ARIZONA PARKS & RECREATION FELLOWSHIP 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 CS R:
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 ten (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).
Arizona Parks & Recreation Fellowship
SECTION 1 Name of Organization:
Name of Licensed Contractor only (if any):'! e
SECTION 2 Non-Profit/IRS Tax Exempt Number: 35-2412657 / AZ Corp # 18244504
Mountain Regional Park
SECTION 3 Event Location: USerY
3939 N. Usery Pass Road, Mesa, AZ 85207
Event Address:
SECTION 4 Applicant must be a member of the qualifying organization and authorized by an Officer, Director, or Chairperson
of the Organization.
Hughes, Bryan Christopher
1. Applicant:
Last Date of Birth
2. Applicant's mailing address:
Street City State Zip
3. Applicant's home/cell phone: Applicant's business phone: (520) 868-7589
4. Applicant's email address:
I, (Print Full Name) Bryan Christopher Hughes declare that I am the APPLICANT filing this application
as listed above. I have read the application and the contents and all statements are true, correct and complete.
44- %
Title/ Position Date Phone Number
The foregoing instrument was acknowledged before me this Vi7 J r 2-UI 4))/
Day Month Year
State County of
i4--
My Commission Expires on: i7-4===Pt 1-13 -241
Date
MARIA HERNANDEZ
NOTARY PUBLIC
9/12/2017 STATE OF ARIZONA Page 1 of 5
MY COM1gMtialrE51 PINAL COUNTY 101R@SAID .. A accommodations call (602)542-2999
JANUARY 13,2020

SECTION 5 Regarding the Applicant's application for a special event permit, I hereby certify that the Organization
meets the criteria in A.R.S. § 4-203.02(E) for the issuance of the permit as indicated by checking one of
the boxes below.
(1) The Applicant is a political party or a campaign committee supporting a candidate for public office. Please
indicate the name of the candidate that the Applicant supports, the office that the candidate seeks, and
the month and year that the applicant would first fill the office if successful.
Candidate:
Name Office Month/Year
(2) 12 The Applicant is a non-profit entity organized in Arizona, or pursuant to the laws of another state that is eligible for
designation as a 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 INITIAL in the space provided next
to all following statements to indicate that, to the best of the applicant's knowledge, they are true and correct.
The Applicant 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).
The Applicant is not aware of any action by the IRS to revoke, suspend, or otherwise eliminate the Applicant'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 good faith basis formed upon a reasonable inquiry into IRS regulations,
guidelines, and forms that it is eligible under 501(C).
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.
To be completed only by an Officer, Director, or Chairperson of the organization.
Bryan Christopher Hughes
(Print Full Name) declare that I am an Officer, Director, or Chairperson of
the organization filing this application as listed above. I have read the application and the contents and all statements are
true, cgrreGt.dnd complete.
A ' /01
Title/ Position Date Phone Number
0i)
The foregoing instrument was acknowledged before me this
Day Month Year
State -= County of • ->•(
- 2A
My Co ILIM.1612;m12I10.ZIAIIIMIliNi.C.-.112I11••II._ Cit
MARIA HERNANDEZ editt i ture of Notary Publi
NOTARY PUBLIC
tly licensed premise and within the already approved premises? OYes IS No
(If yes, Local Governing Body 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

X
eitA tfIGZ IRS DEPARTMENT OF THE TREASURY
REVENUE SERVICE
CINCINNATI OH 45999-0023
Date of this notice: 05-31-2011
Employer Identification Number:
001598.876320.0011.001 1 AB 0.368 532 35-2412657
1 1 1 1 1100.11.110 1 1.1wh.H4101.110 1 .11H1v.viuld1H Form: SS-4
Number of this notice: CP 575 E
ARIZONA PARKS & RECREATION
FELLOWSHIP For assistance you may call us at:
12950 N 7TH ST 1-800-829-4933
PHOENIX AZ 85022
001598 IF YOU WRITE, ATTACH THE
STUB OF THIS NOTICE.
WE ATONcil YOU AN EMPLOYER IDENTIFICATION NUMBER
Thank you for applying for an Employer Identification Number (EIN). We assigned
you EIN 35-2412657. This EIN will identify you, your business accounts, tax returns,
and documents, even if you have no employees. Please keep this notice in your
permanent records.
When filing tax documents, payments, and related correspondence, it is very
important that you use your EIN and complete name and address exactly as shown above.
Any variation may cause a delay in processing, result in incorrect information in your
account, or even cause you to be assigned more than one EIN. If the information
is not correct as shown above, please make the correction using the attached tear off
stub and return it to us.
Assigning an EIN does not grant tax-exempt status to non-profit organizations.
Publication 557, Tax Exempt Status for Your Organization, has details on the
application process, as well as information on returns you may need to file. To
apply for formal recognition of tax-exempt status, most organizations will need to
complete either Form 1023, Application for Recognition Under Section 501(c)(3) of
the Internal Revenue Code, or Form 1024, Application for Recognition of Exemption
Under Section 501(a). Submit the completed form, all applicable attachments, and
the required user fee to:
Internal Revenue Service
PO Box 12192
Covington, KY 41012-0192
The Pension Protection Act of 2006 contains numerous changes to the tax law
provisions affecting tax-exempt organizations, including an annual electronic
notification requirement (Form 990-N) for organizations not required to file an annual
information return (Form 990 or Form 990-EZ). Additionally, if you are required to
file an annual information return, you may be required to file it electronically.
Please refer to the Charities & Non-Profits page at www.irs.gov for the most current
information on your filing requirements.

