Section R9-17-311. Submitting an Application for a Dispensary Agent Registry Identification Card

Except as provided in R9-17-107(F), to obtain a dispensary agent registry identification card for an individual serving as a principal officer or board member for the dispensary, employed by the dis- pensary, or providing volunteer services at or on behalf of the dis- pensary, the dispensary shall submit to the Department the following for each dispensary agent:

1.        An application in a Department-provided format that includes:

a.        The dispensary agent’s first name; middle initial, if applicable; last name; and suffix, if applicable;

b.        The dispensary agent’s residence address and mail- ing address;

c.        The county where the dispensary agent resides;

d.        The dispensary agent’s date of birth;

e.        The identifying number on the applicable card or document in subsection (5)(a) through (e);

f.         The name and registry identification number of the dispensary; and

g.        The signature of the individual in R9-17- 304(C)(1)(d) or R9-17-308(B)(1)(e), as applicable, designated to submit dispensary agent applications on the dispensary’s behalf and the date the individ- ual signed;

2.        An attestation signed and dated by the dispensary agent that the dispensary agent has not been convicted of an excluded felony offense as defined in A.R.S. § 36-2801;

3.        One of the following:

a.        A statement that the dispensary agent does not cur- rently hold a valid registry identification card, or

b.        The assigned registry identification number for the dispensary agent for each valid registry identifica- tion card currently held by the dispensary agent;

4.        A statement in a Department-provided format signed by the dispensary agent pledging not to divert marijuana to any individual who or entity that is not allowed to possess marijuana pursuant to A.R.S. Title 36, Chapter 28.1;

5.        A copy of the dispensary agent’s:

a Arizona driver’s license issued on or after October 1, 1996;

b.        Arizona identification card issued on or after Octo- ber 1, 1996;

c.        Arizona registry identification card;

d.        Photograph page in the dispensary agent’s U.S. pass- port; or

e.        Arizona driver’s license or identification card issued before October 1, 1996 and one of the following for the dispensary agent:

i.         Birth certificate verifying U.S. citizenship,

ii.        U.S. Certificate of Naturalization, or

iii.      U.S. Certificate of Citizenship;

6.        A current photograph of the dispensary agent;

7.        For the Department’s criminal records check authorized in A.R.S. § 36-2804.05:

a.        The dispensary agent’s fingerprints on a fingerprint card that includes:

i.         The dispensary agent’s first name; middle ini- tial, if applicable; and last name;

ii.        The dispensary agent’s signature;

iii.      If different from the dispensary agent, the sig- nature of the individual physically rolling the dispensary agent’s fingerprints;

iv.      The dispensary agent’s address;

v.        If applicable, the dispensary agent’s surname before marriage and any names previously used by the dispensary agent;

vi.      The dispensary agent’s date of birth;

vii.     The dispensary agent’s Social Security number;

viii.   The dispensary agent’s citizenship status;

ix.      The dispensary agent’s gender;

x.        The dispensary agent’s race;

xi.      The dispensary agent’s height;

xii.     The dispensary agent’s weight;

xiii.   The dispensary agent’s hair color;

xiv.   The dispensary agent’s eye color; and

xv.     The dispensary agent’s place of birth; or

b.        If the dispensary agent’s fingerprints and informa- tion required in subsection (7)(a) were submitted to the Department within the previous six months as part of an application for a designated caregiver reg- istry identification card or a dispensary agent regis- try identification card for another dispensary, the registry identification number on the registry identi- fication card issued to the dispensary agent as a result of the application; and

8.        The applicable fee in R9-17-102 for applying for a dis- pensary agent registry identification card.

Historical Note

New Section made by exempt rulemaking at 17 A.A.R. 734, effective April 14, 2011 (Supp. 11-2). Amended by emergency rulemaking at 18 A.A.R. 1010, effective April 11, 2012 for 180 days (Supp. 12-2). Emergency expired (Supp. 12-4). Amended by final rulemaking at 18 A.A.R. 3354, with an immediate effective date of December 5, 2012 (Supp. 12-4).