0001677748-17-000001.txt : 20170103 0001677748-17-000001.hdr.sgml : 20170103 20170103100030 ACCESSION NUMBER: 0001677748-17-000001 CONFORMED SUBMISSION TYPE: D PUBLIC DOCUMENT COUNT: 1 ITEM INFORMATION: 06b FILED AS OF DATE: 20170103 DATE AS OF CHANGE: 20170103 EFFECTIVENESS DATE: 20170103 FILER: COMPANY DATA: COMPANY CONFORMED NAME: Champlain Valley Dispensary, Inc. CENTRAL INDEX KEY: 0001677748 IRS NUMBER: 000000000 STATE OF INCORPORATION: VT FILING VALUES: FORM TYPE: D SEC ACT: 1933 Act SEC FILE NUMBER: 021-277472 FILM NUMBER: 17500608 BUSINESS ADDRESS: STREET 1: 70 S. WINOOSKI AVE. #284 CITY: BURLINGTON STATE: VT ZIP: 05401 BUSINESS PHONE: 844-283-9333 MAIL ADDRESS: STREET 1: 70 S. WINOOSKI AVE. #284 CITY: BURLINGTON STATE: VT ZIP: 05401 D 1 primary_doc.xml X0707 D LIVE 0001677748 Champlain Valley Dispensary, Inc. 70 S. WINOOSKI AVE. #284 BURLINGTON VT VERMONT 05401 844-283-9333 VERMONT None None Corporation true Shayne Lynn 70 South Winooski Ave. #284 Burlington VT VERMONT 05401 Executive Officer Director Executive Director and Member of Board of Directors Nina Meyerhof 70 South Winooski Ave. #284 Burlington VT VERMONT 05401 Director Member of Board of Directors Nancy Shaw 70 South Winooski Ave. #284 Burlington VT VERMONT 05401 Director Member of Board of Directors Other Decline to Disclose 06b false 2017-01-03 false true false 500000 500000 500000 0 false 1 0 0 0 false Champlain Valley Dispensary, Inc. /Pauline Law/ Pauline Law Attorney in Fact 2017-01-03