SUN CITY WEST ZYMURGY CLUB_REDACTED.PDF

FOR DLLC USE ONLY
Received Date:
Arizona Department of Liquor Licenses and Control Job tt:
800 W Washington 5th Floor
Phoenix, AZ 85007-2934 CSR:
www.azliquor.gov
(602) 542-5141 License #:
APPLICATION FOR SPECIAL EVENT LICENSE
Fees: $25.00 per day for 1-10 days (consecutive) Cash Checks or Money Orders Only
A service fee of $25.00 will be charged for all dishonored checks (A.R.S § 44-6852)
IMPORTANT INFORMATION: This document must be fully completed or it will be returned.
The Department of Liquor Licenses and Control must receive this application ten (10) business days prior to the event.
SECTION 1 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.
1. Applicant: Houck, William Carl
Lost
2. Applicant's mailing address:
CIly Slate 7Ip
3. Applicanl's home/cell phone: Applicant's business phone: )
4. Applicant's email address:
Sun City West Zymurgy Club
SECTION 2 Name of Organization, Candidate or Political Party/Gov.:
EIN 36-4725914
SECTION 3 Non-Profit/IRS Tax Exempt Number:
19803 RH Johnson Blvd Sun City West 85375 Building D-3
SECTION 4 Event Location:
19803 R H Johnson Blvd Sun City West 85375 Building D-3
Event Address:
SECTION 5 Dates and Hours of Event. Days must be consecutive but may not exceed 10 consecutive days.
See A.R.S. § 4 -244(15) and (17) for legal hours of service.
PLEASE FILL OUT A SEPARATE APPLICATION FOR EACH "NON-CONSECUTIVE" DAY
Event Start License End
Date Day of Week Time AM/PM Time AM/PM
11-14-2019 Thursday 5 P.M. 9 P.M.
DAY 1:
DAY 2:
DAY 3:
DAY 4:
DAY 5:
DAY 6:
DAY 7:
DAY 8:
DAY 9:
DAY10:
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Individuals requiring ADA accommodations call (6021542-2999

SECTION 4 What type of security and control measures will you take to prevent violations of liquor laws at this event?
(List type and number of police/security personnel and type of fencing or control barriers, If applicable.)
Humber of Pol ice 2 Number of Security Personnel oFencing Barriers
Event will take place inside our Club Room
Explanation:
The Club Room Holds 92 people and is completely enclosed with the exception of three emergency exits.
Security will be at the entrance to the club room and inside the room. There will be approximately 15 participants in the lecture series tasting various wines.
This is an educational class limited to Club Members
SECTION 7 Will this event be held on a currently licensed premise and within the already approved premises? E3Yes flNo
(If yes, Local Governing Body Signature not required)
Name of Business License Number Phone (Include Area Code)
5ECTI011 8 How is this special event going to conduct all dispensing, serving, and selling of spirituous liquors? Please read R-I 9-
318 for explanation and check one of the following boxes.
DPlace license in non-use
DDispense and serve all spirituous liquors under retailer's license
DDispense and serve all spirituous liquors under special event
DSOS premise between special event and retail location
(IF USING RETAIL LICENSE, PLEASE SUBMIT A LETTER OF AGREEMENT FROM THE AGENT/OWNER OF THE LICENSED PREMISES TO SUSPEND OR RUN
CONCURRENT WITH THE PERMANENT LICENSE DURING THE EVENT. IF THE SPECIAL EVENT IS ONLY USING A PORTION OF THE PREMISES,
AGENT/OWNER WILL NEED TO SUSPEND THAT PORTION OF THE PREMISES.)
SECTION 9 What is the purpose of this event?
Fl On-site consumption DOff-site (auction/wine/distilled spirits pull) DBoth
SECTION 10
1 . Has the applicant been convicted of a felony, or had a liquor license revoked within the last five (5) years?
DYes ON° Of yes, atiach explanation.)
One
2. How many special event days have been issued to this organization during the calendar year?
(The number cannot exceed 10 days per year.)
3. Is the Organization using the services of a Licensed Contractor?
Dyes ON0 If yes, please provide the following: Name of Licensed Contractor:
el. Is the organization using the services of a series 6, 7, 11, 01 12 licensee to manage the sale or service of alcohol?
DYes EINo If yes, please provide the following: Name of Licensee License #:
5. List all people and organizations who will receive the proceeds. Account for 100% of the proceeds. The organization
applying must receive 25% of the gross revenues of the special event liquor sales. Attach an additional page if necessary,
Sun City West Zymurgy Club Percentage: 100%
Name
19803 RH Johnson Blvd. Sun City West , AZ 85375 Building D-3
Address
Name Percentage:
Address Sheet City State Zip
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Individuals requiring ADA accommodations call (6021542-2999

