RECREATION CENTERS OF SUN CITY WEST REDACTED.PDF

' 08 2018 09:49AM RCSCW 6235446042 page 1
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FOR DLLC USE ONLY
Event Da1641
Arizona Department of Liquor Licenses and Control
800 W Washington 5th Floor Event time skutienck
Phoenix, AZ 85007-2434
www.crzliquor.gov
(602) 542-5141 License:
APPLICATION FORSPECIAL EVENT LICENSE
Fee= $25.00 per day for 1-10 days (consecutive)
Cash Checks or Money Orders Only
A service fee of $25.00will be charged for all dishonored checks (A.R.S § 44-6852)
• IMPORTANT INFORMATION:INS dot Ument-must be fully completed or IE be returned.
The Department of Liquor Licenses and Control must receive ibis appRcatton ten (10) business days prior to the event. If the special
event will be held at a location wOhout a permanent Squor license or lithe event wSI be on any portion of a location that is not covered
by the exhfingtiquo license, this appricafion mOst.be approved by the local gcryernment before submission' to the Department of
Liquor.Ucenset and Control(seeSecfion 12). •
CE-Nratg F 610f) Ct T')/ Wesir
SECTION 1 Name of Organization:
Name of Licensed Contractor only (if any):
SECTION 2 Nort,Proffl/IRS Tax Exrpt Numb, Ex, 7 03745-0k,
SECTION I Event Location: aLAA RE-oem- 7.7(› 6117-ey„,1
Event Address: /3860 ti,,v (ivy g 5375-
SECTION 4Applicant must be a member of the qualifying organization and authorized by an Officer, Director, or Chairperson
of the Organization.
1. Applicant: itrig K(
2. Applicant's mailing address:
3. Applicant's home/cell phone: business phone: 5-4f - 6411
Lt. Applicant's email address:
I, pint Fig Marne) _ declare that I am the APPLICANT firing this application
a4ritec1169ove: e read the application and the content and all statements are true, correct and complete..
The foregoirt instrument was acknowledged before me this
State i1011/41 Pr County of Rail r...0ferU
My Commission Expires on: If A:01134:36 Signalize at tioicny
Matloops Cann
My Commission Expires
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Individuals requiring ADA accommodations call (602)542-2999
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SECTION 5 Regarding the Applicant's application for a special event permit, I hereby certify that the Organization
meets the criteria in A.RS. § 4-203.02(E) for the issuance of the permit as indicated by checking one of
the boxes below.
(1) 0 TheApplicant is a political party or a campaign comrnitteestipporting a candidate fortiubfic °tilde: Please
indicate the name of the candidate thcitthe APPlicarit supports, the office that the candidate seeks, and
the month and year that the applicant would first filtthe office if successful.
Candidate:
Name Monfh/Year
(2) X The Applicant is a non-profit entity organized in Arizona; Or pursuant to the laws of another state that is eligible for
designation as 9 nonprofit entity under Section 501(C) of the internal revenue code of the United States.
If the Applicant is apPlying under option (2) as a nonprofit entity, please also INMAL in the space provided next
to all following statements to Irv:Act:11v that. fo the best of the applicant's knowledge. they are true and correct.
The Applicant has received a determination teller from the Internal Revenue Service ; (IRS") indicating that it is
eligible for designation as el .nonprofit entity under Section 501(C), eligibility or be eligibleon.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 eitherlhelRS' •
determination letter or the application [without attachments] with this application).
KO The Applicant is not aware of any action by the IRS to revoke, suspend, or otherwise eliminate the Appliaant's
eligibility Under 501(C), or if there is a pending application, the Applicant has not received any indication that
the IRS will deny its application and has a goad faith basis formed upon areasopable inquiry into IRS - regulations;• .
guidelines, and forms that it is eligible under 501(C).
'KO The Applicant 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 then take appropriate action with
regard to the loss of eligibility.
lismounimmby an Officer, Director, or Chatperson of the organization.
