Person of Interest Entity Disclosure Form 2026

1. Click ‘Get Form’ to open it in the editor.
2. In Section A, enter your Canopy License Number if applicable, followed by the Business Name and the Name of the entity applying as a Person of Interest.
3. Proceed to Section B. Specify the Type of Entity or Person Applying (e.g., Sole Proprietor, LLC) and provide the Assumed Business Name (DBA) along with the FEIN. If you are a Sole Proprietor without hired staff, indicate N/A.
4. In Section C, list all owners, partners, and members. Include their SSN for individuals and FEIN for entities. Ensure that each individual submits fingerprint cards and a signed Privacy Act Statement.
5. Section D requires you to disclose any financial interests related to other medical marijuana licenses. Answer each question accurately and attach additional pages if necessary.
6. Finally, in Section E, declare that all information is true by signing and dating where indicated. Ensure all required signatures are collected before submission.

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