ST. KATHERINE GREEK ORTHODOX CHURCH REDACTED.PDF

FOR DLLC USE ONLY
Event Date(s):
Arizona Department of Liquor Licenses and Control
800 W Washington 5th Floor Event time start/end:
Phoenix, AZ 85007-2934 CSR:
www.azliquor.gov
(602) 542-5141 license:
APPLICATION FOR SPECIAL EVENT LICENSE
Fee= $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 fen (10) business days prior to the event. 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 (see Section 12).
St. Katherine Greek Orthodox Church
SECTION 1 Name of Organization:
Name of Licensed Contractor only (if any):
94-2876533
SECTION 2 Non-Profit/IRS Tax Exempt Number:
St. Katherine Greek Orthodox Church
SECTION 3 Event Location:
2716 N Dobson Rd Chandler AZ 85224
'Event Address:
SECTION 4 Applicant must be a member of the qualifying organization and authorized by an Officer, Director, or Chairperson
of the Organization.
Archuleta Evangelia
1. Applicant:
Last first Middle Date of Birth
2716 N Dobson Rd Chandler AZ 85224
2. Applicant's mailing address:
City State Bp
3. Applicant's home/cell phone: Applicant's business phone: ( 48( ) 899-3330
4. Applicant's email address
Evangelia — - - - Archuleta
I, (Print Full Name) declare that I am the APPLICANT filing this application
as listed above. I have reackihe application and the contents and all statements are true, correct and complete.
Chairperson 7-23-18
Title/ Position Date Phone Number
The foregoing instrument was acknowledged before me this 2.0
Day Month Year
State -11-044 County of Fitheia-)Pg
74,4-/ace,t,
9' .37 .2OIY
My Commission Expires on:
Date Signature of Notary Public
9/12/2017 Page 1 of 5
Individuals requiring ADA accommodations call (602)542-299p KERRI L FLETCHER
NOTARY PUBLIC, ARIZONA
MARICOPA COUNTY
My Commission Expires
September 29, 2018

SECTION 5 Regarding the application for a special event permit: The Officer, Director, or Chairperson of the organization
certifies that the Organization meets the criteria in A.R.S. § 4-203.02(E) as indicated by checking one of the
boxes below.
(1) 0 The Organization is a political party or a campaign committee supporting a candidate for public office. Please
indicate the name of the candidate that the Organization supports, the office that the candidate seeks, and the
month and year that the candidate would first fill the office if successful.
Candidate:
Name Office Month/Year
(2) li/J The Organization is a non-profit entity organized in Arizona, or pursuant to the laws of another state that is eligible
for designation under Section 501(C) of the internal revenue code of the United States. If the Organization is
applying under option (2) as a nonprofit entity, please also INITIAL in the spaces provided next to all following
statements to indicate that, to the best of the Organization's knowledge, the following statements are correct.
To be initialed only by an I icer, Director, or Chairperson of the organization.
ea
The Organization has received a determination letter from the Internal Revenue Service ("IRS") indicating that it
is eligible for designation as a nonprofit entity under Section 501(C), eligibility or will be eligible on all days that the
special event will occur, or has a pending application with the IRS for such treatment that has not been resolved
but that will retroactively cover all days that the special event will occur. (Please provide a copy of either the IRS
determination letter or the application [without attachments] with this application).
ea
The Organization is not aware of any action taken by the IRS to revoke, suspend, or otherwise eliminate their
Eligibility under 501(C), or if there is a pending application, the eligibility has not received any indication that
the IRS will deny its application and has a good faith basis formed upon a reasonable inquiry into IRS regulations,
guidelines and forms that are eligible under 501(C).
ea
The Organization understands that if there is a change in circumstances after completing this form that may
cause or has caused it to lose its eligibility under 501(C), whether before or after receiving an IRS determination
letter, that it has an affirmative duty to notify the Department of Liquor, which may take appropriate action
regarding the loss of eligibility.
To be completed only by an Officer, Director, or Chairperson of the organization.
Evangelia Archuleta
i, (Print Full Name) declare that I am an Officer, Director, or Chairperson of
the organization filing this applicatipn as listed above. I have read the application and the contents and all statements are
true, correapnd completq
Chairperson 7/23/18
Signature X Title/ Position Date Phone Number
The foregoing instrument was acknowledged before me this F
Day Month Year
State dr-/Z-O/JA County of Hthei Cl-OP/1
My Commission Expires on: 02-013` dAiti
Date Signature of Notary Public
KERR! I ri
PUBLIC, ARIZONA
MARICOPA COUNTY
Will thissepwbvp2g, MY Commission Vrf a c rrently licensed premise and within the already approved premises?aes ON°
(If yes, Loca Signature not required)
Name of Business License Number Phone (Include Area Code)
9/12/2017 Page 2 of 5
Individuals requiring ADA accommodations call (602)542-2999

