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R420.4 Application requirements; financial and criminal background.
Rule 4. (1) Each applicant shall disclose the identity of any other person who controls, either
directly or indirectly, the applicant, including, but not limited to, date of birth, government issued
identification, and any other documents required by the agency.
(2) Each applicant shall disclose the financial information required in the acts and these rules on
a form created by the agency, including the following:
(a) For an applicant seeking licensure under the medical marihuana facilities licensing act,
required information includes, but is not limited to, all of the following:
(i) Financial statements regarding all of the following:
(A) A pecuniary interest.
(B) Any deposit of value of the applicant or made directly or indirectly to the applicant, or
both.
(C) Financial accounts including, but not limited to, all of the following: funds, savings,
checking, or other accounts including all applicable account information, such as the name of the
financial institution, names of the account holders, account type, account balances, and a list of
all loans types specified by the agency, amounts, securities, or lender information.
(ii) Property ownership information, including, but not limited to, deeds, leases, rental
agreements, real estate trusts, or purchase agreements.
(iii) Tax information, including, but not limited to, W-2 and 1099 forms, and any other
information required by the agency.
(iv) Disclosure by the applicant of the identity of any other person who meets either of the
following:
(A) Controls, directly or indirectly, the applicant.
(B) Is controlled, directly or indirectly, by the applicant or by a person who controls, directly
or indirectly, the applicant.
(v) Each applicant shall disclose all shareholders holding a direct or indirect interest of greater
than 5%, officers, and directors in the proposed marihuana facility.
(vi) The sources and total amount of the applicant’s capitalization to operate and maintain the
proposed marihuana facility in compliance with R 420.11.
(vii) A financial statement attested by a certified public accountant (CPA), on a form created
by the agency, including a foreign-attested CPA statement, or its equivalent if applicable on
capitalization pursuant to R 420.11.
(viii) Information on the financial ability of the applicant to purchase and maintain adequate
liability and casualty insurance in compliance with R 420.10.
(ix) Any other documents, disclosures, or attestations created or requested by the agency that
are not inconsistent with the acts or these rules.
(b) For an applicant seeking licensure under the Michigan regulation and taxation of marihuana
act required information includes, but is not limited to, all of the following:
(i) Tax information, including, but not limited to:
(A) W-2 forms for the most recent tax year.
(B) 1099 forms for the most recent tax year.
(ii) Any other information required by the agency.
(3) Each applicant shall disclose all shareholders holding a direct or indirect interest of greater
than 5%, officers, and directors in the proposed marihuana establishment.
(4) Each applicant shall disclose the applicant’s business organizational documents filed with
this state, any other state, local county, or foreign entity, if applicable, including proof of