Colorado Department of Revenue – Medical Marijuana Caregiver Cultivation Location Registration Form

Colorado Department of Revenue – Medical Marijuana Caregiver Cultivation Location Registration Form

Colorado Department of Revenue

 Marijuana Enforcement Division (MED) 

Medical Marijuana Caregiver Cultivation Location Registration Form

Mail to: 455 Sherman Street, Suite 390

Denver, CO 80203

In accordance with C.R.S. §25‐1.5‐106(7)(e), a Caregiver who cultivates Medical Marijuana for his or her patients must register the location of that cultivation operation with the MMED. This information will be kept confidential and only provided to local government or a law enforcement agency upon receipt of an “address‐specific request for verification.”

Please provide the requested information below:

Patient MMR Number (Red Card) ‐ do not provide any additional patient information Physical Location of Cultivation Recommended Number of plants

If the Colorado Department of Public Health and Environment Medical Marijuana Registry has given the Caregiver an exception to serve more than five (5) patients pursuant to C.R.S. § 25‐1.5‐106(8)(a), please provide the above information for each patient you serve on an additional sheet of paper.

Please update your MMED Cultivation registration should the location of your cultivation change.

Printed Name

of Caregiver______________________________________________     Date: ________________

 

Signature of Caregiver______________________________________________________________

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