HomeMy WebLinkAboutLabor peace agreement notarized formLABOR PEACE AGREEMENTNOTARIZED S
CSPHMANUFACTUREDCANNABISSAFETYBRANCH
Cannabis rAantfacturing license applicants who have not yet entered into a labor peace agreement can
use the form below to complete the notarized statement required by Business and Professions Code
section 26051.5.The statement must be signed by an owner who is identied and disclosed on the
license application.
BUSINESS INFORMATION
BusinessName:SLOCAL ROOTS,LLC Application/License #:21TMP-O23316
Retail
PremisesAddress:3535 S.Higuera St.San Luis Obispo,Ca 93454
BOR PEACE AGREEMENT STATEMENT
As an owner of the business named above,I afrm that the business will enter into and abide by the terms
of a labor peace agreement as required by California state law (BPG 26051.5),.
SignatureofOwner:
Name of Owner:Austen Connella
NOTARYINFORMATION
A notary public or other ofcer completing this certicate veries only the identity of the individual who signed the
document to which this certicate is attached,and not the truthfulness,accuracy or validity of that document.
State of California
ourtyo San ls Obisps
This record was signed before me on by
proved to me on the basis of satisfactory evidence to be the person who appeared before me.
SEE ATTACHED FORM
OR NOTARY CERTIFICATE
Signature of Notary:
Notary Seal/Stamp)Name of Notary:
This form is optional and is intended to assist you with providing the requested information.If you would prefer not to use this
form,you can provide a separate statement containing the required afrmation,owner's signature and notarization.
www.cannabis.ca.gov www.cdph.ca.gov/mcsb mcsb@cdph.ca.gov
V.1-7.1.2020 Page 1 of 1
CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE 5 1189
A notary public or other ofcer completing this certicate veries only the identity of the individual who signed the
document to which this certicate is attached,and not the truthfulness,accuracy,or validity of that document.
State of California
County of San Luis Obispo
ber 7,s l beforeme,RobertMathews,NotaryPublic,
Date AvstenConnellapersonallyappeared
Name(s)of Signer(s)
who proved to me on the basis of satisfactory evidence to be the person(s)whose name(s)is/are
subscribed to the within instrument and acknowledged to me that he/she/they executed the same in
his/her/their authorized capacity(ies),and that by his/her/their signature(s)on the instrument the person(s),
or the entity upon behalf of which the person(s)acted,executed the instrument.
I certify underPENALTYOFPERJURYunder the laws
of the State of California that the foregoing paragraph
is true and correct.
WITNESSmy hand and efciat seat.
ROBERT MATHEWS
Notary Public -California
San Luis Obispo County
Commission #2366148
My Comm.Expires Aug 14,2025
Signaturé
Signature of Notary Public
O
Place Notary Seal Above
OPTIONAL
Though this section is optional,completing this information can deter alteration of the document or
fraudulent reattachment of this form to an unintended document.
Description of Attached Docyment
Title orTypeofDocument;LabyrYeace Agceneat
Document Date:Sept
Signer(s)Other Than Named Above:
Number of Pages:
Eapacity(ies)Claimed by Signer(s)
Signer'same:
O CorporateOffcer -Title(s):
OPartner-DLmited
OIndividual
OTrustee
O Other:
Signey1s Representing:
Signers Name:
OCorporateOcer -Title(s):
OPartner–DLimited
O Individual
OTrustee
OOther:
Signer Is Representing:
DGenera Generat
O AttorAey Tn Fact
6uardianorConservator
DAtormey in Fact
IGuardianorConservator
2015 National Notary Association www.NationalNotary.org·1-800-US NOTARY (1-800-876-6827)Item #5907