CITY OF DAVID MINISTRIES

1421 S Palo Verde, Buckeye

Sunday October 3rd following 9:00 a.m. service

THANK YOU FOR LEARNING ABOUT EXPUNGEMENT THROUGH ONE OF OUR COMMUNITY OR CHURCH PARTNERS! THE FOLLOWING INFORMATION IS REQUIRED TO DETERMINE IF YOU MEET EXPUNGEMENT AND/OR THE RECREATIONAL MARIJUANA LICENSURE CRITERIA.

Name

Email

Phone

Addresses you've lived the past 5 years

Location and approximate date of your minor drug infraction

Will you be over the age of 21 by December 1st, 2021?

Yes

No

Number of family members within your household

1

2

3

4 or more

Total household income

Below 40,000

$40,000 - $70,000

$70,000 - $100,000

Over $100,000

You heard about us through City of David Community Church, correct?

Thanks for submitting!

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