Rev. MMP 09 2017 STATE OF NEW JERSEY DEPARTMENT OF HEALTH MEDICINAL MARIJUANA PROGRAM . . - "ial?_ ALTERNATIVE TREATMENT CENTER RENEWAL PERMITTING REQUEST FORM QPRAPAGE1 RENEWAL PERMITTING REQUEST FORM INSTRUCTIONS PLEASE READ ALL INSTRUCTIONS CAREFULLY BEFORE COMPLETING THIS FORM. I. COMPLETING THIS ORM: a. The Alternative Treatment Center (ATC) must make accurate statements and include all material facts. Any misrepresentation, or the failure to provide requested information, may result in denial of the request for renewal permit. b. Read each question carefully prior to answering. Answer every question completely. Do not leave blank spaces. If a question does not apply to the ATC, indicate ?Does Not Apply? in response to that question. If there is nothing to disclose in response to a particular question, indicate ?None? in response to that question. Failure to provide a response to every question may result in the rejection of the request for renewal permit. c. All entries on this form, except initials and signatures, must be typed or printed in block lettering using dark ink. If the entries are not legible, the form will not be accepted. d. If the space available is insuf?cient to respond to a question, the ATC must supply the required information on an attachment page. If an attachment page(s) is used, clearly identify which question it is responsive to. If the ATC makes any modification to the pre-printed questions or information contained in this form, the request for renewal permit may be rejected. Once the form is accepted, it becomes the property of the Department of Health and will not be returned. II. BEE ORE SUBMITTING THIS FORM. BE SURE THAT: a. All attachments are labeled with corresponding item number and inserted after the appropriate page in the application. b. The Af?davit, Release Authorization, Consent to Inspections, Search and Seizures, and Waiver of Liability are notarized and executed by the appropriate individual. c. Every question has been answered completely. d. The ATC has maintained a completed copy of this form for its own records. e. Ensure all directors, of?cers, members and employees schedule and complete an appointment to have their fingerprints taken by MorphoTrak. The renewal permit request will not be processed if the fingerprint appointments are incomplete. OPRA PAGE 2 NJSA 47 1A-1 reasonable privacy expectation NJSA 47:1A-1 reasonable privacy expectation OPRA PAGE 3 PRINCIPAL BUSINESS ADDRESS OF ATC 950 US. Highway 1 North Street Woodbridge, NJ 07095 (Middlesex County) City, Zip Code, and County (848) 999-2005 Telephone Number Website ADDRESSES WHERE MEDICINAL MARIJUANA IS CULTIVATED '(If different than the principal business address) Same Street City, Zip Code, and County Telephone Number ADDRESSES WHERE MEDICINAL MARIJUANA IS DISPENSED (If different than the principal business address) Same Street City, Zip Code, and County Telephone Number OPRA PAGE 4 ITEM 1 - GENERAL ATC STATUS A. Is the ATC incorporated? Yes No If no, continue below to the section ?If the ATC is not incorporated?: if yes: i. In what state(s) is the ATC incorporated? New Jersey 2. Is the ATC in good standing in all states in which it is incorporated? Yes No lfnot, list the states in which it is not in good standing. D065 ?Qt apply 3. Provide the following (labeled as Attachment 1A): a. Current certi?cates of good standing from all states in which the ATC is incorporated (to the extent the ATC is in good standing). b. All documents indicating that the ATC is not in good standing in any state in which it is incorporated. If the ATC is not incorporated: l. 2. Identify how the ATC is organized partnership, LLC, etc.) D095 mt apply In which states is the ATC authorized/registered to conduct business. D035 ?Oi apply State whether the ATC is in good standing in any and all states in which it is authorized/registered to conduct business. Does not apply Identify any states in which the ATC is not in good standing. DOCS not apply Provide the following: a. All current certi?cates of good standing (to the extent applicable) and/or any documents re?ecting that the ATC is not in good standing (to the extent applicable). OPRA PAGE 5 NJSA 47:1A-1.1 trade secret, proprietary commercial/financial; competitive advantage NJSA 47:1A-1.1 trade secret, proprietary commercial/financial; competitive advantage OPRA PAGE 6 AT TACHMENT 1A STA TE OF NEW JERSEY DEPARTMENT OF THE TREASUR DIVISION OF RE VENUE AND ENTERPRISE SER VICES SHOR FORM STANDING 0MPASSI ONA TE CARE RESEARCH INSTITUTE, INC. 010] 013868 I, the Treasurer of the State of New Jersey, do hereby certi?