Incident Report Form
0
0

Administrative
Force

1. Log Number

EX-17-011473

0
D

Gang Related
Arrests Made

T

1a. County Number

53

0
D

INDIANA STATE EXCISE POLICE

Investigation
Suspects

T

®

EX-17-011473

Tic.

1b. ATC Permit

2. UCR
POSSESS MARIJUANA
5. Source
16. ~istrict
01

Tab/Gaming Permit

TC12662001

3. Incident Type

4. Authority

ADMIN ENFORCEMENT
8. Date Received

raa.

Rcvd

IBb

lac. Arrv

Disp

8d. Gird

5/22/2017

1245

5/22/2017
(Monday)

y

112. Business Name

TOBACCO BUSINESS
13. Department Programs

14. Complaint Information

#PROGRAMS:
PROGRAM TYPE:
ATIENDANCE:

COMPLAINT SOURCE:
COMPLAINT TYPE:
CP1:
CP2:

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EXCISE DEPT EMPLOYEE
Name (Last, First, Middle)

10b. G PS Coordinates
X

SUITE 4

1i. Premise Code

CLSD

NOV· NOTICE OF VIOLATION

1Oa.Additional Address Information I Cross Street

421 E 3RD STREET SUITE 4
BLOOMINGTON IN 47401

7. Status

Sf. Latest Date and Time

(Monday)

10. Location

i

9. Disposition

Be. Earliest Date and Time

INCIDENT OCCURRED AT OR BETWEEN

!

Officer: ASHLEE LYNN BENNETT- AB1092

Address

I

Juvenile Date of Birth

D

BENNETT,ASHLEE
651 S COMMERCE DR
SEYMOUR IN 47274

Weight

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Race

Age

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Sex

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Height

Elhnic

Eyes

Hair

Driver License Number

Slate

Social Security Number
Phone Number

Later Name Edit

D
Employee Permit

Name {Lasl, First, Middle)- Address

ATC Permit Expiration

D

TURNER, EMILY D
651 S COMMERCE DR
SEYMOUR IN 47274

Weight

8/18/2007

I

Juvenile Date of Birth

Race

Ag•

I

I I
Sex

I

Height

Hair

Driver License Number

1

Ethnic

Social Security Number

Eyes

Phone Number

State

Later Name Ed1t

D
Employee Permit

ATC Permit Expiration

OWNER@ PERMIT PREMISES
Name (Last, First, Middle)

Address

Juvenile Date of Birth

D

KAUR, GURPREET
657 BLUE MEADOW DR

01/10/1992
Weight

130

I

I 25 I~ce IS~ IE~nic
Ag•

Height

503

Driver License Number

I BLK
Hair

Eyes

Social Security Number
Phone Number

BRO
State

Later Name Edit

D

IN
Employee Permit

CITATJONS/-SUMMON$ES·tWABNlNGSIS$U:EC-

EX-17-011473
IRF 1.4

00

ATC Permit Expiration

:

Approved By:
Approved On:

.. ,: c' :.

: :'·

BRIAN KEITH LANG
6/13/2017 1 :31 :13 PM

PAGE

1

I

 INDIANA STATE EXCISE POLICE

Officer: ASH LEE LYNN BENNETT- AB1 092

EX-17-011473

VIOLATION

Charges

1.
2.
3.
4.
5.

7.1-3-18.5-11
35-48-4-11(1)
35-48-4-4.6(C)
7.1-5-12-4(0)
35-46-1-11(C)

Tob Nuisance
Poss Marijuana
Poss Counter
Post Ent Signs
Tob Ret Sign

TOBACCO SALES AT SITE OF NUISANCE OR CRI
POSSESS MARIJUANA
POSSESSION OF COUNTERFEIT SUBSTANCE
FAIL TO POST ENTRANCE SIGNS
TOBACCO RETAIL SIGN FORMAl

KAUR

KAUR

421 E 3RD STREET
SUITE 4

BLOOMINGTON, IN 47401

LYNN BENNEn

Date Entered

06/06/2017

Y DIANE TURNER

9:44

13:48

see email

EX-17-011473
IRF 1.4

Approved By:
Approved On:

BRIAN KEITH LANG
6/13/2017 1:31:13 PM

PAGE

2

 INDIANA STATE EXCISE POLICE
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Review Comments

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Date Entered

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06/14/201710:49

Disposition

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06/13/201713:31

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Review Comments

EX-17-011473
IRF 1.4

00

Approved By:
Approved On:

BRIAN KEITH LANG
6/13/2017 1:31:13 PM

PAGE

3

 INDIANA STATE EXCISE POLICE
COMMENTS i NARRATIVES' ,

,. .

