This form contains 105 fields organized into 39 sections. Below is a complete list of every field, its type, and what information is expected.

Field Name	Type	Description
Action Button
Add More Key Participants	Button	Button used to insert or generate another supplemental page when you have more Key Participants than space allows on this sheet.
Applicant
Applicant Name	Text	Type the full legal name of the individual applicant or the business entity applying for the industrial hemp registration.
Applicant certification
Signature	Signature	Applicant (or authorized representative) signs here to certify that all information provided is true and complete and that all industrial hemp regulations will be followed.
Date	Date	Enter the date the Applicant Certification was signed (MM/DD/YYYY).
Print Name and Title	Text	Print the signatory’s full name and official title (e.g., Owner, Managing Member) exactly as it appears in section 1 of the form.
Applicant Details
Applicant Name	Text	Enter the full name of the applicant (individual or business entity) as it appears on the main application, for cross‑reference on supplemental pages.
Applicant Information
Applicant Name	Text	Enter the full legal name of the individual applicant OR the authorized representative who is signing on behalf of a business entity (Last, First, Middle Initial).
Mailing Address	Text	Enter the complete mailing address where you wish to receive official correspondence (street/PO box, apt./suite if any).
City	Text	City associated with the mailing address you provided.
State	Text	State abbreviation (e.g., CA) for the mailing address.
Zip	Text	Five‑digit ZIP Code (plus 4 if applicable) for the mailing address.
Applicant Name	Text	Enter the same Applicant/Registrant name that appears on the main application (individual or business/legal name applying for the industrial hemp registration).
Attachments & supplemental sheets
Additional cultivars associated with cultivation site #1 attached	CheckBox	Check this box if you are attaching an additional Cultivar Supplemental Sheet for cultivation site #1 (i.e., you have more cultivars than fit in the on‑form table).
Business Information
undefined	CheckBox	Check this box if the legal Business/Entity Name is exactly the same as the Applicant Name; leave unchecked if the business has a different name.
Business Name: Same as applicant	Text	Enter the full legal name of the business or entity that will hold the registration. If you checked the “same as applicant” box you may leave this blank.
DBA (“doing business as”) Names	Text	List any trade, fictitious, or “doing business as” (DBA) names under which hemp will be grown or marketed. Separate multiple names with commas.
Sole Proprietor	CheckBox	Select if the business structure is a Sole Proprietorship.
Partnership	CheckBox	Select if the business structure is a Partnership.
Limited Liability Company	CheckBox	Select if the business structure is a Limited Liability Company (LLC).
Corporation	CheckBox	Select if the business structure is a Corporation.
Other	CheckBox	Select if the business structure is not covered by the listed options. If checked, describe the structure in the adjacent “Other” text box.
Other	Text	If you checked “Other” for business structure, briefly describe the type of entity (e.g., Cooperative, Trust).
EIN	Text	Enter the nine‑digit Federal Employer Identification Number (EIN) issued by the IRS for the business entity. Sole proprietors without an EIN may enter a Social Security Number if allowed by the county.
undefined	CheckBox	Check this box if the Principal Business Address is the same as the Mailing Address you provided earlier.
Principal Business Address: Same as mailing address	Text	If different from the mailing address, enter the physical street address of the principal place of business where records are kept (no P.O. boxes).
Business Tax ID
No EIN	CheckBox	Check this box if the business entity does not have a federal Employer Identification Number (EIN).
Cannabis License Status
Premise: Yes	CheckBox	Indicate YES if this site already holds a cannabis cultivation premises license issued by CDFA/CalCannabis.
Premise: No	CheckBox	Indicate NO if this site does NOT hold a cannabis cultivation premises license.
Premise: Yes	CheckBox	Select “Yes” if this site currently holds or is included in a state or local commercial cannabis license.
Premise: No	CheckBox	Select “No” if this site is NOT covered by any state or local commercial cannabis license.
County information
CountyNames	ComboBox	Select the California county in which you are registering to cultivate industrial hemp. This determines where the application and payment will be submitted. Shasta Napa Contra Costa Santa Cruz Sierra Colusa Modoc Humboldt Imperial Lassen Sonoma Ventura Siskiyou Santa Clara Yolo Plumas San Luis Obispo Sutter San Benito Solano Stanislaus Inyo Please Select Tehama Marin Madera Los Angeles Tulare Fresno Kern Monterey Riverside San Diego San Mateo Santa Barbara San Francisco San Joaquin San Bernardino Butte Alameda Orange Del Norte Sacramento Kings Glenn Lake Merced Mariposa Mendocino
Agricultural Commissioner’s Office	Text	Provide the mailing street address of the selected County Agricultural Commissioner’s Office (where you will send the application and fee).