/ that the above?named New Jersey Domestic Non-Prg?t Corporation was registered by this of?ce on February 10, 20 I. As of the date of this certi?cate, said business continues as an active buszness in good standin in the State of New Jerse . Annual Reports are outstanding or the following year(s) 0] 7 I further certi?r that the registered agent and of?ce are: AARON J. EPSTEIN, ESQ. COMPASSIONA TE CARE RESEARCH 950 US NORTH OODBRIDGE, NJ 07095 IN TESTIMONY WHEREOF, Ihave hereunto set my hand and affixed my Of?cial Seal at Trenton, this I 3th day of October, 2017 Ford Scudder Acting State Treasurer Certi?cate Number 6083243 000 Verify this certi?cate online at .state. j. PAGE 7 NJSA 47 1A-1.1 trade secre NJSA 47:1A-1.1 trade secret, proprietary commercial/financial; competitive advantage OPRA PAGE 8 NJSA 47 1A-1.1 trade secret NJSA 47:1A-1.1 trade secret, proprietary commercial/financial; competitive advantage OPRA PAGE 9 NJSA 47 1A-1.1 trade secre NJSA 47:1A-1.1 trade secret, proprietary commercial/financial; competitive advantage OPRA PAGE 10 NJSA 47 1A-1.1 trade secre NJSA 47:1A-1.1 trade secret, proprietary commercial/financial; competitive advantage OPRA PAGE 11 ITEM 2 CORPORATE ENTITIES A. Attach as Item 2, a list of the following: 1. All parent, subsidiary, af?liate, predecessor, successor, and related entities of the ATC since the last permit renewal period; 2. The business engaged in by any parent, subsidiary, af?liate, predecessor, successor or related entities of the ATC, including the approximate time period during which each identi?ed business was/has been conducted since the last permit renewal period; 3. All sales, mergers, and/or consolidations involving the ATC since the last permit renewal period; 4. All former names of the ATC. OPRA PAGE 12 NJSA 47:1A-1.1 trade secret, proprietary commercial/financial; competitive advantage NJSA 47:1A-1.1 trade secret, proprietary commercial/financial; competitive advantage OPRA PAGE 13 ITEM 3 - PRINCIPALS, PARTNERS. INVESTORS, MEMBERS, BOARD MEMBERS, DIRECTORS AND TRUSTEES Provide the following information for each principal, partner, investor, member, board member, director, and trustee of the ATC. (Note: Any principal, investor, member, board member, director and trustee of the ATC, who has not completed and ?led a Personal History Disclosure Form (PHDF) since the last permit renewal period must do so immediately.) DATES NAME AND HOME ADDRESS BUSINESS ADDRESS DATE or BIRTH FROM r0 Please see attachment OPRA PAGE 14 NJSA 47:1A-1 reasonable privacy expectation NJSA 47:1A-1 reasonable privacy expectation NJSA 47 1A-1 reasonable privacy expectation NJSA 47:1A-1 reasonable privacy expectation NJSA 47:1A-1 reasonable privacy expectation NJSA 47:1A-1 reasonable privacy expectation NJSA 47:1A-1 reasonable privacy expectation NJSA 47:1A-1 reasonable privacy expectation NJSA 47:1A-1 reasonable privacy expectation NJSA 47:1A-1 reasonable privacy expectation NJSA 47:1A-1 reasonable privacy expectation NJSA 47:1A-1 reasonable privacy expectation NJSA 47:1A-1 reasonable privacy expectation NJSA 47:1A-1 reasonable privacy expectation NJSA 47:1A-1 reasonable privacy expectation NJSA 47:1A-1 reasonable privacy expectation OPRA PAGE 15 NJSA 47:1A-1 reasonable privacy expectation NJSA 47:1A-1 reasonable privacy expectation NJSA 47:1A-1 reasonable privacy expectation NJSA 47 1A-1 reasonable privacy expe NJSA 47:1A-1 reasonable privacy expectation NJSA 47:1A-1 reasonable privacy expectation NJSA 47:1A-1 reasonable privacy expectation NJSA 47:1A-1 reasonable privacy expectation NJSA 47:1A-1 reasonable privacy expectation NJSA 47:1A-1 reasonable privacy expectation NJSA 47:1A-1 reasonable privacy expectation NJSA 47:1A-1 reasonable privacy expectation OPRA PAGE 16 