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.
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