Hawaii Administrative Rules › Title 11 - DEPARTMENT OF HEALTH › Subtitle 1 - GENERAL DEPARTMENTAL PROVISIONS › Chapter 850 - MEDICAL CANNABIS DISPENSARIES › Subchapter 2 - LICENSING › Section 11-850-14 - Documentation and information for individual applicant

Current through June, 2024
(a)
				  An individual applicant shall provide the following required information and
				  documents:
(1) Legal name, date of birth,
				  legal residence, last four digits of the applicant's social security number,
				  mailing address, and principal residence address if different from the mailing
				  address, phone number, facsimile number, email address, whether the individual
				  applicant was convicted of a felony, the person's authority to act on behalf of
				  the applying entity, and date of start of residency in the State of Hawaii;
				  and
(2) The following supporting
				  documents shall be submitted at the time of application:
(A) To establish legal name an applicant must
				  present at least one of the following source documents:
(i) Certified copy of a birth certificate or
				  marriage certificate filed with a state office of vital statistics or
				  equivalent agency in the individual's state of birth or marriage;
(ii) Valid, unexpired U.S. passport or U.S.
				  passport card;
(iii) Consular
				  report of birth abroad Form FS-240, DS-1350 or FS-545 issued by the U.S.
				  Department of State;
(iv) Valid,
				  unexpired permanent resident card (Form I-551) issued by the Department of
				  Homeland Security (OHS) or the U.S. Citizenship and Immigration Services
				  (USCIS);
(v) Unexpired employment
				  authorization document issued by the DHS, Form I-766 or Form I-688B;
(vi) Unexpired foreign passport with the
				  following: a valid, unexpired U.S. visa affixed, and an approved I-94 form
				  documenting the applicant's most recent admittance into the United States or a
				  DHS admittance stamp on the passport;
(vii) Certificate of naturalization issued by
				  DHS, Form N-550 or Form N-570;
(viii) Certificate of citizenship, Form N-560
				  or Form N-561, issued by DHS
(ix)
				  Court-issued, certified copy of a divorce decree; or
(x) Certified copy of a legal change of name
				  order;
(B) To establish
				  date of birth an applicant must present at least one of the following source
				  documents:
(i) At least one document included
				  in clauses (i) through (viii) of subparagraph (A) of this paragraph;
				  or
(ii) Valid, unexpired driver's
				  license or government issued photo identification card;
(iii) To establish residency in the State of
				  not less than five years preceding the application, an applicant must present
				  at least one of the following source documents:
(iv) State of Hawaii tax return Form N-11 for
				  each of the five years preceding the application without schedules, worksheets,
				  or attachments, and redacted to remove all financial information and all but
				  the last four digits of the individual's social security number;
(v) Evidence of voter registration;
(vi) Ownership, lease, or rental documents
				  for place of primary domicile;
(vii) Billing statements including utility
				  bills; or
(viii) Vehicle
				  registration;
(D) To
				  establish proof of no felony convictions or other disqualifying background
				  information, an individual applicant shall provide the following documentation:
(i) Report and validation code from an eCrim
				  report generated by the Hawaii Criminal Justice Data Center not more than 60
				  days prior to the date of application; and
(ii) Consent to a background check including
				  fingerprinting; and
(E)
				  Documentation of the authority of the individual to act on behalf of the
				  applying entity.