Please read A.R.S. § 4-203.02 Special event license; rules and R19-1-205 Requirements for a Special Event License.
Note: ALL ALCOHOLIC BEVERAGE SALES MUST BE FOR CONSUMPTION AT THE EVENT SITE ONLY.
NO ALCOHOLIC jN AUCTION WINE OROISTII aLarEariaj
SEALED CONTAINERS OR THE SPECIAL EVENT LICENSE IS STACKED WITH WINE /CRAFT DISTILLERY FESTIVAL LICENSL
SECTION 11 License premises diagram. The licensed premises for your special event is the area in which you are
authorized to sell, dispense or serve alcoholic beverages under the provisions of your license. Please attach a diadram
of your special event licensed premises. Please show dimensions, serving areas, fencing, barricades, or other control
measures and security position.
If the 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 license, this application must be approved by the local government before submission to the
Department of Liquor Licenses and Control. Please contact the local governing board for additional application requirements and
submission deadlines, Additional licensing fees may also be required before approval may be granted. For more Information, please
contact your local Jurisdiction.
I, (Print Full Name) William Houck hereby swear under penalty of perjury and In compliance with
A.R.S. § 4-210(A)(2) and (3) that I have read and understand the foregoing and verify that the Information/and statements
that I have made herein are true and correct to the best of my knowledge. ',7` f I
Applicant Signature:
LOCAL GOVERNING BOARD
Date Received:
recommend DAPPROVAL 0 DISAPPROVAL
(Government Official) (Title)
On behalf of
(City, Town, County) Signature Date Phone
DLLC USE ONLY
APPROVAL ODISAPPROVAL BY: DATE: /
A.R.S. § 41-1030. Invalidity of rules not made according to this chapter; prohibited agency action: prohibited acts by state
employees; enforcement; notice
B. An agency shall not base o licensing decision in whole or in part on a licensina requirement or condition that is not specifically
authorized by statute, rule or stale tribal gaming compact. A, general grant of authority in statute does not constitute a basis for imposing a
licensing requirement or condition unless a rule is made pursuant to that general grant of authority that specifically authorizes the requirement or
condition.
D. THIS SECTION MAY BE ENFORCED IN A PRIVATE CIVIL ACTION AND RELIEF MAY BE AWARDED AGAINST THE SI 'ATE, THE COURT MAY
AWARD REASONABLE ATTORNEY FEES, DAMAGES AND ALI.. FEES ASSOCIATED WITH THE LICENSE APPLICATION TO A PARTY THAT PREVAILS IN All
ACTION AGAINST THE STATE FOR A VIOLATION OF THIS SECTION.
E. A STATE EMPLOYEE MAY NOI INTENTIONALLY OR KNOWINGLY VIOLATE THIS SECTION. A VIOLATION! OF THIS SECTION IS CAUSE FOR
DISCIPLINARY ACTION OR DISMISSAL PURSUANT TO THE AGENCY'S ADOPTED PERSONNEL POLICY.
F. THIS SECTION DOES NOT ABROGATE THE IMMUNITY PROVIDED BY SECTION 12-820.01 OR 12-820.
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Individuals requiring ADA accommodations call (602)542-2999

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