ITEM 4 FORMER PRINCIPALS, PARTNERS, INVESTORS, MEMBERS, BOARD MEMBERS, DIRECTORS AND TRUSTEES Provide the following information for each person, not listed in response to Item 3, who formerly held the position of principal, partner, investor, member, board member, director or trustee of the ATC since the last permit renewal period. DATES POSITION HELD NAME AND LAST KNOWN HOME ADDRESS POSITION HELD PRESENT OCCUPATION AND BUSINESS DATE OF BIRTH ADDRESS FROM TO None 8 OPRA PAGE 17 ITEM 5 OFFICERS Provide the following information for each of?cer of the ATC. Of?cers include, but are not limited to, all persons serving as president, secretary, treasurer, Vice- president, general/corporate counsel, or any such other officer as may be prescribed by the incorporation documents or corporate bylaws. (NOTE: Any of?cer of the ATC, who has not completed and ?led a Personal History Disclosure Form (PHDF) since the last permit renewal period must do so immediately.) DATES OFFICE HELD NAME AND HOME ADDRESS TITLE 7 BUSINESS ADDRESS DATE OF BIRTH FRONI TO Please see attachment 9 OPRA PAGE 18 NJSA 47:1A-1 reasonable privacy expectation NJSA 47 1A-1 reasonable privacy expect NJSA 47:1A-1 reasonable privacy expectation NJSA 47:1A-1 reasonable privacy expectation NJSA 47:1A-1 reasonable privacy expectation NJSA 47:1A-1 reasonable privacy expectation NJSA 47:1A-1 reasonable privacy expectation NJSA 47:1A-1 reasonable privacy expectation NJSA 47:1A-1 reasonable privacy expectation NJSA 47:1A-1 reasonable privacy expectation NJSA 47:1A-1 reasonable privacy expectation NJSA 47:1A-1 reasonable privacy expectation OPRA PAGE 19 ITEM 6 - FORMER OFFICERS Provide the following information for each person not listed in response to Item 5 who, since the last permit renewal period, is no longer an of?cer of the ATC. Of?cers include, but are not limited to, all persons serving as president, secretary, treasurer, Vice?president, general/corporate counsel, or any such other of?cer as may be prescribed by the incorporation documents or corporate bylaws. NAME AND LAST KNOWN HOME DATES OFFICE HELD OFFICE HELD ADDRESS PRESENT OCCUPATTON AND BUSINESS ADDRESS DATE OF BIRTH ROM TO None lO OPRA PAGE 20 ITEM 7 STAFF MEMBERS AND EMPLOYEES Provide the following information regarding each person not listed in the previous items Who is a staff member and/or employee of the ATC. (NOTE: The position listed for each staff member and employee of the ATC must be clearly de?ned so that the New Jersey Department of Health may determine whether the ATC staff member or employee is required to ?le a Personai History Disclosure Form The is required to submit the name and position of any new ATC staff or employee to the DOH at time of hire and must not wait until the annual ?ling of this ATC renewal permit request form. NAME AND HOME ADDRESS DATES POSITION HELD FROM TO BUSINESS ADDRESS DATE OF BIRTH Please see attachment ll OPRA PAGE 21 NJSA 47:1A-1 reasonable privacy expectation NJSA 47 1A-1 reasonable privacy expectation NJSA 47:1A-1.1 security measure NJSA 47:1A-1.1 trade secret, proprietary commercial/financial; competitive advantage OPRA PAGE 22 NJSA 47:1A-1.1 trade secret, proprietary commercial/financial; competitive advantage NJSA 47:1A-1 reasonable privacy expectation NJSA 47 1A-1 reasonable privacy expecta NJSA 47:1A-1.1 security measure OPRA PAGE 23 NJSA 47:1A-1.1 security measure NJSA 47:1A-1 reasonable privacy expectation NJSA 47 1A-1 reasonable privacy expectation NJSA 47:1A-1.1 trade secret, proprietary commercial/financial; competitive advantage OPRA PAGE 24 NJSA 47:1A-1 reasonable privacy expectation NJSA 47 1A-1 reasonable privacy expectation NJSA 47:1A-1 reasonable privacy expectation NJSA 47:1A-1 reasonable privacy expectation NJSA 47:1A-1 reasonable privacy expectation NJSA 47:1A-1 reasonable privacy expectation NJSA 47:1A-1 reasonable privacy expectation NJSA 47:1A-1.1 security measure NJSA 47:1A-1.1 trade secret, proprietary commercial/financial; competitive advantage OPRA PAGE 25 NJSA 47:1A-1 reasonable privacy expectation NJSA 47 1A-1 reasonable privacy expecta ion NJSA 47:1A-1.1 trade secret, proprietary commercial/financial; competitive advantage NJSA 47:1A-1.1 