TEXAS DEPARTMENT OF STATE HEALTH SERVICES
BUSINESS FILING AND VERIFICATION SECTION
TEMPLATE LETTER FOR CONSUMABLE HEMP PRODUCT LICENSE
APPLICATION
Instructions: This template does not have to be used. There is no set
format for this information. This template does give the minimum
information required by statute and rule.
1. Enter the date you fill out the document
2. Enter the name of the property owner or property owner
representative in the case of a corporation, limited liability corporation,
or other business entity
3. Enter the street number of the consumable hemp product facility
4. Enter the street name of the consumable hemp product facility
5. Enter the name of the city where the consumable hemp product facility
is located
6. Enter the name of the county where the consumable hemp product
facility is located
7. Enter the zip code of the consumable hemp product facility
8. Have the property owner or property owner representative sign and
the document
9. Print the name and title of the property owner or property owner
representative
10. Scan the document
11. Attach the scanned document to the email you received with
your application summary
12. Leave the application summary attached
a. The application summary has information that will help us match
your email to your license record.
13. Attach any other required documents such as the Legal
Description of the property and GIS coordinates
14. Forward that email to [email protected]
Page 1 of 2
___________________________________________________________
___________________________________________________________
Date: __________________
I, ______________________________, (circle one) owner or owner’s
representative, (list business entity person named represents),
___________________________________________________ of the
property located at:
Street number: _______________________________________
Street name: _________________________________________
City: _______________________________________________
County: _____________________________________________
Zip code: ____________________________________________,
Give consent allowing the Department of State Health Services, the
Department of Public Safety, and any other state or local law enforcement
agency to enter onto all premises where hemp is processed, or consumable
hemp products are manufactured to conduct a physical inspection or to
ensure compliance with Texas Health and Safety Code Chapter 443, 25
Texas Administrative Code Chapters 229 and 300.
Signature and Date
Printed Name and Title
Page 2 of 2
