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COMPASSIONCENTERSOFAMERICA,LLC
ApplicationforMedicalMarijuanaDispensary
Submittedto:TheDistrictofColumbiaDepartmentofHealthDepartmentofHealth899nNorthCapitolStreet,NE2
nd
FloorWashington,DC20002Tuesday,November15~2011
CompassionCentersofAmerica,LLC
1.Question
1:
Pleaseprovidethefollowing:Forpartnershiporlimitedliabilitycompany:a)Legalnameofthebusinessor,
if
thebusiness
will
beusingatradenameotherthanit'slegalname,acopyofthetradenameregistrationfromtbeDepartmentofConsumerandRegulatoryAffairs.CompassionCentersof
America,
LLCb)Namesandaddressesofeachmemberofthepartnershiporlimitedliabilitycompany.
ChrisGardAlameda,CA94501
JustinJarin
Alameda,
CA
94501
Thomas
Lindenfeld
Washington,
DC
20015
ApplicationforMedicalMarijuanaDispensary
1
CompassionCentersofAmerica,LLCc)DateofbirthofcachmemberofthepartnershiporlimitedliabilitycompanyChrisGard
DOB:
JustinJaren
DOB:
Thomas
Lindenfeld
DOB:
d)Certificate
of
GoodStandingforthepartnershiporlimitedliabilitycom-panyissuedbytheDepartmentofConsumerandRegulatory
Affairs
within30days
ofthe
application'ssubmission.
Please
see
AppendixA
for
theCertificate
ofGood
Standing,BasicBusinessLicense,CertificateofRegistration,BasicBusinessCleanHandsForm,DCBusinessTaxRegistrationNumber,ApplicationforCertificateofForeignLimitedLiabilityCorporation,andOfficeofTaxandRevenueSalesandUseTaxCertificateofRegistration.
ApplicationforMedicalMarijuanaDispensary
2
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