INTERNAL REVENUE SERVICE DEPARTMENT OF THE TREASURY
P. 0. BOX 2508
CINCINNATI, OH 45201
Employer Identification Number:
Date: 011 35-2412657
DLN:
17053147311011
ARIZONA PARKS & RECREATION Contact Person:
FELLOWSHIP DALE T SCHABER ID# 31175
12950 N 7TH ST Contact Telephone Number:
PHOENIX, AZ 85022 (877) 829-5500
Accounting Period Ending:
December 31
Public Charity Status:
170(b) (1) (A) (vi)
Form 990 Required:
Yes
Effective Date of Exemption:
May 14, 2010
Contribution Deductibility:
Yes
Addendum Applies:
No
Dear Applicant:
We are pleased to inform you that upon review of your application for tax
exempt status we have determined that you are exempt from Federal income tax
under section 501(c)(3) of the Internal Revenue Code. Contributions to you are
deductible under section 170 of the Code. You are also qualified to receive
tax deductible bequests, devises, transfers or gifts under section 2055, 2106
or 2522 of the Code. Because this letter could help resolve any questions
regarding your exempt status, you should keep it in your permanent records.
Organizations exempt under section 501(c)(3) of the Code are further classified
as either public charities or private foundations. We determined that you are
a public charity under the Code section(s) listed in the heading of this
letter.
Please see enclosed Publication 4221-PC, Compliance Guide for 501(c)(3) Public
Charities, for some helpful information about your responsibilities as an
exempt organization.
Lois G. Lerner
Director, Exempt Organizations
Enclosure: Publication 4221-PC
Letter 947 (DO/CG)

SECTION 7 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.
PPlace license in non-use
ODispense and serve all spirituous liquors under retailer's license
1±'_]Dispense and serve all spirituous liquors under special event
aSplit 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 8
What is the purpose of this event? a0n-site consumption aOff-site (auction/wine/distilled spirits pull) aBoth
SECTION 9
1. Has the applicant been convicted of a felony, or had a liquor license revoked within the last five (5) years?
1(es alo (If 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 promoter or other person to manage the sale or service of alcohol? aes laio
(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.
Name Arizona Parks & Recreation Fellowship Percentage: 100
Address 12950 N. 7th Street, Phoenix, AZ 85022
Name Percentage:
Address
Street City State Zip
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.
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.)
Number of Police I Number of Security Personnel aFencing K2 Barriers
Event to be held in Group Picnic area that is secured by entry gate. Only participants will
Explanation:
be allowed into secure area. Caution tape will be used to define service area which will
be limited to four covered patios. Park Supervisor will be on premises during the event for
security and enforcement of liquor laws. Event will be 50 to 100 participants
9/12/2017 Page 3 of 5
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-CONSECUTIVE" DAY
Event Start License End
Date Day of Week Time AM/PM Time AM/PM
2/3/2018 Saturday 10:00 A.M. 1:30 P.M.
DAY 1:
DAY 2:
DAY 3:
DAY 4:
DAY 5:
DAY 6:
DAY 7:
DAY 8:
DAY 9:
DAY] 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
9/12/2017 Page 4 of 5
Individuals requiring ADA accommodations call (602)542-2999

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Scale 1:24,000
1000 -0 1000 2000 3000 Feet
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250 0 250 500 750 1000 Meters
Contour Interval 40 Feet
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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 ['APPROVAL 0 DISAPPROVAL
(Government Official) (Title)
On behalf of
(City, Town, County) Signature Dote Phone
SECTION 13 For Department of Liquor Licenses and Control use only,
0APPR0VAL 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 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