security measure OPRA PAGE 26 ITEM 8 - OTHER PERSONNEL Provide a listing of all other personnel associated with the ATC not otherwise listed above. Other personnel shall mean all people and entities in any way af?liated with the operation or funding of the ATC including, but not limited to volunteers, consultants, vendors, independent contractors, subcontractors, landlords, suppliers, business partners, investors, joint ventures, registered agents, attorneys, accountants, and other professionals retained by the ATC since the last permit renewal period. DATES POSITION HELD NAME AND HOME ADDRESS POSITION BUSINESS ADDRESS DATE OF BIRTH FROM TO Please see attachment 12 OPRA PAGE 27 NJSA 47:1A-1.1 trade secret, proprietary commercial/financial; competitive advantage OPRA PAGE 28 ITEM 9 - COMPENSATION OF OWNERS. PRINCIPALS, PARTNERS, INVESTORS, MEMBERS, BOARD MEMBERS, DIRECTORS, TRUSTEES, OFFICERS, STAFF MEMBERS, AND EMPLOYEES Provide the following information regarding the total amount of annual compensation received in connection with the ATC since the last permit renewal period and any future amount agreed upon in connection with the ATC by each person identi?ed in Items 3, 5, and 7 above, whether such compensation is in the form of salary, wages, commissions, fees, bonuses, or otherwise. COMPENSATION LAST COMPENSATION SUBSEQUENT NAME CALENDAR YEAR CALENDAR YEAR FORM OF COMPENSATION Please see attachment l3 OPRA PAGE 29 Item 9 (continued) - Compensation of Owners, Principals, Partners, Investors, Members, Board Members, Directors, Trustees, Officers, Staff Members, and Employees Name '2016 Compensation er0. Order 26 4b1 2017 Compensation (projected) Form of Compensation Salary Salary Salary Salary Salary Fees Salary Salary Salary Fees Salary Salary Salary Salary Salary Salary Salary Salary Salary Salary Salary Salary Fees Fees Salary Salary Salary Salary Salary OPRA PAGE 30 Exec. Order 26 4b1 Sakyy Saw?y . Sakny FY Fees FY Saw?y Sakuy Fees Sakny Sakuy Fees Sakny Iaw' man; ees ees OPRA PAGE 31 ITEM 10 - COMPENSATION OF ALL OTHERS Provide the following information for any person, other than those listed in response to Item 9, who currently receives, or who is expected to receive, any compensation in connection with the ATC in the form of salary, wages, commissions, fees, bonuses, or otherwise. Also, include in this attachment any compensation which was paid to individuals listed in response to Items 4 and 6 in the form of salary, wages, commissions, fees, bonuses, or otherwise. NAME DATE OF BIRTH BUSINESS ADDRESS POSITION AND LENGTH OF TIME EMPLOYED BY OR AFFILIATED WITH ATC AMOUNT OF COMPENSATION Please see attachment l4 OPRA PAGE 32 NJSA 47:1A-1.1 trade secret, proprietary commercial/financial; competitive advantage NJSA 47:1A-1.1 trade secret, proprietary commercial/financial; competitive advantage NJSA 47:1A-1.1 trade secret, proprietary commercial/financial; competitive advantage OPRA PAGE 33 NJSA 47:1A-1.1 trade secret, proprietary commercial/financial; competitive advantage NJSA 47:1A-1.1 trade secret, proprietary commercial/financial; competitive advantage NJSA 47:1A-1.1 trade secret, proprietary commercial/financial; competitive advantage NJSA 47:1A-1.1 trade secret, proprietary commercial/financial; competitive advantage OPRA PAGE 34 NJSA 47:1A-1.1 trade secret, proprietary commercial/financial; competitive advantage NJSA 47:1A-1.1 trade secret, proprietary commercial/financial; competitive advantage OPRA PAGE 35 NJSA 47:1A-1.1 trade secret, proprietary commercial/financial; competitive advantage OPRA PAGE 36 NJSA 47:1A-1.1 trade secret, proprietary commercial/financial; competitive advantage OPRA PAGE 37 NJSA 47:1A-1.1 trade secret, proprietary commercial/financial; competitive advantage OPRA PAGE 38 NJSA 47:1A-1.1 trade secret, proprietary commercial/financial; competitive advantage OPRA PAGE 39 NJSA 47:1A-1.1 trade secret, proprietary commercial/financial; competitive advantage OPRA PAGE 40 NJSA 47:1A-1.1 trade secret, proprietary commercial/financial; competitive advantage OPRA PAGE 41 ITEM 17 - CONTRACTORS AND SUPPLIERS Provide the following information with respect to all persons and/or entities with whom the