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STATE OF NEVADA DEPARTMENT OF TAXATION Web Site: https://tax.nv.gov 1550 College Parkway, Suite 115 Carson City, Nevada 89706-7937 Phone: (775) 684-2000 Fax: (775) 684-2020 RENO OFFICE 4600 Kietzke Lane Building L, Suite 235 Reno, Nevada 89502 Phone: (775) 687-9999 Fax: (775) 688-1303 STEVE SISOLAK Governor JAMES DEVOLLD Chair, Nevada Tax Commission MELANIE YOUNG Executive Director LAS VEGAS OFFICE Grant Sawyer Office Building, Suite1300 555 E. Washington Avenue Las Vegas, Nevada 89101 Phone: (702) 486-2300 Fax: (702) 486-2373 HENDERSON OFFICE 2550 Paseo Verde Parkway, Suite 180 Henderson, Nevada 89074 Phone: (702) 486-2300 Fax: (702) 486-3377 Change of Location Request Form 10/3/2018 Change of Location Request Form E-mail to [email protected], submit to Nevada Department of Taxation Office or mail to: Department of Taxation, Attention: Marijuana Enforcement Division, Change of Location 1550 E. College Parkway, Suite 115, Carson City, NV 89706 Date: _______Establishment ID # (Example: D026): __________ License #:______________________ Marijuana Establishment Name: _________________________________________________________ Point of Contact Name (POC): _________________________Phone:____________________________ E-mail:__________________________________ POC Signature:______________________________ Current Establishment Physical Address: _______________________________________________ City:______State:_____Zip: ____ Current Jurisdiction City:_________________County: ___________ Proposed Physical Address: ___________________________ City:_________State:_____Zip:______ Assessor’s Parcel Number (APN):________________________________________________________ TAB CHECKLIST – Please complete and submit with requested documents in all tabs. Yes/No I Include required documentation from a public meeting in the local jurisdiction approving the location change. Agenda meeting & minutes are suggested. II Professional survey demonstrating the location meets the statutorily-required distance from schools and community facilities (1000 feet from schools & 300 feet from community facilities/parks/etc.). III Written & signed attestation: New address meets/exceeds merits of previous location. IV Nevada Business Registration form and $15 administrative fee. https://tax.nv.gov/uploadedFiles/taxnvgov/Content/Forms/Nevada_Business_Registration(1).pdf V Agent Cards current for owners, officers, board members. https://taxagentportal.nv.gov/ Internal use only Received by: Received Date: Jurisdiction check: NBR submitted to Processing date: TAS changed by: Final Mailing List updated by:

Change of Location Request Form - Nevada · 2019-01-07 · Change of Location Request Form 10/3/2018 . Change of Location Request Form . E-mail to . [email protected], submit

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Page 1: Change of Location Request Form - Nevada · 2019-01-07 · Change of Location Request Form 10/3/2018 . Change of Location Request Form . E-mail to . MJChange@tax.state.nv.us, submit

STATE OF NEVADA DEPARTMENT OF TAXATION

Web Site: https://tax.nv.gov 1550 College Parkway, Suite 115 Carson City, Nevada 89706-7937

Phone: (775) 684-2000 Fax: (775) 684-2020

RENO OFFICE4600 Kietzke Lane

Building L, Suite 235Reno, Nevada 89502

Phone: (775) 687-9999 Fax: (775) 688-1303

STEVE SISOLAK Governor

JAMES DEVOLLD Chair, Nevada Tax Commission

MELANIE YOUNG Executive Director

LAS VEGAS OFFICE Grant Sawyer Office Building, Suite1300

555 E. Washington Avenue Las Vegas, Nevada 89101

Phone: (702) 486-2300 Fax: (702) 486-2373

HENDERSON OFFICE 2550 Paseo Verde Parkway, Suite 180

Henderson, Nevada 89074 Phone: (702) 486-2300

Fax: (702) 486-3377

Change of Location Request Form 10/3/2018

Change of Location Request Form E-mail to [email protected], submit to Nevada Department of Taxation Office or mail to:

Department of Taxation, Attention: Marijuana Enforcement Division, Change of Location 1550 E. College Parkway, Suite 115, Carson City, NV 89706

Date: _______Establishment ID # (Example: D026): __________ License #:______________________

Marijuana Establishment Name: _________________________________________________________

Point of Contact Name (POC): _________________________Phone:____________________________

E-mail:__________________________________ POC Signature:______________________________

Current Establishment Physical Address: _______________________________________________

City:______State:_____Zip: ____ Current Jurisdiction City:_________________County: ___________

Proposed Physical Address: ___________________________ City:_________State:_____Zip:______

Assessor’s Parcel Number (APN):________________________________________________________

TAB CHECKLIST – Please complete and submit with requested documents in all tabs. Yes/No I Include required documentation from a public meeting in the local jurisdiction approving

the location change. Agenda meeting & minutes are suggested. II Professional survey demonstrating the location meets the statutorily-required distance

from schools and community facilities (1000 feet from schools & 300 feet from community facilities/parks/etc.).

III Written & signed attestation: New address meets/exceeds merits of previous location. IV Nevada Business Registration form and $15 administrative fee.

https://tax.nv.gov/uploadedFiles/taxnvgov/Content/Forms/Nevada_Business_Registration(1).pdf V Agent Cards current for owners, officers, board members. https://taxagentportal.nv.gov/

Internal use only Received by: Received Date:

Jurisdiction check: NBR submitted to Processing date:

TAS changed by: Final Mailing List updated by:

mailto:[email protected]
https://tax.nv.gov/uploadedFiles/taxnvgov/Content/Forms/Nevada_Business_Registration(1).pdf
https://taxagentportal.nv.gov/

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