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Form #6 <br />Manager - Application for Cannabinoid License <br />Manager Personal Information: <br />First Name: <br />Middle Name: <br />Last Name: <br />Date of Birth: <br />Email Address: <br />Street: <br />City: <br />Address of <br />Residence: <br />State: <br />Zip: <br />Driver's License # State of Issue: <br />Day Telephone: Evening Telephone: <br /> I certify that I am 21 years of age or older <br />Business Information: <br />Complete Legal <br />Business Name: <br />Doing Business As Name: <br />Business Phone: <br />Street: <br />City:Lexington <br />Address of <br />Business: <br />State:MN <br />Zip: 55014 <br />Have you ever been convicted within the last five years of violating any federal, state or local laws <br />relating to the sale of tobacco, alcohol, THC/cannabinoids products? <br /> Yes; No. If yes, please describe the circumstances, including the date and location: <br /> <br /> <br />