1, (Friths* Nome) •,/°7197 41. f-;7 //1 ",67'....1A/4 deciore that I am an Officer, Director, or Chairperson of
the organization tiling this application as d above. I have read the application and the contents and all statements are
true, correct and c lete.
X 40011 ant DLrecia 4-14ZOIEEMMI-
tre- nlie/P
c,4
The foregoing insirumentwos-adowledged before me this Mal&
State Ptf Zonp% • AI._ _ ;Lk -
P.ONKENCHENRY — wiPMeilArik OP-0
Marlcope County
My Commission Expire*,
mhixr a 9n7n
SECTION 6, Will this event be held on a currently licensed premise and within the already approved premises?
(If yes, Local Governing Body Signature nsd required)
Nome of Susinets • UcenseNurither ,-PtiorielInciede4senecide
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Individuals reqviring ADA accommodatiohs call (602)542-2499
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Internal Revenue Service
Department of the Treasury
Date: April 28, 2004 P. O. Box 2508
Cincinnati, OH 45201
Person to Contact:
Recreation Centers of Sun City West, Inc. Brenda Fox 31-07209
19803 N. R. H. Johnson Blvd. Customer Service Representative
Sun City W., AZ 85375-4417 Toll Free Telephone Number:
8:00 a.m. to 830 p.m. EST
877-829-5500
Fax Number:
513-263-3756
Federal Identification Number:
86-0374506
Dear Sir or Madam:
This is in response to your request of April 28, 2004, regarding your
organization's tax-exempt status.
In May 1982 we issued a determination letter that recognized your
tax. Our records indicate that your organization is currently organization as exempt from federal income
Revenue Code. exempt under section 501(c)(4) of the Internal
All exempt organizations (unless specifically . ?
Contributions Act (social security taxes) on remuneration excluded) are liable for taxes under the Federal Insurance
calendar year. Your organization is also liable for tax under of $100 or more paid to each employee during a
employee to whom it pays 350 or more during a calendar the Federal Unemployment Tax Act for each
year, the organization had one or more employees at any quarter if, during the current or preceding calendar
of $1,500 or more in any calendar quarter. time in each of 20 calendar weeks or it paid wages
consider If your organization's the effect of the character, change method of operation, or purposes change, please let us know so we can
us of all changes in its name or address. on the organization's exempt status. Also, your organization should inform
Your organization is required to file.Form 990, Return of Organization
receipts each year are normally more than $25,000. If a return is Exempt from Income Tax, if its gross
the fifth month after the end of the organization's annual required, it must be filed by the 15th day of
a day, up to a maximum of $10,000, when a return is filed accounting late, period. The law imposes a penalty of $20
unless there Is reasonable cause for the delay.
contributions Because your organization is not one described in section 170(c) of the Code, donors
made to it. You should advise your organization's may not deduct
contributors to that effect.
Your business organization income under is not required to file federal income tax returns unless it is subject to the tax
must file an income tax section return on 511 Form of the Internal Revenue Code. If your organization is subject on to unrelated this tax, it
we are not determining whether any of your 990-T, organization's Exempt Organization Business Income Tax Return. In this letter
in Code section 513. activities are unrelated trade or business as defined
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Recreation Centers of Sun City West, inc.
86-0374506
Section 6104 of the Internal Revenue Code requires you to make your organization's
for,public inspection without charge fo? three years after the due date of the return. The annual law return available
inspection organizations that received recognition of exemption on July 15, 1987, or later, to make available also for requires
a copy of the exemption application, any supporting documents and the public
individual who requests such documents in person or in writing. Organizations exemption letter to any
exemption before July 15, 1987, and had a copy of their exemption application that received recognition of
required to make available for public inspection a copy of the exemption on July 15, 1987, are also
and the exemption letter to any individual who requests such documents application, any supporting documents
information on disclosure requirements, please refer to Internal in person or in writing, For additional
Revenue Bulletin 1999 - 17.
As this letter could help resolve any questions about your organization's exempt
your organization's permanent records. status, you should keep it with
If you have any questions, please call us at the telephone number shown in the heading
of this letter.