CountyCity	Text	Enter the city (and state abbreviation ‘CA’) and ZIP code for the County Agricultural Commissioner’s Office address you supplied above.
County Office
CountyNames	ComboBox	Choose from the list the California county where you are submitting this application (County Agricultural Commissioner’s office). Shasta Napa Contra Costa Santa Cruz Sierra Colusa Modoc Humboldt Imperial Lassen Sonoma Ventura Siskiyou Santa Clara Yolo Mariposa Plumas Sutter San Benito Solano Stanislaus Inyo Please Select Tehama Marin Madera Los Angeles Fresno Kern Monterey Riverside San Diego San Mateo San Francisco San Joaquin San Bernardino Butte Alameda Orange Del Norte Sacramento Kings Glenn Lake Merced El Dorado Mendocino
Agricultural Commissioner’s Office	Text	Street address of the selected County Agricultural Commissioner’s office.
CountyCity	Text	City (and, if space allows, state and ZIP code) for the County Agricultural Commissioner’s office address.
Breeders Application	Text	Main telephone number of the County Agricultural Commissioner’s office.
Cultivar Details
Cultivation Site #1 Approved Cultivars	List
Cultivation Site Address
Physical Address	Text	Street address (number and street) where this supplemental cultivation or storage site is physically located.
City	Text	City in which the supplemental cultivation / storage site is located.
Zip	Text	5‑digit ZIP Code (ZIP+4 optional) for the supplemental site’s physical address.
City	Text	City in which this supplemental cultivation / storage site is located.
Zip	Text	5‑digit ZIP Code (ZIP+4 optional) for this supplemental site’s physical address.
Cultivation Site Details
Site	Text	Assign a simple identifier for this cultivation/storage location (e.g., “Site 1”).
Physical Address	Text	Enter the complete physical street address (no P.O. Box) of the cultivation or storage site.
GPS Latitude	Number	Enter the latitude (decimal degrees) for the center point of the site.
Cultivation Site Identification
Site	Text	Write the identifier you are giving to this supplemental cultivation / storage location (e.g., “Site 2”). Use the same label on all related maps and attachments.
Cultivation Site Summary
Total Sites	Number	State the total number of non‑contiguous cultivation or storage sites you are registering, counting all main and supplemental pages.
Total Sites	Number	Repeat the total number of cultivation/storage sites registered (duplicate field on this page).
Fee / payment
Payment	Number	Enter the amount paid for the annual registration fee (usually $900). If you are paying a different amount, explain in an attachment.
Form Administration
Page Number	Number	Page number of this supplemental sheet (auto‑filled; change only if instructed).
Form Controls
Add More Cultivation Sites and Cultivars	Button	Button that inserts an additional supplemental page for more cultivation sites and cultivars.
Form Metadata
Page Number	Text	This box shows the page number of the application. It is already filled in and does not require any action from you.
Page Number	Text	Auto‑filled page number for internal reference; no entry needed.
Form Navigation
PageNumber	Text	Pre‑printed page number for the supplemental Key Participant sheet. Normally left as‑is; if you create additional supplemental pages, update this number so the pages stay in numerical order.
Key Participant Info
Key participant Info table	List
Primary Contact
undefined	CheckBox	Check this box if the Primary Contact is the same person listed in the Applicant Name field; leave unchecked if the contact person is different.
Primary Contact Name (Last, First, Middle Initial): Same as applicant	Text	If someone other than the applicant should be contacted about this application, enter that person’s full name (Last, First, Middle Initial). Leave blank if you checked the “same as applicant” box.
Phone Number	Text	Provide the primary daytime telephone number for the applicant or designated contact, including area code.
Email (optional)	Text	Provide an email address for the applicant or primary contact. Supplying an email is optional but recommended for faster communication.
Primary Supplemental Cultivation Site Cultivar Information
Primary Supplemental Cultivation Site Cultivar Information	List
Principal Business Address
City	Text	Enter the city for the principal business address of the applicant or entity exactly as it appears in postal records.
State	Text	Enter the two‑letter state abbreviation (CA, NV, etc.) for the principal business address.
Zip	Text	Enter the 5‑ or 9‑digit ZIP Code for the principal business address.
Registration Type
New	CheckBox	Check this box if you are applying for a brand‑new Industrial Hemp Grower Registration (you have not held a valid registration in this county that is still current).
Renewal	CheckBox	Check this box if you currently hold, or previously held, a registration in this county and are submitting this form to renew it.
Previous Registration	Text	If you marked “Renewal,” enter your most recent Industrial Hemp Registration Number exactly as it appears on your certificate (e.g., CA‑XXX‑000123). Leave blank if this is a new application.
