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SECTION 10 1. Has the applicant been convicted of a felony, or had a liquor license revoked within the last five (5) years? EYes El No (If yes, attach explanation.) 2. How many special event licenses have been issued to this location this year? 1 (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? riYes MI 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 SCW Boomers Club Percentage: I ()(1) Address Sun City West, AZ 85376 Sheet City State Zip Name Percentage: Address Street City State Zip 5. 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 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 barriers, if applicable.) Number of Police 3 Number of Security Personnel EFencing NBarriers Explanation: Club members will act as security personel SECTION 11 Date(s) and Hours of Event. May not exceed 10 consecutive days. See A.R.S. § 4-244(15) and (17) for legal hours of service. Date Day of Week Event Start License End Time AM/PM Time AM/PM DAY 1: Dec. 31, 2015 Thursday 8:30PM 12:30AM DAY 2: DAY 3: DAY 4: DAY 5: DAY 6: DAY 7: DAY 8: DAY 9: DAY 10: 8/13/2015 Page 2 of 4 Individuals requiring ADA accommodations call (602)542-9027.