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Medical Marijuana Registry 4300 Cherry Creek Drive South, Denver, CO 80246-1530 303-692-2184 E-mail: medical.marijuana@state.co.us Website: Report of Lost, Stolen or Damaged Registry Card Instructions:Do not use this form to check on your Registry Card application status. Call the Registry at 303-692-2184 if you
applied more than 35 days ago and have not received anything from us. You must submit paperwork within ten (10) days of the date you have it notarized. There are no fees to file this form.Do not write-over, cross-out, or use white-out on this form, or it will be voided. If you make a mistake on the form,
please complete a new one. Patient social security numbers are used to confirm identity and protect confidentiality.If you find your Registry card after sending in this form, return it to the Registry. Do not use the old card. Once
your form is approved, the old card is voided and may be reported to law enforcement. Replacement cards cannot be mailed to a third party or sent “in care of” another party. After completing the form, you must sign and date it in front of a notary and have it notarized. Include a copy of your valid photo ID. The chart below lists the documents the Registry will accept: PROOF OF IDENTITYThe Registry requires a verifiable, photo ID for all forms. Please submit one of the following IDs with your form: