ANTHEM ROTARY FOUNDATION-11.12.2026 _REDACTED.PDF

Arizona Department of Liquor Licenses and Control DLLC USE ONLY
Job #:
https://www.azliquor.gov
(602) 542-5141
Data Acoapeed:
“
SPECIAL EVENT LICENSE
License #:
APPLICATION FEE $25.00 PER DAY
MUST be submitted to the Department of Liquor 10 days prior to the event.
SECTION 1
Name of Non-Profit Organization, Candidate or Political Party; Anthem Rotary Foundation
If the event will be held on an unlicensed premises, it {ViUST be approved and signed by the Local Governing
Body Before submitting to the Arizona Department of Liquor.
LOCAL GOVERNING BODY
es
Date Received:
Government Official Title
On behalf of
City, Town, County Signature
SECTION 2
Will the event be at a location with a current liquor license and within the approved and licensed area?
[lyes [/]No (if no skip to section 3)
If yes, MUST attach a letter of explanation/permission/suspension from the licensed location and choose ONE option below.
Name of Licensed Location Liquor License Number
[-] Suspend license for the duration of the Special Event; Licensee selling all alcohol without retailer involvement.
Letter of suspension required.
[-] Dispense and serve all spirituous liquors under retailer’s license — Business operates normally, minimum of 25% of
gross revenue from alcohol sales will be donated to licensee. Letter of permission required.
C] Dispense and serve all spirituous liquors under special event - The special event licensee is in charge of selling alcohol
that was purchased or donated by the special event licensee. The retailers existing alcohol inventory must be kept
separate from any alcohol used during the special event. Letter of suspension required.
LC] Split premises between special event and licensed location - Both the special event licensee and the licensed
location will conduct sales of alcohol. (These sales must be done in separate areas. If alcohol is donated or purchased
by the special event licensee, it must be in a separate area from the alcohol that is dispensed by the licensed
location.) Letter of explanation and permission required.
C] Off Sale only - Wine/Distilled Spirits Pull, Live or Silent Auctions — Retailer will be permitted to conduct all normal
sales and service of alcohol. Letter of permission required.
10/28/2025 Page 1 of 4
Indivdidiiale raciiringa ANA AecAmmocaAton: nlanca call (A018 A99000

SECTION 3
Applicant MUST be a member of a qualifying nonprofit organization, political party, or Government entity and
authorized by an Officer, Director, or Chairperson of the Organization.
Salem Edward John, Jr
1, Applicant:
Last le
2. Applicant’s mailing *
t City State Zip
928-279-8733
3. Applicants home/cell — Non-profit organization phone:
| sis@d
4. Applicant's email address:
S, Has the applicant been convicted of a felony, or had a liquor license revoked within the last five (5) years?
Ives (if yes, attach letter of explanation) [“} No
SECTION 4
Anthem Rotary Foundation 47-0930766 / 26-00640058
1. Name of non-profit organization:
47-0930766 109477921
2. Non-Profit/IRS Tax Exempt Number: Arizona Corporation Commission File #:
Required Required
3. If Out Of State, specify State (Attach letter of good standing):
ROtary Charity Classic Golf Tournament Gala Dinner
4, Special Event Name:
SECTION 5
The Ironwood Course - Anthem Golf and Country Club
s. Event Location Name:
41551 N Anthem Hills Dr, Phoenix, AZ 85086
6 Event mileiress:
SECTION 6
Must list type of security and control measures will you take to prevent violations of liquor laws at this event.
— Number of Police 1 Number of Security Personnel [Fencing [_lparriers
There is a fence around the serving and seating area that is
Must explain security measures:
patrolled by Maricopa County Sheriff's Deputies.
1. How is this special event going to conduct all dispensing, serving, and selling of spirituous liquors?
Check one of the following boxes. (R-19-318)
On-site consumption Cc] Off-site (auction/wine/distilled spirits pull) C] Both
9
2. How many special event days have already been issued to this organization during the current year?
10/28/2025 Page 2 of 4
Individiiale raniiiringa ADA ArcAmmadatians nlance call (49916 A9.90090