Officer: ASHLEE LYNN BENNETT· AB1092

EX-17-011473

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Title

NARRATIVE
~U~aled By I On

Created By I On

ASHLEE LYNN BENNETT

05/24/2017

ASHLEE LYNN BENNETT

06/13/2017

On Monday, May 22, 2017 at approximately 12:45 pm, I, Officer Ashlee Bennett along with Cpl. Emily Turner
of the Indiana State Excise Police was on duty when we conducted a permit inspection at Bloomington Smoke
INC located at 421 E. 3rd Street, Suit 4, Bloomington, Indiana. The following was observed and reported:
On the above date, time and location we entered the premise. As we entered I observed they did not have the
required sign of "No Smoking within 8 feet of the door" anywhere. We also did not observe the required Point
of Sale signage. As we entered I identified us as police officers by name and display of my badge to an
employee. The employee then contacted the owner "Ricky" who advised that he would be there. As we waited
for the owner we conducted an inspection. I observed a display of several packages that appeared to be
various types of edible cannabidiol oil products. Cannabidiol Oil will from here on out will be referred to as
CBD in this report. As I looked at the packages I observed they all had "CBD" on it and were brightly
packaged. On the listed ingredients, CBD (a controlled substance), was listed. Many also had a disclaimer
that the product had not been evaluated or approved by the FDA. Along with the edibles were bottles of CBD
oil bottles. The following is a list of what was observed and seized.
1. 8 · Packages of Heady Harvest OG Gold · 175 MG of 100% Pure CBD Oil
2. 4 · Packages of Green Roads CBD Capsules. Each package contains 4 capsules and was listed for $24.99
3. 2 · Packages of CBD Concentrates 250 mg Crystal (99.9% Pure)
4. 1 · Package of CBD Concentrates 250 mg Dabwax
5. 1 · Package of CBD Concentrates 450 mg Blueberry OG Shatter
6. 1 - Package of CBD Crumble (Greenroadsworld.com)
7. 11 · Packets of Cozy O's Donnie Trump-O's red gummy rings containing CBD oil
8. 3 · Packets of Cozy O's Peach Rings containing CBD oil
9. 8- Packets of Cozy O's Watermelon Rings containing CBD oil
10. 3 - Packets of Cozy O's Green Apple Rings containing CBD oil
11. 4 - Packets of CBD Slice containing CBD oil
12. 7 - Packets containing CBD Slice
13. 2 - Packets of CBD Edibles 200 mg Froggies
14. 2 · Packets of CBD Edibles 30 mg Lollypops
15. 4 - Packets of CBD Edibles 30 mg Jollies
16. 11 - Packets of 25 mg Magic Stix various flavors
17. 11 - Vaportech Drip and CBD 500 mg Greenworks bottles
18. 8 - Vaportech Drip and CBD 250 mg Pink Dream bottles
19. 7- Vaportech Drip and CBD 125 mg Silver Haze bottles
20. 7- Bottles of CBD Terps Various Flavors
21. 4- Boxes containing bottles of CBD and Vape additive - 60 mg
22. 1 - Open bottle of Vaportech Drip and CBD by Greenworks
23. 1 - Open bottle of CBD and Vape Additive - 60 mg
Once the owner "Ricky" appeared we identified ourselves and explained why we were there and that all the
CBD items would be seized. We asked for his identification in which he avoided the request and eventually
informed us that his wife, Gurpreet Kaur, was the actual owner. She provided me with her Indiana Drivers
License. Ricky insisted that the product he had was legal because the distributor sold it to him. We attempted
to explain that CBD is a controlled substance and that he cannot sell or even possess the products. During
this time Cpl. Turner spoke with Green Roads representative Michael Ward over the phone. Green Roads is
the company of most of the products found. Mr. Ward informed Cpl. Turner that we needed to know our job
better and that we were not taking any product that day.
I filled out, explained and issued a Notice of Violation for Public Nuisance (7.1-3-18.5-11) to wit:

EX-17·011473
IRF 1.4

'3C'
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Approved By:
Approved On:

BRIAN KEITH LANG
6/13/20171:31:13 PM

PAGE

4

 INDIANA STATE EXCISE POLICE

Officer: ASHLEE LYNN BENNETT- AB1092

EX-17-011473

possession/sale of CBD products, Possession of Marijuana (35-48-4-11), Possession of Counterfeit
Controlled Substance (35-48-4-4.6), No 18 to Purchase Sign and No Smoking within 8 Feet of the Door Sign.
I also completed an ESP-3 detailing a list of the items being seized. Owner Kaur understood both, signed and
received a copy of each. We left the premise without incident.
Subpoena: Gurpreet Kaur
Officer to Testify: Bennett and/or Turner
Evidence: All evidence was placed into the evidence room

EX-17-011473
IRF 1.4

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Approved By:
Approved On:

BRIAN KEITH LANG
6/13/20171:31:13 PM

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