A-371 Nunavut Liquor and Cannabis Board Appeals Form

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Nunavut Liquor and Cannabis Board Appeals Form

Date of Appeal Submission

Date of Notice Received from Superintendent

Cannabis Retailer Licence Holder Name

Email Address

Phone Number

Mailing Address

City/Town

State/Province

ZIP/Postal Code

Licence Number

Reason for Appeal:

I am appealing a decision made by the Superintendent under the following section of the Cannabis Act:

Reason for Appeal

13(1) of the Act – Appeal of non-renewal of a cannabis retail licence

16(1) of the Act – Appeal of cannabis retail licence suspension

16(1) of the Act – Appeal of cannabis retail licence cancellation

16(1) of the Act – Appeal of denied request to vary a cannabis retail licence condition.

I am appealing this decision based on the following reasons:

* Provide explanation on the impacts this decision on your business as well as any other information you wish to present to support your appeal. You may add more pages as needed.

Include a copy of the decision notice provided by the Superintendent

I have included a copy of the decision notice provided to me by the Superintendent.

*This is a requirement under section 8 of the Cannabis Regulations.

Declaration:

certify that the foregoing information is true, correct and complete to the best of my knowledge, information and belief. I agree that falsification or omission of information may result in the denial of my appeal request.

I understand that the Access to Information and Protection of Privacy Act applies to this application.

I understand that the NLCB may request additional information from me to enable them to evaluate this application.

Signature:

Sign above

Date

Steps

Current Nunavut Liquor and Cannabis Board Appeals Form
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