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FOR DLLC USE ONLY Received Date: Arizona Department of Liquor Licenses and Control Job #: 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: DE 10L4L. Last 2. Applicant's mailing address: i‘Lubs- 3. Applicant's home/cell ph 4. Applicant's email address: SECTION 2 Name of Organization, Candidate or Political Party/Gov.: Ti f5 7-RE WiC371 Name of Licensed Contractor (if any): SECTION 3 Non-Profit/IRS Tax Exempt Number: 94 - 4 1 3 z- A SECTION 4 Event Location: 114 ONA160 CSIOC 1144 96w3 P u HAjSt 1 BLVP 54'iv e/r -i9 a7, Az 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 ft) /iv 7 1 201g -r 63. /6 =80 441 • 5?-1)0 Pin DAY 1: DAY 2: DAY 3: DAY 4: , DAY 5: DAY 6: DAY 7: DAY 8: DAY 9: DAY 10: 1/22/2019 Page 1 of 3 Individuals requiring ADA accommodations call (602)542-2999 SECTION 6 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.) Number of Police 7 Number of Security Personnel 1:]Fencing OBarriers Explanation: ezu8 OFF/6 rifq-5- 404--- 47. 7-4.674E" h Mb eiVaLgTE bbuiviJ 777 -Errre7 ' SECTION 7 Will this event be held on a currently licensed premise and within the already approved premises? 0Yes No (If yes, Local Governing Body Signature not required) Name of Business License Number Phone (Include Area Code) SECTION 8 How is this special event going to conduct all dispensing, serving, and sellin g of spirituous liquors? Please read R-19- 318 for explanation and check one of the following boxes. OPlace license in non-use ODispense and serve all spirituous liquors under retailer's license Dispense and serve all spirituous liquors under special event ESplit 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? VjOn-site consumption DOff-site (auction/wine/distilled spirits pull ) DBoth SECTION 10 1. Has the applicant been convicted of a felony, or had a li quor license revoked within the last five (5) years? DYesCgiNo (If yes, attach explanation.) 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 or other person to mana ge the sale or service of alcohol? DYesEINo (If yes, must be a licensed contractor or licensee of series 6, 7, 11, or 12) 4. List all people and organizations who will receive the proceeds. Account for 100% of the proceeds. The or ganization applying must receive 25% of the gross revenues of the special event liquor sales. Attach an additional pa ge if necessary. Name - II 1-4E 14/67- Rercentage: 26 qe) -__ Address / 44o i 8/1 T 0 HAL;M &JD safi 61,1-rci kfies1-, Az 8.5^-375— Name )3E(Ag/97-fpl1/42 cc-Ayr-6-PS triP,5uA) eiTP WEPercentage: 76- Address f92z)3 8/-1 -10/-iiv61) BL V1 tvE-6-7 . Sc.37 Sheet City State zip 1/22/2019 Page 2 of 3 Individuals requiring ADA accommodations call (602)542-2999 SECTION 12 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. The following space is to be used to prepare a diagram of your special event licensed premises. Please show dimensions, serving areas, fencing, barricades, or other control measures and security position. 7;NAk-- /25-4770 (ii/U7M N Nor- m se et._ 6 wx-nt E -r-prto La-5)6- tti< o \?k 9 9 /so Ys ix v f t R iv * 5 e, 1 ICYLp V Y kck 4 s .22r t_s_r Ni SON V 1_ 1 8/13/2015 Page 3 of 4 Individuals requiring ADA accommodations call (602)542-9027. 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 BEVERAGES SHALL LEAVE A SPECIAL EVENT UNLESS THEY ARE IN AUCTION WINE OR DISTILLED SPIRITS PULL SEALED CONTAINERS OR THE SPECIAL EVENT LICENSE IS STACKED WITH WINE /CRAFT DISTILLERY FESTIVAL LICENSE. SECTION II, 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 diagram of your special event licensed premises. Please show dimensions, serving areas, fencing, barricades, or other measures and security position. control ATTACH DIAGRAM 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 not covered by the existing liquor license, this application must be approved by the local government that is Department of Liquor Licenses and Control. Please contact the local governing board for additional before submission to the submission deadlines. Additional licensing fees may also be required before approval may be granted. For application requirements and contact your local jurisdiction. more information, please A.R.S. § 4-210(A)(2) and (3) that I have read and , hereby swear under penalty of perjury and in compliance with that I have made herein are true and correct to the understand best of the foregoing and verify that the inforgiation and statements my knowledge. LOCAL GOVERNING BOARD Applicant Signatu hie-44-694 Date Received: (Government Official) recommend 0A PPROVA L 0 DISAPPROVAL (Title) On behalf of (City, Town, County, State) Signature Date Phone DLLC USE ONLY OA PPROVAL 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 authorized B. by An statute, agency shall not base a licensing decision in whole or in part on a licensing requirement or condition that is hot specifically licensing requirement or rule condition or state unless tribal gaming compact. A general grant of authority in statute does not constitute a basis for imposing a condition. a rule is made pursuant to that general grant of authority that specifically authorizes the requirement or AWARD REASONABLE D. THIS SECTION MAY BE ENFORCED IN A PRIVATE CIVIL ACTION AND RELIEF MAY BE AWARDED AGAINST THE STATE. THE COURT MAY ACTION AGAINST THE STATE ATTORNEY FOR A FEES, VIOLATION DAMAGES AND ALL FEES ASSOCIATED WITH THE LICENSE APPLICATION TO A PARTY THAT PREVAILS IN AN OF THIS SECTION. DISCIPLINARY E. A STATE EMPLOYEE MAY NOT INTENTIONALLY OR KNOWINGLY VIOLATE THIS SECTION. A VIOLATION OF THIS SECTION IS CAUSE FOR 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. 1/22/2019 Page 3 of 3 Individuals requiring ADA accommodations call (602)542-2999