SECTION 7
Dates and Hours of Event - Days must be consecutive and may not exceed 10 days per year.
EVENT START EVENT END
DAYS DATE DAY OF WEEK
TIME AM/PM TIME AM/PM
11/12/2026 Thursday 12:00pm 10:00pm
say,
DAY 2
DAY 3
DAY 4 eae
;
DAY5 a
SEP 15 2026
DAY 6
MARICOPA COU NTY
DAY7 CLERK BOARD OF SUPERVISORS
DAYS
DAY 9
DAY 10
SECTION 8
1. Is the Organization using the services of a DLLC approved Special Event Contractor from the list on our website?
[Wes [Ino if yes, please provide the Name of the Special Event Contractor:
Special Event Contractor Signature:
2. Is 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 a special event contractor)
[_Wes [VINo if yes, Name of Licensee: Liquor License #:
3.List the name of the Organization/individual that will receive revenues:
MUST EQUAL 100 PERCENT, APPLYING NON-PROFIT MUST RECEIVE A MINIMUM OF 25% OF THE PROCEEDS,
Anthem Rotary Foundation Oe
Name: Perortnaen
3000 W Anthem Way #109/ PMB 107, Anthem AZ 85086
Address:
- : 4	1	43	1	4	0	176	2935	1910	68	-1	
5	1	43	1	4	1	176	2935	158	34	48.552532	Address:
5	1	43	1	4	2	447	2982	71	21	15.520573	_
5	1	43	1	4	3	1151	2977	41	26	9.400463	”
5	1	43	1	4	4	1720	2974	60	21	26.024841	__
5	1	43	1	4	5	2052	2969	34	26	27.663345	-
2	1	44	0	0	0	345	2953	2026	20	-1	
3	1	44	1	0	0	345	2953	2026	20	-1	
4	1	44	1	1	0	345	2953	2026	20	-1	
5	1	44	1	1	1	345	2953	2026	20	95.000000	 
2	1	45	0	0	0	441	3036	1685	44	-1	
3	1	45	1	0	0	441	3036	1685	44	-1	
4	1	45	1	1	0	441	3036	1685	44	-1	
5	1	45	1	1	1	441	3047	122	33	96.669167	Please
5	1	45	1	1	2	575	3044	84	36	89.942879	read
5	1	45	1	1	3	670	3044	106	34	89.942879	A.R.S.
5	1	45	1	1	4	789	3044	20	36	92.955032	§
5	1	45	1	1	5	818	3044	167	34	92.888153	4-203.02
5	1	45	1	1	6	998	3041	69	34	93.278877	and
5	1	45	1	1	7	1079	3041	188	34	92.224060	R19-1-205
5	1	45	1	1	8	1277	3039	123	41	96.776482	Special
5	1	45	1	1	9	1409	3041	108	31	96.899353	event
5	1	45	1	1	10	1528	3039	127	39	96.389824	license
5	1	45	1	1	11	1667	3036	90	42	96.395294	rules
5	1	45	1	1	12	1769	3036	70	42	96.216599	and
5	1	45	1	1	13	1851	3036	275	42	96.322464	Requirements.
2	1	46	0	0	0	148	3181	1163	46	-1	
3	1	46	1	0	0	148	3181	1163	46	-1	
4	1	46	1	1	0	148	3181	1163	46	-1	
5	1	46	1	1	1	148	3185	167	42	96.446625	10/28/2025
5	1	46	1	1	2	1137	3184	80	33	94.258316	Page
5	1	46	1	1	3	1228	3181	17	29	82.410934	3
5	1	46	1	1	4	1254	3181	31	29	82.410934	of
5	1	46	1	1	5	1296	3184	15	26	95.645103	4
2	1	47	0	0	0	767	3220	1061	26	-1	
3	1	47	1	0	0	767	3220	1061	26	-1	
4	1	47	1	1	0	767	3220	1061	26	-1	
5	1	47	1	1	1	767	3225	159	21	0.000000	Indidaiieale
5	1	47	1	1	2	936	3225	133	21	6.200781	raring
5	1	47	1	1	3	1084	3225	62	18	47.257290	ADA
5	1	47	1	1	4	1158	3222	276	21	0.000000	Aeenremonacieitians
5	1	47	1	1	5	1446	3222	102	19	0.000000	wlanca
5	1	47	1	1	6	1559	3220	52	21	48.191879	ell
5	1	47	1	1	7	1624	3220	204	21	0.000000	(416499000
Fercsrhogny,
Mame:

SECTION 9
Licensed location diagram: The licensed premises for your special event is the area in which you are
authorized to to sell sell, dispense, or serve alcoholic beverages under the provisions of f your licens license.
=> ATTACH DIAGRAM
Must attach a diagram of your special event showing the area where alcohol will be sold
served, and consumed. Must include dimensions of event area, fencing, barricades,
or other control measures, and include positions of security personnel.
NO ALCOHOLIC BEVERAGES SHALL LEAVE A SPECIAL EVENT UNLESS THEY ARE IN SEALED CONTAINERS FOR AN AUCTION OR
WINE/DISTILLED SPIRITS PULL, OR THE SPECIAL EVENT LICENSE IS STACKED WITH A WINE /CRAFT DISTILLERY FESTIVAL LICENSE.
Declaration:
Edward John Salem Jr declare under penalty of perjury that | am
|, (Print Name) ,
authorized to submit this application. | have read the contents and to the best of my knowledge believe all statements
made on this application to be true, correct, and complete.
WZ y Zia Zot Man ff.
signatres
SPECIAL EVENT DIAGRAM AND
SAFETY PLAN STANDARDS
Diagrams do not need to be overly complicated, they can be hand drawn. However, we
do not accept photographs or aerial views that do not show the premises clearly. The
diagram should clearly depict the special event area in relation to the entire premises.
Each diagram must include:
e Overview of the location
e The event area clearly outlined with black marker
e Where alcohol will be served/stored
e All entrances and exits
e Where security will be positioned
e Square footage of event area
e Show North, East, South, West
10/28/2025 page 4of 4
Individuals requiring ADA accommodations please call (602)542-2999

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