(a) An individual applicant shall provide the following required information:

1. (1) Legal name;
2. (2) Date of birth;
3. (3) Legal residence;
4. (4) Social Security number;
5. (5) Mailing address or principal residence address if different from the mailing address;
6. (6) Phone number;
7. (7) Email address; and
8. (8) Statement of individual’s authority to act on behalf of an entity, if applicable.

(b) The following supporting documents shall be submitted at the time of application:

1. (1) To establish legal name an applicant must present at least one (1) of the following source documents:

   1. (A) Certified copy of a birth certificate or marriage certificate filed with a state office of vital statistics or equivalent agency in the individual’s state of birth or marriage;
   2. (B) Valid, unexpired United States passport or United States passport card;
   3. (C) Consular report of birth abroad Form FS-240, DS-1350, or FS-545 issued by the United States Department of State;
   4. (D) Valid, unexpired permanent resident card (Form I-551) issued by the United States Department of Homeland Security or the United States Citizenship and Immigration Services;
   5. (E) Unexpired employment authorization document issued by the United States Department of Homeland Security, Form I-766 or Form I-688B;
   6. (F) Unexpired foreign passport with the following:

(i) A valid, unexpired United States visa affixed; and

1. (ii) Either:

(b) (b) A United States Department of Homeland Security admittance stamp on the passport;

1. (G) Certificate of naturalization issued by the United States Department of Homeland Security, Form N-550 or Form N-570;

   1. (H) Certificate of citizenship, Form N-560 or Form N-561, issued by the United States Department of Homeland Security;
   2. (I) Court-issued, certified copy of a divorce decree; or
   3. (J) Certified copy of a legal change of name order;

2. (2) To establish date of birth, an applicant must present at least one (1) of the following source documents:

   1. (A) At least one (1) document included in subdivisions (b)(1)(A) – (J) of this section; and
   2. (B) A photocopy of the individual’s valid, unexpired driver’s license or government-issued photo identification card;

3. (3) To establish residency in the state of not less than seven (7) years preceding the application, an applicant must present at least one (1) of the following source documents:

   1. (A) Arkansas tax return Form AR1000 for each of the seven (7) years preceding the application without schedules, worksheets, or attachments and redacted to remove all financial information and all but the last four (4) digits of the individual’s Social Security number;
   2. (B) Evidence of voter registration for the seven (7) years preceding the application;
   3. (C) Ownership, lease, or rental documents for place of primary domicile for the seven (7) years preceding the application;
   4. (D) Billing statements including utility bills for the seven (7) years preceding the application; or
   5. (E) Vehicle registration for the seven (7) years preceding the application;
4. (4) To establish proof of no felony convictions or other disqualifying background information, an individual applicant shall provide consent to a background check, including fingerprinting; and

5. (5) Individuals applying on behalf of an entity must also provide the following proof:

   1. (A) Documentation of the ownership of the entity; and

   2. (B)

      1. (i) Documentation demonstrating that sixty percent (60%) of the equity ownership interests in the entity are held by individuals who have been residents of the State of Arkansas for seven (7) years prior to the application.
      2. (ii) Documentation sufficient to satisfy this requirement shall be the same as required of an individual in subdivision (b)(2) of this section;

   3. (C)

      1. (i) Board members and officers are over the age of twenty-one (21).
      2. (ii) Documentation sufficient to satisfy this requirement shall be the same as required of an individual in this subsections and subsection (c) of this section; and

   4. (D) Consents for criminal background checks for each owner, board member, and officer of the entity.

      1. (c)
6. (1) Applicants shall provide proof that the proposed location of the dispensary is at least one thousand five hundred feet (1,500’) from a public or private school, church, daycare, or facility for individuals with developmental disabilities existing before the date of the dispensary application pursuant to the Arkansas Medical Marijuana Amendment of 2016, Ark. Const. amend. 98.

7. (2) The distance specified in this section shall be measured from the primary entrance of the dispensary to the nearest property line point of the:

   1. (A) School;
   2. (B) Church;
   3. (C) Daycare facility; or

   4. (D) Facility for individuals with developmental disabilities.

      1. (d)
8. (1) Applicants shall provide proof of authorization to occupy the property for the proposed dispensary.

9. (2) To establish proof, the applicant shall provide one (1) of the following:

   1. (A) If the property is owned by the applicant, the applicant shall provide:

      1. (i) Confirmation of land ownership;
      2. (ii) Identification of any mortgagees and perfected lienholders; and
      3. (iii) If applicable, verification of notification to any mortgagees and perfected lienholders that the property is to be used as a medical marijuana dispensary, and consent thereto by any mortgagees and perfected lienholders;

   2. (B) If the property is not owned, but is currently leased by the applicant, the applicant shall provide:

      1. (i) A copy of the lease;
      2. (ii) Confirmation of land ownership;
      3. (iii) Identification of any mortgagees and perfected lienholders;
      4. (iv) A written statement from the property owner or landlord certifying consent that the applicant, if awarded a license, may operate a medical marijuana dispensary on the property; and
      5. (v) If applicable, verification of notification to any mortgagees and perfected lienholders that the property is to be used as a medical marijuana dispensary and consent thereto by any mortgagees and perfected lienholders; or

   3. (C) If the property is not owned or leased by the applicant, the applicant shall provide:

      1. (i) A written statement from the property owner or landlord certifying consent that the applicant has the option to lease or purchase the property, contingent upon the issuance of a dispensary license; and
      2. (ii) If applicable, verification of notification by the property owner to any mortgagees and perfected lienholders that the property is to be used for a medical marijuana dispensary and consent thereto by any mortgagees and perfected lienholders.