Mendocino County Ag Pass Program - Department of Cannabis

This form is to submit both required documentation and the Ag Pass application itself.

All documents must be valid for 2024, issued by Mendocino County, CDFA or USDA, and list site location. 
The Ag Pass application will request your evacuation zone. You can find that information here.

1

Please enter your full name as it appears on your Ag Pass Application.

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Please enter your full name as it appears on your Ag Pass Application.

2

Please download and fill out the Ag Pass Application. Use the form submitter below to submit the filled out application.

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Click button for uploading file Clear Please download and fill out the Ag Pass Application. Use the form submitter below to submit the filled out application. Maximum size allowed: 5 MB Allowed types: .gif, .jpg, .jpeg, .png, .doc, .docx, .xls, .xlsx, .rtf, .pdf, .txt

3

Please use the form submitter below to attach all additional necessary documentation. For the Cannabis application, this includes:

• Employee List
• Your Government Identification Card
  • Employee Government ID Cards (up to 4)
• Proof of Cannabis Cultivation Business License ("CCBL") Number

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Please use the form submitter below to attach all additional necessary documentation. For the Cannabis application, this includes: Employee List Your Government Identification Card Employee Government ID Cards (up to 4) Proof of Cannabis Cultivation Business License ("CCBL") Number

Employee List Click button for uploading file Clear Maximum size allowed: 5 MB Allowed types: .gif, .jpg, .jpeg, .png, .doc, .docx, .xls, .xlsx, .rtf, .pdf, .txt

Your Government Identification Card Click button for uploading file Clear Maximum size allowed: 5 MB Allowed types: .gif, .jpg, .jpeg, .png, .doc, .docx, .xls, .xlsx, .rtf, .pdf, .txt

Employee Government ID Card 1 Click button for uploading file Clear Maximum size allowed: 5 MB Allowed types: .gif, .jpg, .jpeg, .png, .doc, .docx, .xls, .xlsx, .rtf, .pdf, .txt

Employee Government ID Card 2 Click button for uploading file Clear Maximum size allowed: 5 MB Allowed types: .gif, .jpg, .jpeg, .png, .doc, .docx, .xls, .xlsx, .rtf, .pdf, .txt

Employee Government ID Card 3 Click button for uploading file Clear Maximum size allowed: 5 MB Allowed types: .gif, .jpg, .jpeg, .png, .doc, .docx, .xls, .xlsx, .rtf, .pdf, .txt

Employee Government ID Card 4 Click button for uploading file Clear Maximum size allowed: 5 MB Allowed types: .gif, .jpg, .jpeg, .png, .doc, .docx, .xls, .xlsx, .rtf, .pdf, .txt

Proof of CCBL Number Click button for uploading file Clear Maximum size allowed: 5 MB Allowed types: .gif, .jpg, .jpeg, .png, .doc, .docx, .xls, .xlsx, .rtf, .pdf, .txt

1. To receive a copy of your submission, please fill out your email address below and submit.
2. Email Address

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