Required Forms & Documents

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

Required For All Applicants

• LIC-4004-FORM(PDF, 437KB) - 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, 437KB) - 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

Other Contact Changes Modification

Required For All Applicants

• LIC-4003-MOD(PDF, 234KB) - List of Other Personnel Contacts

Only Required If Applicable

None

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

The documents listed below must be the most up to date versions and represent the current (or proposed if modifying) state of the business.

Required For All Applicants

• LIC-4008-FORM(PDF, 858KB) - Legal Business Entity Record Disclosure Form
• LIC-4025-FORM(PDF, 405KB) - Public Health Permit Attestation
  Sample INT-4001-FORM(PDF, 524KB): Sample of DCR Referral Form for LADBS Plan Submittal
• LIC-4005-FORM(PDF, 301KB) - Indemnification Agreement
• Business Premises Diagram (BPD)
  No specific DCR form, but must satisfy all requirements of the checklist
  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
  No specific DCR form, but must be a fully executed lease or property deed valid through December 31, 2026

Only Required If Applicable

• LIC-4004-FORM(PDF, 437KB) - Required if modifying record during renewal process
• LIC-4023-FORM(PDF, 380KB) - Required for Phase 2, Tier 3 applicants only
• LIC-4018-FORM(PDF, 298KB) - Successor In Interest Form (Social Equity Businesses)
  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, 437KB) - 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, 380KB) - Phase 2 (LAMC 104.08) Tier 3 Applicant Attestation
• LIC-4024-FORM(PDF, 387KB) - Business Premises Diagram Checklist
• LIC-4025-FORM(PDF, 405KB) - Public Health Permit Attestation
  • Sample INT-4001-FORM(PDF, 524KB): Sample of DCR Referral Form for LADBS Plan Submittal

• ADM-1002-FORM(PDF, 355KB) - DCR Claim for Refund Application 

Modification Forms

• LIC-4001-MOD(PDF, 850KB) - Application Modification Request Cover Page
• LIC-4002-MOD(PDF, 3MB) - Application Modification Request - Business Premises Relocation
• LIC-4003-MOD(PDF, 234KB) - List of Other Personnel Contacts
• 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

• ADM-1002-FORM
• 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