ATC has contracts or agreements, including, but not limited to, any and all employment, consulting, or service contracts or agreements. Provide a c0py of any such contract or agreement that occurred since the last permit renewal period. NATURE OF CONTRACT OR GOODS OR SERVICES SUPPLIED (ATTACH A COPY NAME BUSINESS ADDRESS OF THE CONTRACT HERETO) Please see attachment 21 OPRA PAGE 42 NJSA 47:1A-1.1 trade secret, proprietary commercial/financial; competitive advantage OPRA PAGE 43 NJSA 47:1A-1.1 trade secret, proprietary commercial/financial; competitive advantage NJSA 47:1A-1.1 trade secret, proprietary commercial/financial; competitive advantage OPRA PAGE 44 NJSA 47:1A-1.1 trade secret, proprietary commercial/financial; competitive advantage NJSA 47:1A-1.1 trade secret, proprietary commercial/financial; competitive advantage OPRA PAGE 45 NJSA 47:1A-1.1 trade secret, proprietary commercial/financial; competitive advantage NJSA 47:1A-1.1 trade secret, proprietary commercial/financial; competitive advantage NJSA 47:1A-1.1 trade secret, proprietary commercial/financial; competitive advantage OPRA PAGE 46 NJSA 47:1A-1.1 trade secret, proprietary commercial/financial; competitive advantage OPRA PAGE 47 NJSA 47:1A-1.1 trade secret, proprietary commercial/financial; competitive advantage OPRA PAGE 48 NJSA 47:1A-1.1 trade secret, proprietary commercial/financial; competitive advantage NJSA 47:1A-1.1 trade secret, proprietary commercial/financial; competitive advantage OPRA PAGE 49 NJSA 47:1A-1.1 trade secret, proprietary commercial/financial; competitive advantage NJSA 47:1A-1.1 trade secret, proprietary commercial/financial; competitive advantage NJSA 47:1A-1.1 trade secret, proprietary commercial/financial; competitive advantage NJSA 47 1A-1.1 trade secret proprietary commercial/financial c NJSA 47 1A-1.1 trade secret proprietary commercial/financial compet tive advantage NJSA 47:1A-1.1 trade secret, proprietary commercial/financial; competitive advantage NJSA 47:1A-1.1 trade secret, proprietary commercial/financial; competitive advantage OPRA PAGE 50 NJSA 47:1A-1.1 trade secret, proprietary commercial/financial; competitive advantage OPRA PAGE 51 NJSA 47:1A-1.1 trade secret, proprietary commercial/financial; competitive advantage OPRA PAGE 52 NJSA 47:1A-1.1 trade secret, proprietary commercial/financial; competitive advantage NJSA 47:1A-1.1 trade secret, proprietary commercial/financial; competitive advantage NJSA 47:1A-1.1 trade secret, proprietary commercial/financial; competitive advantage NJSA 47:1A-1.1 trade secret, proprietary commercial/financial; competitive advantage NJSA 47:1A-1.1 trade secret, proprietary commercial/financial; competitive advantage NJSA 47:1A-1.1 trade secret, proprietary commercial/financial; competitive advantage NJSA 47 1A- NJSA 47:1A-1.1 trade secret, proprietary commercial/financial; competitive advantage NJSA 47:1A-1.1 trade secret, proprietary commercial/financial; competitive advantage NJSA 47:1A-1.1 trade secret, proprietary commercial/financial; competitive advantage OPRA PAGE 54 NJSA 47:1A-1.1 trade secret, proprietary commercial/financial; competitive advantage NJSA 47:1A-1.1 trade secret, proprietary commercial/financial; competitive advantage NJSA 47 1A NJSA 47:1A-1.1 trade secret, proprietary commercial/financial; competitive advantage NJSA 47:1A-1.1 trade secret, proprietary commercial/financial; competitive advantage OPRA PAGE 55 NJSA 47:1A-1.1 trade secret, proprietary commercial/financial; competitive advantage NJSA 47:1A-1.1 trade secret, proprietary commercial/financial; competitive advantage NJSA 47 1A NJSA 47:1A-1.1 trade secret, proprietary commercial/financial; competitive advantage NJSA 47:1A-1.1 trade secret, proprietary commercial/financial; competitive advantage OPRA PAGE 56 NJSA 47:1A-1.1 trade secret, proprietary commercial/financial; competitive advantage OPRA PAGE 57 NJSA 47:1A-1 reasonable privacy expectation NJSA 47:1A-1 reasonable privacy expectation OPRA PAGE 58 NJSA 47:1A-1.1 trade secret, proprietary commercial/financial; competitive advantage NJSA 47:1A-1.1 trade secret, proprietary commercial/financial; competitive advantage OPRA PAGE 59 NJSA 47:1A-1.1 trade