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Dispensary Agent - Attestation Form 2026

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The document is an attestation form for dispensary agent applicants in Illinois' Medical Cannabis Pilot Program. It requires agents to confirm they have not been charged with excluded offenses, agree to legal liabilities, and adhere to regulations regarding the handling of medical cannabis. The form includes various attestations related to criminal history, responsibilities upon conviction, and identification requirements.

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Click ‘Get Form’ to open it in the editor.
Begin by filling out your printed name at the designated section. Ensure that your name is clear and legible.
Proceed to answer each question by selecting 'YES' or 'NO'. Be sure to read each statement carefully, especially those regarding excluded offenses and responsibilities.
If you answer 'YES' to being delinquent in child support obligations, provide a brief explanation in the comments section below.
Sign and date the form at the bottom. Your signature confirms that all information provided is true and correct.
Review all entries for accuracy before submitting. Utilize our platform's editing features to make any necessary adjustments.

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