CITY MANAGER OFFICE
1001 West Center Street
Manteca, CA 95337
Ph: (209) 456-8011
Email: [email protected]
PROPERTY OWNER CONSENT/LANDLORD AFFIDAVIT
Property Owner Consent/Landlord Affidavit is required for all Applications. If the business owner is the same person/entity as the property owner, the business owner must complete, sign and notarize the Property Owner Consent/Landlord Affidavit form. If the property is owned by an entity, the entity owner must complete, sign, and notarize the Property Owner Consent/Landlord Affidavit.
I certify that I am/we are the record owner(s) of the property at:
____________________________________________________________________________________, Street City State Zip
and that the information filed is true and correct to the best of my (our) knowledge. I/We, as the owner(s) of the subject property, consent to the filing of this application and use of the property for the purposes described herein. I/We further consent and hereby authorize City representative(s) to enter upon my property for the purpose of examining and inspecting the property in preparation of any reports and/or required environmental review for the processing of the application(s) being filed.
BY MY SIGNATURE BELOW, I CERTIFY TO EACH OF THE FOLLOWING:
I am the property owner or am authorized to act on the property owner's behalf, and the information I have provided above is correct. I acknowledge that I have read and understand the information contained herein.
I acknowledge that the proposed commercial cannabis business ________________________________ Tenant (Corporation/LLC/Partnership/Sole Owner)
has the legal right to occupy the property, and consent to the business conducting the following commercial cannabis activity at the Property:
Retail (Storefront)
Retail (Non-Storefront)
Retail (Storefront with Delivery)
I agree to comply with all applicable City Ordinances and State Laws relating to (MAUCRSA).
SIGNATURE OF PROPERTY OWNER(S):
PRINTED NAME OF PROPERTY OWNER(S) SIGNATURE OF PROPERTY OWNER(S)
PRINTED NAME OF PROPERTY OWNER(S) SIGNATURE OF PROPERTY OWNER(S) Subscribed and sworn to before me this day of , 20 , proved to me on the basis of satisfactory evidence to be the person(s) who appeared before me _____________________________________. *NOTARIZATION REQUIRED. This authorization form will not be valid without notarization. The authorization contained in this form automatically expires upon sale or transfer of title to the Property. If sale or transfer of the Property occurs prior to obtaining a business license, the applicant must resubmit this notarized form with approval of the new legal owner(s) of the Property. Property Owner authorization must be signed by all Property Owners of the property identified in the Application.
Attach additional pages if necessary.
A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document, to which this certificate is attached,
DRAFT
and not the truthfulness, accuracy, or validity of that document.
ATTACHMENT 5