secret, proprietary commercial/financial; competitive advantage NJSA 47:1A-1 reasonable privacy expectation OPRA PAGE 60 NJSA 47:1A-1.1 trade secret, proprietary commercial/financial; competitive advantage OPRA PAGE 61 ITEM 23 - STATUTORY AND REGULATORY VIOLATIONS Since the last permit renewal period, has the ATC or any parent, subsidiary, af?liate, predecessor, successor, or related entity been charged (as de?ned in Item 19) with a Violation of any state or federal statute, regulation, or code? Yes No Since the last permit renewal period, has the ATC had ajudgment, order, consent decree, or consent order entered against it, or any parent, subsidiary, af?liate,- predecessor, successor, or related entity pertaining to any state or federal statute, regulation, or code? Yes No If yes to either question, provide the following information for each charge, judgment, order, consent decree, or consent order. Additionally, provide any and all documentation relating toeach charge, judgment, order, consent decree, or consent order. DATE OF NATURE OF TITLE OF CASE AND NAME AND ADDRESS OF COURT OR AGENCY NATURE OF DEGREE, OR ATE ENTERED DOCKET NUMBER Does not apply 27 OPRA PAGE 62 ITEM 24 - BANKRUPTCY 0R INSOLVENCY PROCEEDINGS AND APPOINTED RECEIVER. AGENT, OR TRUSTEE A. Has the ATC or any parent, subsidiary, af?liate, predecessor, successor, or related entity had any petition under any provision of the Federal Bankruptcy Code or under any state insolvency law ?led by or against it since the last permit renewal periodany parent, subsidiary, affiliate, predecessor, successor, or related entity sought relief under any provision of the Federal Bankruptcy Code or under any state insolvency law since the last renewal period? Yes No If yes to either question, provide the following information for each bankruptcy or insolvency proceeding. DATE PETITION NAME AND ADDRESS OF ILEEOOJRGEELIEF INVOLVED TETLE OF CASE AND DOCKET NUMBER COURT OR AGENCY NATURE OF JUDGMENT OR RELIEF DATE ENTERED Does not apply 28 OPRA PAGE 63 C. Has any receiver, ?scal agent, trustee, reorganization trustee, or similar of?cer been appointed by a court since the last permit renewal period for the business or property of the ATC or any parent, subsidiary, af?liate, predecessor, successor, or related entity? Yes No If yes, provide the following information for each proceeding. NAME OF PERSON APPOINTED AND FOR WHICH DATE ENTITY APPOINTED COURT REASON FOR APPOINTMENT Does not apply 29 OPRA PAGE 64 ITEM 25 - LICENSES A. Since the last permit renewal period, has the ATC or any principal, partner, investor, member, board member, director, trustee, of?cer, employee, parent, subsidiary, af?liate, predecessor, successor, or related entity had any license or certi?cate issued by a government agency in this state or any other jurisdiction, denied, suspended, or revoked? This page pending custodian review. B. If yes, provide the following information for each license or certi?cate denied, suspended, or revoked. TYPE OF LICENSE ENTITY NAME AND LOCATION OF OR CERTIFICATE INVOLVED GOVERNMENTAL AGENCY ACTION TAKEN DATE REASON FOR ACTION TAKEN This page pending custodian review. 30 OPRA PAGE 65 C. Since the last permit renewal period, has the ATC or any principal, partner, investor, member, board member, director, trustee, of?cer, employee, parent, subsidiary, af?liate, predecessor, successor, or related entity ever applied in any jurisdiction for a license, permit, or other authorization to participate in the sale I or distribution of marijuana? This page pending custodian reVIew. If yes, provide the following information about each'license, permit, or other authorization applied for. DISPOSITION IF ISSUED, GIVE APPROPRIATE ENTITY DATE OF LICENSE, PERMIT, OR OTHER NAME AND ADDRESS OF LICENSING AGENCY INVOLVED APPLICATION TYPE OFACTIVITY SUCH NUMBER AND EXPIRATION DATE This page pending custodian review. 31 OPRA PAGE 66 NJSA 47:1A-1.1 trade secret, proprietary commercial/financial; competitive advantage NJSA 47:1A-1.1 trade secret, proprietary commercial/financial; competitive advantage OPRA PAGE 67 NJSA 47:1A-1.1 trade secret, proprietary commercial/financial; competitive advantage N OPRA PAGE 68 ITEM 27 - TAX Provide a copy of all tax returns submitted by the ATC or on its behalf to the Internal Revenue Service or any other government (foreign, federal, state, municipal, etc.) entity or agency since the last permit renewal period. 