Amended License Request Application

Please complete the below form to its entirety. Forms not completed to their entirety will not be accepted and deemed incomplete by the division. A licensee shall submit to the division an application form for an amended license or application, submit any required documentation associated with the change and must obtain approval from the division, prior to implementing any type of amendment. Required documentation for specific amendments are listed at the end of this document.

Applicant information:

Applicant Full Name:
Mailing Address:

Business/Application Details:

Applicant’s Legal Business Name:

Type of Amendment requested:

Type of amendment being requested (check one):

Amendment information:

Is this request for an:

Premise Details:

If address change is requested, please put new premise address here. If no change in address, please enter premise address here:
Physical Address:
Will the proposed expansion bring the licensed premises within 300 feet of a church or school?

Plant count information (if change requested):

Producers: If increasing plant count, plant count increase must be in increments of 500. No more than 4 increments of 500 at a time.
*Please note that if you are increasing your plant count, a plant count fee of $5 per plant for recreational or $2.50 per plant for licensee’s exclusively growing medical cannabis may be required prior to approval of this request. Increase of a plant count will require additional proof of legal access to water. See required documents checklist below.
Microbusiness producers: Current plant count level (check one):
Proposed plant count level (check one):

Water source information (if change requested):

Current water source (check one):
Proposed water source (check one):
*Please note that additional documentation will be required for proof of water rights. See required documents checklist below.

Operating hours (if change requested):

Please enter time using a 24 hour clock (military time)
Current start time:
:
Current end time:
:
Proposed start time:
:
Proposed end time:
:
I,
(Full Legal Name of Applicant/Licensee)
, attest that:
he/she is the licensee, applicant or is authorized by the applicant to make this application; that he/she has read the same; knows the contents therein contained are true. Applicant(s) agree(s) that if any statements or representations herein are found to be false, the Director may refuse to issue or renew the license or may cause the license to be revoked at any time.
MM slash DD slash YYYY

For Cannabis Control Division Use Only:

MM slash DD slash YYYY
Staff member processing request:
Request approved:
MM slash DD slash YYYY
Director approval if required:
MM slash DD slash YYYY

Additional required documents:

If your amendment is not included on the list below, no other documentation is required.

Water source changes-

For all water source changes, you are required to submit the following documents along with this request.
  1. Documentation from a water provider that the applicant has the right to use water from the provider and that the use of water from cannabis production is compliant with provider's rules, or
  2. Documentation from the office of the state engineer showing that the applicant has a valid and existing water right, or a permit to develop a water right, for irrigation purposes for outdoor cultivation, or a commercial purpose for indoor cultivation at the proposed place of use of the cannabis establishment. The documentation may include any of the following:
      a. a state engineer permit or license in good standing, but not including a permit issued pursuant to Sections 72-12-1, -1.1, -1.2, or -1.3, NMSA 1978;
      b. a sub file order or decree issued by a water rights adjudication court;
      c. the findings of an office of the state engineer hydrographic survey; or
      d. other documentation the office of the state engineer has deemed in writing as acceptable to the office of the state engineer under this rule.
  3. An updated water and energy use plan

Material or substantial change of the size of the premises OR material or substantial modification of the premises change-

For changes to the premises, you are required to submit the following documents along with this request:
  1. A completed premise diagram attestation form
  2. A copy of the applicable building permit; and
  3. A new certificate of occupancy, if applicable

Plant count increase requests-

For plant count increases, you are required to submit the following documents along with this request:
  1. Proof of legal water source for new plant count
  2. A completed premise diagram attestation form
  3. An updated water and energy use plan

Change or modification in extraction type(s) or equipment-

For a change or modification in extraction type(s) or equipment used in manufacturing, you are required to submit the following documents along with this request:
  1. A completed premise diagram attestation form
  2. A valid and current compressed gas extraction permit (if applicable)
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