g ie Department of the Treasury
/ X 10 Internal Revenue Service
P.O. Box 2508 In reply refer to: 0248467585
Cincinnati OH 45201 Jan. 20, 2012 LTR 4158C E0
94-2876533 000000 00
00013872
BODC: TE
ST KATHERINE GREEK ORTHODOX CHURCH
2716 N DOBSON ROAD
CHANDLER AZ 85224-1803
012387
Employer Identification Number: 94-2876533
Person to Contact: Mrs Pamela Skiles
Toll Free Telephone Number: 1-877-829-5500
Dear Taxpayer:
This is in response to your Jan. 11, 2012, request for information
about your Employer Identification Number (EIN).
Our records indicate that you have been assigned EIN 94-2876533.
Please keep this number in your permanent records. Your name and EIN,
as shown above, should be entered on all Federal income tax forms, as
well as all correspondence or documents submitted to the IRS. Other
government agencies may also require you to provide your EIN on forms
you submit to them.
An EIN does not indicate that a non-profit organization is tax-
exempt. Organizations that want to be recognized as exempt from
Federal income tax must file Form 1023 or Form 1024, with limited
exceptions. Visit our website at www.irs.gov/eo for additional
information about applying for tax exempt status, as well as forms,
publications and instructions. Publication 557, Tax-Exempt Status
for Your Organization, provides general information about tax-exempt
organizations. Publication 4220, Applying for 501(c)(3) Tax-Exempt
Status, provides specialized information for charitable organizations.
You may also request forms and publications by calling our toll-free
number 1-800-829-3676 (1-800-TAX-FORM). For further information, see
the Life Cycle of a Public Charity and Life Cycle of a Private
Foundation on our website at www.irs.gov/eo.
Churches, their integrated auxiliaries, and conventions or
associations of churches that meet the qualifications for exemption
are automatically considered tax exempt under section 501(c)(3) of
the Code without applying for formal recognition of such status. No
determination letters are issued to these organizations. Refer to
Publication 1828, Tax Guide for Churches and Religious Organizations,
Publication 557, Tax Exempt Status for Your Organization, and our
website, www.irs.gov/eo for the organizational and operational
requirements if you feel you meet these requirements.

SECTION, Z How is this special event going to conduct all dispensing, serving, and selling 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
OSplit premise between special event and retail location
(IF USING RETAIL LICENSE, PLEASE SUBMIT A LETTER OF AGREEMENT FROM THE AGENT/OWNER OF THE IJCENSED PREMISES TO SUSPEND OR
RUN CONCURRENT WITH THE PERMANENT LICENSE DURING THE WENT. IF THE SPECIAL EVENT IS ONLY USING A PORTION OF THE PREMISES,
AGENT/OWNER WILL NEED TO SUSPEND THAT PORTION OF THE PREMISES.)
SECA()
What is the purpose of this event? DOn-site consumption a)ff-site (auction/wine/distilled spirits pull) 03oth
SECTION 9
1. Has the applicant been convicted of a felony, or had a liquor license revoked within the last five (5) years?
aes 0\lo Or yes, attach explanation.)
0
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 manage the sale or service of alcohol?
Ekes DNO (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 organization
applying must receive 25% of the gross revenues of the special event liquor sales. Attach an additional page if necessary.
St. Katherine Greek Orthodox Church 100%
Name Percentage:
Address
Name Percentage:
Address
Street City State Bp
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.
jv 0 ALCOHOLIC BEVERAGES SHALL LEAVE A SPECJAL EVENT UNLESS THEY ARE IN AUCTION WINE OR DISTILLED SPIRITS PULL
SEALED CONTAINERS OR THE SPECIALEVENT UCENSE IS STACKED WITH WINE /CRAFT DISTILLERY FESTIVAL LICENSE.
5. 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.)
5 Number of Police 8 Number of Security Personnel Fencing laarriers
Existing block wall and fencing will be used in areas without block wall.
Explanation:
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Individuals requiring ADA accommodations call (602)542-2999

SECTION 10 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-CONSECUI1VE" DAY
Event Start License End
Date Day of Week Time AM/PM Time AM/PM
10/5/18 Friday 4:00 pm 11:59 pm
DAY 1:
10/6/18 Saturday 11:00 am 11:59 pm
DAY 2:
10/7/18 Sunday 11:00 am 11:59 pm
DAY 3:
DAY 4:
DAY 5:
DAY 6:
DAY 7:
DAY 8:
DAY 9:
DAY1 0:
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 diagram
of your special event licensed premises. Please show dimensions, serving areas, fencing, barricades, or other control
measures and security position.
ATTACH DIAGRAM
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Individuals requiring ADA accommodations call (602)542-2999

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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.
SECTION 12 Local Governing Body Approval Section.
Date Received:
recommend 0APPROVAL 0 DISAPPROVAL
(Government Official) (Title)
On behalf of
(City, Town, County) Signature Date Phone
SECTION 13 For Department of Liquor Licenses and Control use only.
0APPROVAL ODISAPPROVAL BY: DATE: / /
A.R.S. § 41-1030. Invalidity of rules not made according to this chapter; prohibited aoency action; prohibited acts
by state employees; enforcement; notice
B. An agency shall not base a licensing decision in whole or in part on a licensing requirement or condition that is
not specifically authorized by statute, rule or state 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 STATE.
THE COURT MAY AWARD REASONABLE ATTORNEY FEES, DAMAGES AND ALL FEES ASSOCIATED WITH THE LICENSE
APPLICATION TO A PARTY THAT PREVAILS IN AN ACTION AGAINST THE STATE FOR A VIOLATION OF THIS SECTION.
E. A STATE EMPLOYEE MAY NOT 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 12-820.02.
9/12/2017 Page 5 of 5
Individuals requiring ADA accommodations call (602)542-2999