Sincerely,
drviAtaliafrA)
Janne K. Skufca, Director, TE/GE
Customer Account Services
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SECTION Z How is this special event going to conduct all dispensing, serving, and selfing of spirituousfiquors? Pleose read R-19-
318 for explanation and check one of the following boxes.
OPiace license in non-use
ElDispense and serve all spirituous liquors under retailer's license
Bin spense and serve all spirituous tinder special event
ClbSplit premise between special event and retail location
(IF USING RETAIL UCENSE, PLEASE sow 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 ME PREMISES,
AGENT/OWNER WILL NEED TO SUSPEND THAT PORTION OF THE PREMISES)
SECTION 8
What is the purpose of this event? R)On-site consumption 00ff-site (auction/wine/distilled spirits pull) D3oth
SECTION 9
1. Has the apolicant been convicted of a felony, or had a liquor license revoked within the last five (5) years?
o (It 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 promoter or other person to manage the sale or service of alcohol? Ekes)*
(if yes, must be a licensed coniractar 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.
Name Req.6)-7/bni CEP/Th3& o c Slit,/ City tAkti-
Address 1.3/4 I 07-
Name Percentage:
Address
Please read A.R.S. § 4-203.02 Special event Icense., rules and R19-1-205 Requirements for o Special Event License.
Note: ALL ALCOHOLIC BEVERAGE SALES MUST BE FOR CONSUMPTION AT THE EVENT SITE ONLY.
NO ALCOHOLIC BEVERAGES SHALL LEAVE SPECIAL EVENT UNLESS THEY AREINAUCTION WINE OR DISTILLED SPIRITS PULL
SEALED CONTAINERS OR THE SPECIALEVENT LICENSEASSTACKED-WITH WINEJCRAF1 DISIILLERY FESTIVAL LICENSE
5. What type of security-and control measures will ypu take to prevent Ylolations -Offiquorlaws at-this event?
(List type and nurniset . of . polige/securfty,porsoorkel . and type of fenciap orpontrottianiers, if appF;cal0f)c
Number of Police V Number of Security Personnel Eaencing OBaniefs
Explanation: vkAir w RE HELO t4 7WE AllYN Id/)6E REC.- CEA/ ree. SvmANT
Roon.‘ 1A11 Icti 1,4 Fou_i 640.-OSE7j WE _flieF e:xiEaa /bo -125 40er l4'/0
1-1-/WE ft e6 revt el) Met 1-- A/4 0 itt4 ilYiela coeEhiniyei Ai4 foog,mmiAir
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SECTION 10 Dates and HOUfS of Event. Days must be consecutive but may not exceed 10 consecutive days.
See A.R.S, § 4-244(15) and (17) far legal hours of sievice;
PLEASE FILL OUT A SEPARATE APPLICATION FOR EACH "NON-CONSECUTIVE" DAY
Dale Day of Week" Event Sit -license End
Time AM/PM lime AM/PM
DAY 1: /VW+ -rolievy 4:5 ° frk. 7O.0
DAY 2:
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.
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Individuals requiring ADA accommodations call (602)542-2999
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Mar 06 2018 04:26PM RCSCW 6235446042 page 6
Please confaci the local governing board for additional application requirements and submission deadlines, Addfflonal
licensing fees may also be required before approval may be granted. For more information, please contact your local
jurisdiction.
SECTION 12 Local Governkm Body Approval Section.
Date Received:
recommend 0APPROVAL 0 DISAPPROVAL
(Governmerd °Said) MHO
On behalf of
(City, Town, County) Signature Dale Phone
$ECT10N 13 For Department of Liquor Licenses and Control use only,
DAPPROVAL D DISAPPROVAI. BY DATE
A.R.S. § 41-1030. Inyaildtty of rules not made according to this chapter; prohibited agency action; prohibited acts
by stale 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 Rcensing requirement or condition unless a rule is made pursuant to that general grant of
authority that specifically authorizes the requirement or condition.
a 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
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Individuals requiring ADA accommodations call (602)542-2999
Received Tim Mar. 6. 2018 4:21PM No 3821