34 OPRA PAGE 69 NJSA 47:1A-1.1 trade secret, proprietary commercial/financial; competitive advantage NJSA 47:1A-1.1 trade secret, proprietary commercial/financial; competitive advantage NJSA 47 1A-1.1 trade secret proprietary commercial/financial compet ive a NJSA 47 1A-1.1 trade secret proprietary c NJSA 47 1A-1.1 trade secret proprietary NJSA 47 1A-1.1 trade secret proprietary commercial/financia NJSA 47 1A-1.1 trade secret proprietary commercial/financial competitive advantage OPRA PAGE 70 OPRA PAGES 71 to 90 (Tax Returns) withheld in their entirety: Executive Order No. 26 § 4b3 N.J.S.A. 47:1A-1.1 trade secrets, proprietary commercial and financial information NJSA 47:1A-1.1 trade secret, proprietary commercial/financial; competitive advantage NJSA 47:1A-1.1 trade secret, proprietary commercial/financial; competitive advantage NJSA 47 1A-1.1 trade secret proprietary commercial/financial compet tive advanta NJSA 47 1A-1.1 trade secret proprietary NJSA 47 1A-1.1 trade secret proprietary co NJSA 47 1A-1.1 trade secret proprietary commercial/financia NJSA 47 1A-1.1 trade secret proprietary commercial/financial competitive advantage OPRA PAGE 91 OPRA PAGES 92 to 108 (tax returns) withheld in their entirety: Executive Order No. 26 § 4b3 N.J.S.A. 47:1A-1.1 trade secrets, proprietary commercial and financial information ITEM 28 - APPROVAL FROM MUNICIPALITY tatus as an ATC facility? Yes No Yes No A. Has the ATC received all current necessary approvals by the community, governing body and tax authority in order to maintain its 3 B. Has the ATC received any variances related to its operations since the last permit renewal period? If so, please explain and attach any such approvals and variances. Previously prairided; no change. 35 OPRA PAGE 109 NJSA 47:1A-1.1 trade secret, proprietary commercial/financial; competitive advantage NJSA 47:1A-1.1 security measure OPRA PAGE 110 NJSA 47:1A-1.1 trade secret, proprietary commercial/financial; competitive advantage NJSA 47:1A-1.1 trade secret, proprietary commercial/financial; competitive advantage NJSA 47 1A-1.1 trade secret proprietary commercial/financial competitive advantage NJSA 47:1A-1.1 trade secret, proprietary commercial/financial; competitive advantage NJSA 47:1A-1.1 trade secret, proprietary commercial/financial; competitive advantage OPRA PAGE 111 NJSA 47 1A-1.1 trade secret proprietary commercial/financial competi ive ad NJSA 47 1A-1.1 trade secret proprietary commercial/financial competi ive adv This item pending custodian review. NJSA 47 1A-1.1 trade secret proprietary commercial/ inancial competitive a NJSA 47:1A-1.1 trade secret, proprietary commercial/financial; competitive advantage OPRA PAGE 112 ITEM 31 - AFFIDAVITS AND SIGNATURES This Renewal Permitting Request Form must be sworn to or affirmed, signed, and dated before a person legally competent to take an oath or af?rmation who shall himself/herself date the signature of the af?ant and indicate the basis of his/her authority to take oaths and af?rmations, The following documents are to be signed in accordance with the foregoing: AFFIDAVIT RELEASE AUTHORIZATION CONSENT TO INSPECTIONS, SEARCHES AND SEIZURES WAIVER OF LIABILITY The President or any officer of the ATC authorized to affirm may complete the af?davit. The remaining documents are to be signed by the President or Chief Executive Of?cer. 39 OPRA PAGE 113 AFFIDAVIT STATE OF N5 - SS: Middlesex I, Aamn- Epsteini Esq. tha Exacutive Vice President I General Manager, NI 0f (NAME) the Alternative Treatment being duly sworn awarding to law, on my oath, under penalties of perjuqz, {1613058 and say that I make this stat?ment-on behalf of the ATC and that the abbve statements an": true and correct to the best of my kmwledge and belief, "and that this statement is executed with the knowledge- that any misrepresentation 91' failure to reveal infomation may be deemed suf?cient cause for the refusal to issua, 0r tha revacati'on of, a pennit/Iicense. I am voluntarin submitting this statement and understand that misieading siatements may subject me to criminal or other sanctions 0r punishment. Further,.1 agree to pmvide updates to the Statements provi?ed herein as required under 3.3% applicabie statutes and rules, or as requested by the New Jersey Department of Heaith.. Campassionate Care Research Instith Inc. Name of Aaron. I. Epst?in, Esq.g rant! General Manager, Ms?gnm?aveg?ssg?my A. .H a r5151 Subscribed and sworn te befcre mathis I 'y day 9f {higher ?20 i7 camsma 53mm. I I ?