Change of Location Request Form - Nevada · 2019-01-07 · Change of Location Request Form...
Transcript of Change of Location Request Form - Nevada · 2019-01-07 · Change of Location Request Form...
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: