HEALING HEARTS ANIMAL SANCTUARY, INC REDACTED.PDF

FOR DLLC USE ONLY
Arizona Department of Liquor Licenses and. Control Evenl Dole(s):
800 W Washington Sth Floor | Event time stan/end:
Phoenix, AZ 85007-2934 ee
CSR:
www.azliquor.gov
(602) 542-5141 license:
APPLICATION FOR SPECIAL EVENT LICENSE
Fee= $25.00 per day for 1-10 days (consecutive)
Aservice fee of $25.00 will be charged for all dishonored checks RS. 8 46852)
is
IMPORTANT INFORMATION: This document must be fully completed or it will be med
The. Department of Liquor Licenses and Control. must receive this application ten (10) business days prior to the e
special event will be held ata location without a permanent Iiquar license or ff the event will be on any portion of alocatio
S not covered by the existing liquor license, thls application must be approved by the local government before subm {
the Department of Liquor Licenses and Control (see Section 15).
SECTION 1. Name of Organization: Healing Hearts Animal Sanctuary, i inc. |
_
SECTION 2. Non-Profit/IRS Tax Exempt Number; 65-1259871
SECTION 3: The organization is a: (check one box only) __
charitable! IFratemal (must have regular membership and h
Oplace license in non-use
Cibispense and serve alls
MDispense and serve all spi
(if not using retail licen: Ss
event. ifthe special event is
Address
SECTION 8 Will thi
SECTION 9 Ap

SECTION 10
1. Has the applicant been convicted of a felony, or had a liquor license revoked within the last five (5) years?
les (YINo (il yes, altach explanation.) :
1
2. How many special event licenses have been issued to this location this yeare¢ _—
(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?LHes [ZINo
{if yes, attach a copy of the agreement.)
4, List and who will receive the proceeds. Account for 100% of the proceeds. The organization —
all people organizations if
applying must receive 25% of the gross revenues of the special event liquor sales. Attach an additional page necessary.
Healing Hearts Animal Sanctuary, Inc percentage: = 100%
Name
Address ee
Clly State ap
Steet
Name Percentage:
Address Stats ip
Street Gly
5, Please read A.R.S. § 4-203.02 Special event license; rules and Ri 9-1-205 Requirements for a Special Event License.
Note: ALL ALCOHOLIC BEVERAGE SALES MUST BE FOR CONSUMPTION AT THE EVENT SITE ONLY.
NO
5	1	17	1	1	2	351	1146	231	34	60.162636	ALCOHOLIC
5	1	17	1	1	3	596	1143	214	33	96.579857	BEVERAGES
5	1	17	1	1	4	823	1142	112	46	96.766731	SHALL
5	1	17	1	1	5	947	1139	113	33	95.915077	LEAVE
5	1	17	1	1	6	1070	1138	150	32	95.915077	SPECIAL
5	1	17	1	1	7	1233	1136	112	32	96.602180	EVENT
5	1	17	1	1	8	1355	1133	128	33	86.881042	UNLESS
5	1	17	1	1	9	1495	1127	86	47	73.198746	THEY
5	1	17	1	1	10	1593	1131	28	30	73.198746	ARE
5	1	17	1	1	11	1677	1129	34	31	95.663818	IN
5	1	17	1	1	12	1724	1125	169	35	96.619835	AUCTION
5	1	17	1	1	13	1905	1123	136	33	96.946152	SEALED
5	1	17	1	1	14	2054	1111	241	52	91.086250	CONTAINERS
5	1	17	1	1	15	2338	1113	25	30	91.086250	OR
5	1	17	1	1	16	2375	1092	82	66	85.995033	THE
4	1	17	1	2	0	577	1166	1541	58	-1	
5	1	17	1	2	1	577	1192	153	32	96.858536	SPECIAL
5	1	17	1	2	2	741	1191	113	31	96.879715	EVENT
5	1	17	1	2	3	866	1188	148	33	96.569206	LICENSE
5	1	17	1	2	4	1025	1188	26	30	92.905594	IS
5	1	17	1	2	5	1061	1186	121	32	95.886879	STACKED
5	1	17	1	2	6	1242	1184	85	31	94.704666	WITH
5	1	17	1	2	7	1342	1182	92	31	93.305031	WINE
5	1	17	1	2	8	1495	1179	87	32	90.992012	/CRAFT
5	1	17	1	2	9	1592	1176	183	32	96.824921	DISTILLERY
5	1	17	1	2	10	1787	1173	155	33	96.567444	FESTIVAL
5	1	17	1	2	11	1954	1166	164	49	38.805077	LICENSE”
5	1	17	1	2	12	2454	1164	3	32	42.175056	|
2	1	18	0	0	0	242	1232	2128	175	-1	
3	1	18	1	0	0	242	1232	2128	175	-1	
4	1	18	1	1	0	242	1232	1957	71	-1	
5	1	18	1	1	1	242	1267	29	30	72.230362	6.
5	1	18	1	1	2	284	1266	100	31	96.477913	What
5	1	18	1	1	3	395	1267	81	36	96.878357	type
5	1	18	1	1	4	488	1265	37	31	96.958199	of
5	1	18	1	1	5	534	1263	137	37	58.617531	security
5	1	18	1	1	6	681	1262	71	31	96.905464	and
5	1	18	1	1	7	764	1260	125	31	96.430595	control
5	1	18	1	1	8	901	1265	168	25	96.245743	measures
5	1	18	1	1	9	1079	1257	53	30	96.848190	will
5	1	18	1	1	10	1143	1263	64	29	96.914795	you
5	1	18	1	1	11	1220	1255	78	29	95.480415	take
5	1	18	1	1	12	1309	1254	36	30	96.718910	to
5	1	18	1	1	13	1356	1252	137	37	96.718910	prevent
5	1	18	1	1	14	1503	1248	163	40	94.459526	violations
5	1	18	1	1	15	1678	1247	36	30	96.203140	of
5	1	18	1	1	16	1723	1246	98	36	96.449959	liquor
5	1	18	1	1	17	1831	1232	75	42	85.624199	laws
5	1	18	1	1	18	1916	1242	38	31	96.151573	at
5	1	18	1	1	19	1964	1240	57	32	92.900047	this
5	1	18	1	1	20	2032	1236	135	37	42.811600	event?
4	1	18	1	2	0	286	1281	2024	62	-1	
5	1	18	1	2	1	286	1310	58	33	92.525818	(Ust
5	1	18	1	2	2	353	1311	69	32	96.928642	type
5	1	18	1	2	3	432	1310	59	26	96.092628	and
5	1	18	1	2	4	502	1309	116	27	96.476364	number
5	1	18	1	2	5	627	1306	29	27	93.286079	of
5	1	18	1	2	6	664	1304	227	35	52.430439	police/security
5	1	18	1	2	7	900	1303	147	32	96.894577	personnel
5	1	18	1	2	8	1057	1301	58	26	96.528542	and
5	1	18	1	2	9	1124	1301	68	31	96.528542	type
5	1	18	1	2	10	1201	1299	29	26	96.969177	of
5	1	18	1	2	11	1237	1297	113	32	96.622353	fencing
5	1	18	1	2	12	1359	1303	30	19	95.094727	or
5	1	18	1	2	13	1397	1294	103	27	91.125137	control
5	1	18	1	2	14	1509	1293	119	28	34.299744	baners,
5	1	18	1	2	15	1637	1291	17	26	96.132233	if
5	1	18	1	2	16	1662	1287	183	35	94.847816	applicable.)