(inky gm SIGEATURE OF NOTARY CW S?i?ge. 1. . PRINTED NAME 0F NOTARY PUBLIC 40 OPRA PAGE 114 OPRA PAGE 115 :7sz 311.241th :31: 353131.: .. - ya: mmwis?ag ii magma-mg 'maasamsfim mm:an f: v: liq. Mi? .120 {33m m; {Iii 3.131.2?2? 3&1} . awaw H: ww?m?3??fmfi 2' is s' 1 15 3.3332251pwuaxq?mit mzs- m?as; ?mfg 5131;;131}magiuamimim 3? We g?J-H?ti *5 35112153; msgm?) gram g: 31:32sz ?531mg gamma ?3ii-ii $3323 V1. .m?ngHJ; gnaw}; my" 9311.? mag-1mg at}: 52:333. 2:!ailsayigim? 1'11) mm; futagicj??-w umng ?tvmm; g? Emilia-m3. . I i: in); 32:33:11 2:5 3 mg?m??g; ma?a"; ?9,5313%? "313ml? 33?" i 3?in {an who?? of {"mnpasg?m?mg: Emit Racismh. {mm-um. 12w, tjrzMIL-5M 3? Lm?? l-A?t?bm-l? (ml-L? hf) 215E :nz'aimngiiziin'm.'Hcesg'chtm and gamma; {rakm?s'?'?mrzi mm! ERH Lian?: 1m :5 mppiying a i? hmId-xa-?ritihg taxman} am; {Af?i??IiS :?a-xqamm' us nigh: rah-mums? [113' Linilcd 5mm and i3? 2:134: nf 1m: 51211;; of" New juicy mg: cmmim s?nrg?ws am} .Ssz?zmrcisj; and?! EXPEWEEF wr?rix-i: and Eiregu 21165:: rigma mi baimli?uf Elisa: .3331; 313;?- ?ux: reikasni'u'; . m? Mm Jana-ac}; ?E?ijz um}; innit mocm?natsm?zim mmij?ts?liu-cmc and-any mum Ewih?irit p?m?ucd by Fem-2 Midla? I 1317:1-3- angry; ??ui??crih?d and ?u?um a . V. it: away: an: aim; n13? mums? .613 rm} rim?? rig MEIER {f 7- - :1 (mu if}? HERE :15 my: Mimi . .5 EXPEHES: Beaembar 18, 932:: $5?st ifvl? "?11 . . OPRA PAGE 116 OPRA PAGE 117 4.: A $9233, 3 A?mis ?435: mu magma; A .A I A. if g?lwwiw - mg; Emmi: g; If?hj? gamma; u; ,izmg? at} 3:22 gtg?i?gmw mug? gm: k. mug-up sgju' ?mi may imzl?szg ikir?mimm i: mg in $511335: gmii mm 0:155ng ma?t?r?ag?ig: ?923.7333? ism; ?lm} .1 s? rim-333511;? wawm Mu MiamiState of New Jersey Division of Revenue 1' k' i it? 5; CERTIFICATE OF FORMATION I i i OF u-t- ?Em: tow" GrowTech, LLC v? FIRST: The name of the Limited Liability Company is: GrowTech, LLC SECOND: The purpose for which this Limited Liability Company is organized is to engage in any activity within the purposes for which limited liability companies may be formed under NJSA 42. THIRD: The formation date will be effective upon filing. FOURTH: The name and address of the Registered Agent in New Jersey will be: Alex Zaleski 2 Corporate Drive Cranbury, NJ 08512 FIFTH: The dissolution date will be NA (optional) The undersigned represents that this Limited Liability Company has one or more members, and that this filing complies with requirements detailed in NJSA 42. The undersigned hereby attests that she is authorized to sign this certi?cate on behalf of the Limited Liability Company. WMa-??xd?w? Vera B. Ray Organizer Dated this: June 4, 2013 25ml: View; i?/849?il r59 State of New Jersey Division of Revenue CERTIFICATE OF FORMATION OF Commercial Group, LLC Under NJSA 42 of the Limited Liability Company Act FIRST: The name of the Limited Liability Company is: Commercial Group, LLC SECOND: The purpose forwhich this Limited Liability Company is organized is to engage in any activity within the purposes for which limited liability companies may be formed under NJSA 42. THIRD: The formation date will be effective upon ?ling. FOURTH: The name and address of the Registered Agent in New Jersey will be: Alex Zaleski 2 Corporate Drive Cranbury, NJ 08512 The dissolution date will be NA (optional) The undersigned represents that this Limited Liability Company has one or more members, and that this filing complies with requirements detailed in NJSA 42. The undersigned hereby attests that she is authorized to sign this certi?cate on behalf of the Limited Liability Company. values/?M Vera B, Ray Organizer Dated this: June 7, 2013 9428's? Tim: .2. says) Li r- 7 9?