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

Universal Citation: HI Admin Rules 11-850-14

Current through February, 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 (DHS) or the U.S. Citizenship and Immigration Services (USCIS);

(v) Unexpired employment authorization document issued by the OHS, 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 OHS admittance stamp on the passport;

(vii) Certificate of naturalization issued by OHS, Form N-550 or Form N-570;

(viii) Certificate of citizenship, Form N-560 or Form N-561, issued by OHS

(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.

(b) The information and documents shall be submitted in a manner prescribed by the department in the notice of open application, and all of the original documents or certified copies shall be retained on file by the applicant and be subject to physical inspection by the department as part of the application evaluation process.

Disclaimer: These regulations may not be the most recent version. Hawaii may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.