Rosebud Sioux Tribe Hemp Grower Application Form

Hemp Grower Application

Applicant name*
First Middle Last
Applicant birthdate (must be 18)*
MM slash DD slash YYYY
Mailing address*
Street Address Address Line 2 City State ZIP Code
Name of registered business

Name of the applicant business registered with Rosebud Sioux Tribe (if applying as a business)
Business phone*
Mobile phone*
Email*
Website
Key Participant Information
All key participants must be listed on this form. Key participant is a person or persons who have a direct or indirect financial interest in the entity producing hemp, such as an owner or partner in a partnership or anyone who exercises executive managerial control. A key participant also includes persons in a corporate entity at executive levels including chief executive officer, chief operating officer and chief financial officer. This does not include such management as farm, field or shift managers. The FBI Identity History Summary Check dated no more than 60 days prior to application must be submitted to the Hemp Commission via mail for each individual listed below. You will receive a mailing address for the FBI Identity History Summary to be sent via email after submitting this application.
Business name (if applicant is a business)
Principal business address
Street Address Address Line 2 City State ZIP Code
Key participant name #1*
First Middle Last Suffix
Key participant #1 title*
Key participant #1 birthdate*
MM slash DD slash YYYY
Key participant name #2
First Middle Last Suffix
Key participant #2 title
Key participant #2 birthdate
MM slash DD slash YYYY
Key participant name #3
First Middle Last Suffix
Key participant #3 title
Key participant #3 birthdate
MM slash DD slash YYYY
Site Information
One site only per application. You must file a separate application for each site (contiguous area with a single hemp variety)
Type of hemp being grown*
Choose all that apply (must choose at least one) and use shift key to select multiple choices
Number of acres (outdoor)
Number of square feet (greenhouse or indoor)
Site address (if none, provide nearest intersection*
Street Address Address Line 2 City State ZIP Code
Legal description*

Section, Township and Range
GPS coordinates*
Location ID N W
You can obtain GPS coordinates using Google Maps free app on your smart phone. Location ID means the unique identifier established by a licensee for each unique set of GPS coordinates where hemp is cultivated, handled, or processed.
Certifications
Please check the box next to each of the following statements acknowledging your agreement and acceptance.
*
I certify that I am 18 years of age or older.
*
I consent to the jurisdiction of the Rosebud Sioux Tribe.
*
I certify that I have not been convicted of a drug felony under tribal, state or federal law, within the past ten (10) years.
*
I consent to an annual criminal background check.
*
I certify that I have registered to do business with the Rosebud Sioux Tribe.
*
I certify that I have reasonable grounds to believe that the crop that will be planted is of a type and variety of Cannabis that will produce a delta-9 THC concentration of no more than 0.3% on a dry weight basis.
*
I understand that it is my responsibility as a registrant to notify the Hemp Commission of any changes to the contact information provided in the registration within 10 days of the change.
*
I understand that it is my responsibility as the registrant to have the legal right to grow Hemp on the land that I am registering and to fully cooperate with the Hemp Commission for any inspections and sampling that may be requested including without limitation granting access to such land or premises.
*
I agree not to allow unsupervised access to hemp plots and hemp cultivation, processing or manufacturing facilities.
*
I consent to allow inspection and tetrahydrocannabinol testing of my crop by the Hemp Commission.
*
I consent to the potential disposal, forfeiture, and/or destruction of any hemp plants or hemp product with a with a delta-9 tetrahydrocannabinol concentration of more than the Acceptable Hemp THC Level on a dry weight basis pursuant to the procedures outlined in this code and subsequent regulations.
*
I understand that any land under the ownership or control, trust, fee or otherwise, of the Rosebud Sioux Tribe, or any of its offices, subsidiaries or enterprises, (“Tribal Land”), which is leased for Hemp Production may only be leased to Rosebud Sioux Tribal members, enterprises, offices, agencies, and political subdivisions, such as Communities and may not be subleased.
*
I understand that any economic benefit emanating from Tribal Land Hemp Production leases must primarily benefit the Tribal lease holder.
*
I agree to submit a report with my a) street address, geospatial location, for each hemp lot or indoor growing facility where such producer grows hemp; b) Acreage, or indoor square footage dedicated to hemp production; and c) Tribal hemp production license number to the to the Farm Service Agency and I agree to comply with any other reporting requirements set forth in the Rosebud Sioux Tribe Hemp Code and applicable regulations, as may be amended from time to time.
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2021-02-15

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Rosebud Sioux Tribe Hemp Grower Application Form

Hemp Grower Application

Key Participant Information

Site Information

Certifications