Secondary Supplemental Cultivation Site Cultivar Information
Secondary Supplemental Cultivation Site Cultivar Information	List
Site
Premise: Yes	CheckBox	Select “Yes” if the cultivation or storage site described on this supplemental sheet is located on a premises that already holds an active commercial cannabis license.
Premise: No	CheckBox	Select “No” if the cultivation or storage site described on this supplemental sheet is NOT located on a premises with an active commercial cannabis license.
Total Sites	Number	Enter the total number of separate, non‑contiguous cultivation and/or storage sites included with this application (count all sites listed on any supplemental sheets).
Total Sites	Number	Enter the total number of separate, non‑contiguous cultivation and/or storage sites included with this application (count all sites listed on any supplemental sheets).
Site Address
Physical Address	Text	Enter the street (physical) address of this cultivation or storage site. Do NOT use a P.O. Box—give the exact location where hemp will be grown or stored.
City	Text	Type the city in which the above physical site is located.
Zip	Text	Enter the 5‑digit ZIP Code for the site’s physical address.
Site Area Unit
Acres	CheckBox	Select if the site’s area will be reported in acres.
Square Feet	CheckBox	Select if the site’s area will be reported in square feet.
Site Coordinates
Longitude	Number	Enter the longitude (center point) of the cultivation/storage site in decimal degrees (e.g., -121.123456).
Latitude	Number	Enter the latitude (center point) of the cultivation/storage site in decimal degrees (e.g., 38.987654).
Site Details
Legal Description of Site: REQUIRED: Attach a map showing boundaries of this growing area	Text	Enter the full legal description of this non‑contiguous growing or storage area (e.g., township‑range‑section, metes and bounds, assessor’s parcel number, etc.). The description must match the boundary map you will attach to the application.
Size	Number	Indicate the total area of this site in acres (outdoor) or square feet (indoor/greenhouse). Use numbers only; do not include the unit label.
GPS Latitude	Number	Record the latitude of the center point of this site in decimal degrees (e.g., 38.5750).
GPS Longitude	Number	Record the longitude of the center point of this site in decimal degrees (use a negative value for west, e.g., –121.4788).
Size	Number	Indicate the total area of this additional site in acres (outdoor) or square feet (indoor/greenhouse). Use numbers only; do not include the unit label.
Site Geolocation
GPS Longitude	Number	Longitude of the center point of this supplemental site, expressed in decimal degrees (e.g., –120.123456).
Site Legal Description
Legal Description of Site: REQUIRED: Attach a map showing boundaries of this growing area	Text	Describe the legal land description for this site (e.g., APN, township‑range‑section, metes and bounds). You MUST also attach a map that clearly shows the boundaries of the growing/storage area.
Legal Description of Site: REQUIRED: Attach a map showing boundaries of this growing area	Text	Enter the legal land description of this supplemental site (e.g., parcel number, township‑range‑section, metes and bounds) and remember to attach the required boundary map.
Site Purpose
Cultivation	CheckBox	Check this box if the site will be used for hemp CULTIVATION only.
Storage	CheckBox	Check this box if the site will be used for hemp STORAGE only.
Both	CheckBox	Check this box if the site will be used for BOTH cultivation and storage of hemp.
Cultivation	CheckBox	Check if this location will be used solely for cultivation.
Storage	CheckBox	Check if this location will be used solely for storage.
Both	CheckBox	Check if this location will be used for both cultivation and storage.
Storage	CheckBox	Check if the site will be used only for storage of harvested hemp (no cultivation will occur).
Both	CheckBox	Check if the site will be used for both cultivation and storage activities.
Cultivation	CheckBox	Check this box if the location described is used for cultivating (growing) industrial hemp plants.
Storage	CheckBox	Check this box if the location described is used only for storing harvested or processed industrial hemp material.
Site Size
Size	Number	Provide the total size of the growing or storage area. Enter only the numeric value; indicate the unit by selecting Acres or Square Feet below.
Acres	CheckBox	Select if the size entered above is measured in ACRES.
Square Feet	CheckBox	Select if the size entered above is measured in SQUARE FEET.
Site Size Unit
Acres	CheckBox	Check this box if the area you report for this site is stated in acres.
Square Feet	CheckBox	Check this box if the area you report for this site is stated in square feet.
Supplemental Key Participant Info
Supplemental Key Participant Info	List	Fill out this section ONLY if any supplemental ke participant information is explicitly provided.
Supplemental Sheets
Additional Key Participants Attached	CheckBox	Check this box if you have filled out and attached an additional ‘Key Participants – Supplemental Sheet’ because more than six key participants exist.
Additional Cultivation Sites Attached	CheckBox	Check this box if you have attached one or more ‘Cultivation Site – Supplemental Sheets’ for additional sites beyond those listed on the main form.

Form 69-001, Industrial Hemp Registration Instructions