HEALING HEARTS ANIMAL SANCTUARY, INC REDACTED.PDF

if; EEP 15 Licr,. Dept 141411
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 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 15).
SECTION 1 Name of Organizaton: i Healing Hearts Animal Sanctuary, Inc.
SECTION 2 Non-Profit/IRS Tax Exempt Number: 65-1259371
SECTION 3 The organization is a: (check one box only)
Charitable0Fratemal (must have regular membership and have been in existence for over five (5) years)
OReligious OCivic (Rotary, College Scholarship)EIPolitical Party, Ballot Measure or Campaign Committee
SECTION 4 Will this event be held on a currently licensed premise and within the already approved premises?E]Yes No
Name of Business • License Number. Phone (include Area Code)
SECTION 5 How is this special event going to conduct all dispensing, serving, and selling of spirituous liquors? Please read R-19-
318 for explanation (look in special event planning guide) 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 NOT USING RETAIL LICENSE, SUBMIT A LETTER OF AGREEMENT FROM THE AGENT/OWNER OF THE LICENSED PREMISE TO SUSPEND THE
LICENSE DURING THE EVENT. IF THE SPECIAL EVENT IS ONLY USING A PORTION OF PREMISE, AGENT/OWNER WILL NEED TO SUSPEND THAT
PORTION OF THE PREMISE.)
SECTION 6 What is the purpose of this event? On-site consumption EJOff-site (auction) 080th
SECTION 7 Location of the Event: Gemini Acres Equine
Address of Location: 6636 E. Dale Lane, Cave Creek, Maricopa AZ 85297
Sheet City COUNTY State Zip
SECTION 8 Will this be stacked with a wine festival/craft distiller festival? [les 12 No
SECTION 9 Applicant must be a member of the qualifying organization and authorized by an Officer, Director or Chairperson
of the Organization named in Section 1. (Authorizing signature is required in Section 13.)
1. Applicant (Colter) Brumbaugh, Jennifer Kristin
Last Flat Middle Date of Birth
2. Applicant's mailing address:
Street City State Zip
3. Applicant's home/cell phone: Applicant's business phone: ( 480 ) 279-5135
4. Applicant's email address
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Individuals requiring ADA accommodations call (602)542-9027.

SECTION 10
1. Has the applicant been convicted of a felony, or had a liquor license revoked within the last five (5) years?
Yes MI No (If yes, attach explanation.)
2. How many special event licenses have been issued to this location this year?
(The number cannot exceed 12 events per year; exceptions under A.R.S. §4-203.02(D).)
3. Is the organization using the services of a promoter or other person to manage the event?ElYes No
(If yes, attach a copy of the agreement.)
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 Healing Hearts Animal Sanctuary, Inc Percentage: 100%
Address 3S ( C' su;A,_ N-Aigi I( s AL, RSaT1
Street City tate Bp
Name Percentage:
Address
Sheet City State Zip
5. Please read A.R.S. § 4-203.02 Special event license; rules and R19-1-205 Reauirements for a 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 ARE IN AUCTION SEALED CONTAINERS OR THE SPECIAL
EVENT LICENSE IS STACKED WITH WINE/CRAFT DISTILLERY FESTIVAL LICENSE"
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 bafflers, if applicable.)
Number of Police 2 Number of Security Personnel Fencing IS Barriers
The entire premisis is fenced. Attendees will enter through the guest house, and then once outside,
Explanation:
will be surrounded by block wall/gates. Athough, all gates will be locked and access will be through
guest house. Healing Hearts has two volunteers manning entrance, valet staff.
SECTION 11 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
DAY 1: 10/22/201-6 Saturday 7pm 11pm
DAY 2:
DAY 3:
DAY 4:
DAYS:
DAY 6:
DAY 7:
DAY 8:
DAY 9:
DAY 10:
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Individuals requiring ADA accommodations call (602)542-9027.

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.
11
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Individuals requiring ADA accommodations call (602)542-9027.

SECTION 1310 be completed only by an Officer, Director or Chairperson of the organization named In Section 1.
Jennifer Coller Brumbaugh
I, (Prim Full Name) declare that I am an Officer, Director or Chairperson of
the organization filing this application as listed in Section 9. I have read the application and the contents and all statements - —
are true, correct and complete.
X t__
Signature / Dile/ Position Phone Number fic2 ¢ s
5 0 8
The forego instrument was acknowledged before me this S t A 7-54"--42-C,A4 ,2471 < 71 as
Day Month Year 4 5 1 2.
State A e-/2.9,(z4- County of I-(-d-,2-1'd-- i ' Te
-'- 8
My Commission Expires on: 62 /as Id.47v z
Date Signature of Notary Publ
SECTION 14 This section Is to be completed only by the applicant named In Section 9.
Jennifer Coller Brumbaugh
(Print F3i1LAlqme) declare that I am the APPLICANT filing this application
as li}Kol in lection 9. I have read the application and the contents and all statements are true, correct C " *
LLc 6//97/69
Title/ Position Date Phone Number
The V foregoing instrument was acknowledged before me this fc,14-1*--)s-ele- 20 46
Day Month Year
State }Ile /?...oa-4a- County of /14+e-e-1-0,9A-
My Commission Expires on: LP4g /dig
Date Signature of Notary Public
Please contact the local governing board for additional application requirements and submission deadlines. Add;
licensing fees may also be required before approval may be granted. For more information, please contact your
jurisdiction: http://www.azliquor.aoviassetsidocuments/homeoage docsistpec event links.Dclf.
SECTION 15 Local Governing Body Approval Section.
SECTION 16 For Department of Liquor Licenses and Control use only.
DAPPROVAL ODISAPPROVAL BY: DATE:
A.R.S. § 41-1030. Invalidity of rules not made accordina to this chapter; prohibited aaencv 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.
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Individuals requiring ADA accommodations call (602)542-9027.