ST. KATHERINE GREEK ORTHODOX CHURCH_REDACTED.PDF

DLLC USE ONLY

job #: }
SPECIAL EVENT LICENSE ~ —
APPLICATION FEE $25.00 PER DAY ae ee
CSR:

Arizona Department of Liquor Licenses and Control
800 W, Washington St. 5" Floor Phoenix, AZ 85007 ticense

(602) 542-5141 -
v Application MUST be submitted to the Department of Liquor 10 days prior to the event.

SECTION 1 Applicant must be a member of a qualifying nonprofit organization, political parly, or Government entily and
authorized by an Officer, Director, or Chairperson of the Organization.

Evangelia Archuleta
|. Applicant: _

(Must be an Olficer/Member of the N . .
2. Applicant's mailing address

Clly State
480 899 3330

Applicant's business phone:

Zip
3. Applicants home/cell phone:

4. Applicant's email address:
Greek Independence Day

5. Special Event Name:

. — . St-Katherine Greek Orthodox Church
6. Name of Non-Profit Organization, Candidate or Political Parly/Gov.; _

94-2876533
7. Non-Profif/IRS Tax Exemp! Number:

61824710 .
8, Arizona Corporation Commission File #: If out of State please specify:

(Attach letter of good standing)
. . St Katherine Greek Orthodox Church
9, Event Location Name:
2716 N Dobson Rd Chandler, AZ 85224

10. Event Address:

Dates and Hours of Event - Days must be consecutive and may not exceed 10 consecutive days.

“SEPARATE APPLICATION FOR EACH “NON-CONSECUTIVE” DAY**

Event Start License En:
Days Date Day of Week Time AM/PM Time AM oa
aN: Mar 25, 2023 Saturday 5pm 11:59pm
DAY 2:
DAY 3: __ _ _ _.
DAY 4: __ o
Tt
bss}
DAY 5: : : _ a 2 i 8)
Peas
DAY 6: 92m 5
a — Bo © eH
DAY 7: ove Ss
mine) e ea
DAY 8: - 20 SB ml
0 & ~ oO
DAY 9: : ; : Ws

DAY10:

SECTION 2 What type of security and contral measures will you fake to prevent violations of liquor laws al this event?
{list fype and number of police/secuiily personnel and type of fencing or control barrlers, if appticable.)

a tly Personnel (Fencing LlRaniers

St. Katherine will self police in addition to hiring one uniformed sheriff

Number of Police __ ___ Number of Se

Must explain securily mecasu a -
and will nire licensed and bonded bartenders.

SECTION 3 What is the purpose of this event?

[On-site consuraption (Clo#-site (auction/wine/distilled spirits pull) (lBofh

How ts this special event going fo conduc! all dispensing, serving, ancl selling of spirituous licpuors?

Check one of ihe following boxes, {R-19-318)

A) [4] Special Event being held on an unlicensed premises will require approval and signature oy Ihe Local Governing
Bady on page 3. {if checked move to section 4}

d area?

8) (_[ Will Ihis event be held on a currently licensed premises and within the already approved and licen
(Must altach a letter from the licensed premises with an explanation of the option checked below)

Name of Business License Number es Phone (Include Area Code)
Ciace ticense in non-use - Special Event Licensee selling all alcohol without retailer Involvement
Must attach letter from the location suspending license for duration of special event

Cibispense and serve oll spirituous liquors under retailer's ficense ~ Business operates normally, minimum of 25% of gross
revenue from alcohol sales is donated fo licensee

EXdispense and serve ail spirituous liquors under seecial event » The special event licensee is in charge of selling alcohol that wos
purchased or donafed by the special event licensee. The retailers existing alcoho! inventory must be seporatedt from any alcoho!
used during the special event. Must attach letter from the location suspending license for duration of special event

Cspiit premise between special event and retail location - Both the special event licensee and the retailer will conduct
soles of alcohol, (These sales will be done in separate areas. If alcohol is donated or purchased by the special event licensee
it must be in a seperate ored than the alcohot that is dispensed by the licensed retailer.)

lof sale only - Wine/Distilled Spirits Pull, Live or Silent Auctions - Retailer wil still be permitted fo conduc? all nornal sale and
service of alcohol.

SECTION 4
|. Has the applicant been convicted of a felony, or had a liquor license revoked within the last five {5) years?
(1 Yes [21 No If yes, attach letter of explanation.

2. How many special event days have been issued fo this organization during the calendar year?

3, Is the Organization using the services of a Special Event Contractor? {A licensee can utilize the services of a special event
contractor who may purchase ond sell alcohol on behalf of the licensee, if no special event cantractor Is listed, the licensee is
responsible for the soles and service of alcohol. }

(J ves [1 No If yes, please provide the Name of the Special Event Contractor:

4.1s the organization using the services of a series 6, 7, 11, or 12 licensee to manage the sale or service of alcohol?
(Licensees who hold a series 6, 7, 11, or 12 license are automatically qualified to be the special event contractor}

(7) Yes [4] No if yes, please provide the Name of licensee: License #:

5, List the name of the Individual or Organization that will receive revenues, MUST EQUAL 100 PERCENT.
Attach addiflonal sheet If necessary.

7 St.Katherine Greek Orthodox Church 100%

Nam _ Percentage: 7
2716 N Dobson Rd Chandler, AZ 85224
Address: _ —-
Street Clly State Zip
Name: . ___ Percentage: _
Address: .
Street Clty Slate ip

Please recid A.R.S, § 4-203.02 Special event license; rules and R19-1-205 Requirements for a Special Event License.
ALL ALCOHOLIC BEVERAGE SALES MUST BE FOR CONSUMPTION AT THE EVENT SITE ONLY.

SECTION. 5§ License premises diagram. The licensed premises for your special event is Ine area in which you are
avihorized to sell, dispense or serve alcoholic beverages under the provisions of your license. Please atach a diagram
of your special eveni licensed premises. Please show dimensions, serving areas, fencing, barricades, or other control
measures and security position.

ATTACH DIAGRAM

ifthe special event will be held at a location without a permanent liquor license or if the event will be on any portion of a location
that is not covered by the existing liquor llcense, this application must be approved by the local governing body before submitting
to the Deparlment of Liquor Licenses and Control. Please contact the local governing board for additional information,

APPLICANT SIGNATURE

Declaration: rm ra) i /

|, (Print Name) (<_ VA/IZI elit ech be b 4 declore under penalty of perjury that | am

authorized to submit this application. |hdyve read the contents of this application, and tg,the best of my knowledge

believe all statements made on this application to be frue, correc! ae
AD

—>

Signature

LOCAL GOVERNING BODY

Date Received

\,

(Government Oficial) (mile)

On behalf of

(Clty, Town, County) Signature

The local governing body (city, town or municipality where the fair/festival will take place) may require additional
applications to be completed and submitted. Please check with local government as fo how far in advance they require
these applications to be submifted. Additional licensing fees may also be required before approval may be granted.

AZDLLC USE ONLY

DIAPPROVAL 1 DISAPPROVAL BY:

SECTION 12 license premises diagram. The licensed premises for your speciat event is the area in which you are quihorized
to sell, dispense or serve alcoholic beverages under the provisions of your license. The following space is fo be used to
prepare a diagrarn of your special event licensed premises, Please show dimensions, serving areas, fencing, baricades, or
other conirol measures and securily pasition,

Elliot Kad Nt

N Dobson Rd

BT/2016 Page 3 of 4
individuals requiing ADA Gccammodatians call (602}542-9027,