, 387KB) - Business Premises Diagram Checklist
  Note: This document is a checklist. The applicant must submit the actual Business Premises Diagram.
• Evidence of Site Control
  Examples: Executed Lease, Property Deed, etc.

Only Required If Applicable

• LIC-4018-FORM(PDF, 298KB) - Successor In Interest Form
  Only required if not previously submitted or there is an update needed from your prior submission.

8. List of All Licensing Forms (Numerical Order)

General Forms

• LIC-4001-FORM(PDF, 305KB) - Public Convenience or Necessity Finding Request
• LIC-4002-FORM(PDF, 340KB) - Stakeholder Input Request
• LIC-4004-FORM(PDF, 331KB) - Primary Personnel and Owner Attestation
• LIC-4005-FORM(PDF, 301KB) - Indemnification Agreement
• LIC-4008-FORM(PDF, 858KB) - Legal Business Entity Record Disclosure Form
• LIC-4009-FORM(PDF, 315KB) - Authorized Agent Acknowledgement
• LIC-4010-FORM(PDF, 322KB) - Temporary Approval Attestation
• LIC-4013-FORM(PDF, 778KB) - Project-Specific Information
• LIC-4014-FORM(PDF, 439KB) - Denial of an Annual License Appeal Form
• LIC-4015-FORM(PDF, 458KB) - Application Withdrawal - License Cancellation
• LIC-4016-FORM(PDF, 354KB) - Landowner Attestation: Location Eligibility
• LIC-4017-FORM(PDF, 323KB) - Renewal Attestation
• LIC-4018-FORM(PDF, 298KB) - Successor In Interest Form
• LIC-4019-FORM(PDF, 279KB) - Business Premises Surrender Form
• LIC-4020-FORM(PDF, 269KB) - No Alcohol or Tobacco Applicant Attestation
• LIC-4021-FORM(PDF, 306KB) - Initial Inspection Attestation
• LIC-4022-FORM(PDF, 287KB) - Receivership Form
• LIC-4023-FORM(PDF, 315KB) - Phase 2 (LAMC 104.08) Tier 3 Applicant Attestation
• LIC-4024-FORM(PDF, 387KB) - Business Premises Diagram Checklist

Modification Forms

• LIC-4001-MOD(PDF, 850KB) - Application Modification Request Cover Page
• LIC-4002-MOD(PDF, 3MB) - Application Modification Request - Business Premises Relocation
• LIC-4004-MOD(PDF, 3MB) - Application Modification Request - Ownership Structure
• LIC-4005-MOD(PDF, 2MB) - Application Modification Request - Removal of Owner(s)
• LIC-4006-MOD(PDF, 3MB) - Application Modification Request - Applicant Entity Substitution (General)

Information and Procedure Bulletins

• LIC-4001-IPB(PDF, 315KB) - PCN Information and Procedure Bulletin
• LIC-4002-IPB(PDF, 375KB) - Pre-Application Review Information and Procedure Bulletin
• LIC-4003-IPB(PDF, 327KB) - Temporary Approval Information and Procedure Bulletin
• LIC-4004-IPB(PDF, 290KB) - Application Modification - Business Premises Relocation

Workflow Forms

• LIC-4001-WF(PDF, 226KB) - PCN Workflow
• LIC-4002-WF(PDF, 328KB) - Pre-Application Review Workflow
• LIC-4005-WF(PDF, 488KB) - Temporary Approval Application Refiling Workflow