5	1	18	1	2	17	1912	1286	26	38	0.000000	_
5	1	18	1	2	18	2083	1281	2	2	0.000000	_
5	1	18	1	2	19	2254	1306	2	2	12.811499	_
4	1	18	1	3	0	589	1332	1781	75	-1	
5	1	18	1	3	1	589	1375	146	32	96.332939	Number
5	1	18	1	3	2	744	1373	35	31	96.610428	of
5	1	18	1	3	3	791	1372	106	31	96.610428	Police
5	1	18	1	3	4	1214	1365	144	31	96.691261	Number
5	1	18	1	3	5	1367	1362	36	32	96.952446	of
5	1	18	1	3	6	1412	1360	139	38	95.757042	Security
5	1	18	1	3	7	1561	1349	168	41	93.328423	Personnel
5	1	18	1	3	8	1855	1345	187	44	0.000000	M1rencing
5	1	18	1	3	9	2157	1348	2	2	30.648193	—
5	1	18	1	3	10	2168	1332	171	47	63.726391	[Barriers
5	1	18	1	3	11	2368	1347	2	2	1.182537	-
2	1	19	0	0	0	288	1397	2034	149	-1	
3	1	19	1	0	0	288	1387	2044	159	-1	
4	1	19	1	1	0	288	1397	2025	90	-1	
5	1	19	1	1	1	288	1449	218	38	86.031662	Explanation:
5	1	19	1	1	2	522	1431	71	32	66.517639	he
entire is fenced. Attendees will enter through the guest house, and then once outside,
premises
Although, all gates will be locked and access will be through
will be surrounded by block wall/gates.
———
guest house.
SECTION 11 Datels) and Hours of Event. May not exceed 10 consecutive days.
See A.RS. § 4-244(15) and (17) for legal hours of service.
Start — icenseend
Date se of Week Event Time AM/PM
Day Time AM/PM
=
12/31/2015 Thursday 4pm 44pm
DAY 3:
DAY 4
DAY 5:
DAYé:
DAYS:
_
DAY 9:
DAY 10:
8/13/2015

SECTION 12 License premises. diagram. The licensed premises for your special event is the in
fo sell, dispense or serve alcoholic beverages under the area which you are authorized
provisions of your license. The following space istobeusedio
Prepare a diagram of your special event licensed premises. Please show =
other control dimensions, serving areas, fencing, baricades, or
measures and security position. ee.
. .

SE S 1ON 13 To be compieled — <r
only by an Officer, Director or Chaiperson of the
organization narned in Section 1,
(Print Full Name) declare ihat | arn an OFFICER, DIRECTOR, or CHAIRPERSON
Liquor appointin Lic the a pel cam listed in Section 9, to apply on behalf of the
foregoing organization for a Special Event
ot
xX finn, Lia Da oD
{ Excactet Exzeahee Dinah Doub is
Signéyre) fo
=
The foregoing instrument was De
acknowledged before me this o
> BL
State 4 El 2ewWA County ee
of MA (Ce) > | Slap,
My Commission ue 5 Ap OTARY PUBLIC. -ARIZONA }
Expires on: OL f OS fA®L 9 :
Date el ed
SECTION 14 This section is to be Completed only by the applicant named in Section
9.
,, Jennifer Coller Brumbaugh
declare that | am the APPLICANT filing this application as
{Print Full Name)
listed in Section 9. | have. read the. application and the contents and all statements are tue, comect and
comple
x a” » Calle Lamba Crab Dre [5
‘allo
(Signature) Tile/ Position
The foregoing instrument was acknowledged before me this A Z
w AA
State Ariz (2. wst County of “VAC ODP A Eg
MICHAILBALAKIRSKIY
- by
My Commission Expires on:__ 9 2/8S/ do wee \NOTARY PUBLIC- ARIZONA
tt Vdricopa Count
ke Date narturs Vy/Commission Expires
| oo : : Februan
aio
Please contact the local goveming board for édditional application requirements and cubmision decdings ‘Additional
licensing fees may also be required before approval may be granted. For more information, contact your local
Please
jurisdiction: http://www.azliquor.gov/assets/d is/he
:
OF CONTROL
FOR DEPARTMENT LIQUOR LICENSES AND
CIAPPROVAL EJ DISAPPROVAL BY:
An gency sha | i
speciltically agency by. statute, rule or state tribal. gaming compact. Ageneral grant of authority in statute does not constitute a.
for 8 lee hg. requirement or condition unless ¢ iat en ‘aj grant of sey thal. 2
bo impesne
“8/13/2015