Sheet 1: Cannabis Supplemental Form

	
	
	
	
	
	
	
	

		
Supplemental Reporting form #1:   Report each sale made to an Independent Cannabis Consumption Lounge                                                                                                                                                                                                                                                                                                                                                                                                                                                           			                                                                                                                                                                                                                                                                                                                                                                                                                                                               
		
	

		
Taxpayer Name: 
		


		
	

		
Taxpayer ID: 
		


		
	

		
Reporting Month:
		


		
	

		
This form must be completed to document each sale made between an Adult Use Cannabis Retail store and an Independent Cannabis Consumption Lounge during this reporting period .  The "Electronic Supplemental"  tab may be used to import the information, in place of the format below.   Each column must be completed in order to utilize the Electronic Supplemental form. 
		
	

		
Independent Cannabis Consumption Lounge TID 
		
  Date of Sale
		
Name and Address of  Independent Consumption Lounge 
		
Invoice Number
		
Independent Lounge Contractual Agreement in Place ( Y or N) 
		
Total Sales Price of  Cannabis
	
	

		


		


		


		


		


		
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Sheet 2: Electronic Supplemental Form

	
	
	
	
	
	
	

		
Independent Cannabis Consumption Lounge TID 
		
Date of Sale
		
Name and Address of  Independent Consumption Lounge 
		
Invoice Number
		
Independent Lounge Cntractual Agreement in Place ( Y or N) 
		
Total Sales Price of  Cannabis
	
	

		


		


		


		


		


		


	
	

		


		


		


		


		


		


	
	

		


		


		


		


		


		


	
	

		


		


		


		


		


		


	
	

		


		


		


		


		


		


	
	

		


		


		


		


		


		


	
	

		


		


		


		


		


		


	
	

		


		


		


		


		


		


	
	

		


		


		


		


		


		


	
	

		


		


		


		


		


		


	
	

		


		


		


		


		


		


	
	

		


		


		


		


		


		


	
	

		


		


		


		


		


		


	
	

		


		


		


		


		


		


	
	

		


		


		


		


		


		


	
	

		


		


		


		


		


		


	
	

		


		


		


		


		


		


	
	

		


		


		


		


		


		


	
	

		


		


		


		


		


		


	
	

		


		


		


		


		


		


	
	

		


		


		


		


		


		


	
	

		


		


		


		


		


		


	
	

		


		


		


		


		


		


	
	

		


		


		


		


		


		


	
	

		


		


		


		


		


		


	
	

		


		


		


		


		


		


	
	

		


		


		


		


		


		


	
	

		


		


		


		


		


		


	
	

		


		


		


		


		


		


	
	

		


		


		


		


		


		


	
	

		


		


		


		


		


		


	
	

		


		


		


		


		


		


	
	

		


		


		


		


		


		


	
	

		


		


		


		


		


		


	
	

		


		


		


		


		


		


	
	

		


		


		


		


		


		


	
	

		


		


		


		


		


		


	
	

		


		


		


		


		


		


	
	

		


		


		


		


		


		


	
	

		


		


		


		


		


		


	
	

		


		


		


		


		


		


	
	

		


		


		


		


		


		


	
	

		


		


		


		


		


		


	
	

		


		


		


		


		


		


	
	

		


		


		


		


		


		


	
	

		


		


		


		


		


		


	
	

		


		


		


		


		


		


	
	

		


		


		


		


		


		


	
	

		


		


		


		


		


		


	
	

		


		


		


		


		


		


	
	

		


		


		


		


		


		


	
	

		


		


		


		


		


		


	
	

		


		


		


		


		


		


	
	

		


		


		


		


		


		


	
	

		


		


		


		


		


		


	
	

		


		


		


		


		


		


	
	

		


		


		


		


		


		


	
	

		


		


		


		


		


		


	
	

		


		


		


		


		


		


	
	

		


		


		


		


		


		


	
	

		


		


		


		


		


		


	
	

		


		


		


		


		


		


	
	

		


		


		


		


		


		


	
	

		


		


		


		


		


		


	
	

		


		


		


		


		


		


	
	

		


		


		


		


		


		


	
	

		


		


		


		


		


		


	
	

		


		


		


		


		


		


	
	

		


		


		


		


		


		


	
	

		


		


		


		


		


		


	
	

		


		


		


		


		


		


	
	

		


		


		


		


		


		


	
	

		


		


		


		


		


		


	
	

		


		


		


		


		


		


	
	

		


		


		


		


		
TOTAL: 
		
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