DAISY MOUNTAIN FIRE FIGHTERS CHARITIES ASSOCIATION REDACTED.PDF

FOR DLLC USE ONLY
Arizona Department of Liquor Licenses and Control Event Date(s):
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)
A service fee of $25.00 will be charged for all dishonored checks (A.R.S. § 44-6852)
IMPORTANT INFORMATION: This document must be bitty 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 I Name of Organization: 00,...1 M c V:i?)\--rlreTS C hp.r.1 ti e..s A 550-bc-,r)
SECTION 2 Non-Profit/IRS Tax Exempt Number: 3e.-,5 sto
SECTION 3 The organization is a: (check one box only)
jgCharitablel 'Fraternal (must have regular membership and have been in existence for over five (5) years)
Religious 1 (Civic (Rotary, College Scholarship) 1 'Political Party, Ballot Measure or Campaign Committee
SECTION 4 Will this event be held on a currently licensed premise and within the already approved premises?) (Yes 541\lo
Name of Business Ucense 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 plannin g guide) and check one of the followin g boxes.
I I Place license in non-use
I I Dispense and serve all spirituous liquors under retailer's license
14Dispense and serve all spirituous liquors under special event
I I Split 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? cgOn-site consumption 1 lOff-site (auction) I -180th
SECTION 7 Location of the Event: A rtii-lern CiViQ,'..-61.x1' IcA:I (-I
Address of Location: 310i v.i . A n Thefil Wax,' Atrihun Ma_2 r 'ic. ,400_ AZ. 800
Street f Ctty COUNTY State Bp
SECTION 8 Will this be stacked with a wine festival/craft distiller festival? nYes Sio
SECTION 9 Applicant must be a member of the qualifying organization and authorized by an Officer, Director or Chairperson
of-the Or named in Section 1. (Authorizing signature is required in Section 13.)
1. Applicant: er 17.->r) 72)(x\licA
Last First Middle Date of Birth
2. Applicant's mailing address: .1...;•14 E Ave_ —Phcf A7.
Street City State Zip
3. Applicant's home/cell phone: Applicant's business phone: (6-A3 '4105
4. Applicant's email address: cl frl-C-Ce,be cync l ezm
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Individuals requiring ADA accommodations call (602)542-9027.

SECTION 10
1. Has the applicrut been convicted of a felony, or had a liquor license revoked within the last five (5) years?
EIYes104 No (If yes, attach explanation.)
2. How many special event licenses have been issued to this location this year? 0
(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?0Yes No
(If (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 ercentage: Cipcjo
Address A —z_ REQE,a_as3
Street City State Zip
Name N 1 4 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 applicablej
Number of Police Number of Security Personnel OFencing 'Barriers
Explanation: "rhe. i-1/2-1 kx5til `noe. Ct2Tv-in)t cl(4-3rs L6), csn 5 cu-id ckr, tic
. Icx, 0.06 por\-ic--)
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 'EtietitStatt License End
Time AM/PM Time AM/PM
DAY 1: to) 62 -ols e_Yr-Nr1,1a-
DAY 2:
DAY 3:
DAY 4:
DAY 5:
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.
Ni
r s
4e
(
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Individuals requiring ADA accommodations call (602)542-9027.

SECT ON 13 To be completed only by an Officer, Director or Chairperson of the organization named in Section 1.
1/ /2041-'•4 declare that I am an OFFICER, DIRECTOR, or CHAIRPERSON
(Print Full Name)
appointing the applicant listed in Section 9, to apply on behalf of the foregoing organization for a Special Event
Liquor„;cense.
X • Or' Pfc'st-ely•i/ 4 7/cg/ (...c 69 2 1FC —20
nature) Me/ Position 1..)a_e t Phone #
The foregoing instrument was acknowledged before me this j -.2-();
State PO- i C,Qunty of CA V) Day Month Year
JUAIsArrA-6-1- ARZA
My Commission Ex 1At Notary Public - Stated MD=
7.1. TY
144/11ninke8ben Expires Signature of Notary Pubic
SECTION 14 This section is to be completed only by the applicant named in Section 9.
I, L2k (20)el+ declare that I am the APPLICANT filing this application as
(Print Full Name)
listed in Section 9. I have read the application and the contents and all statements are true, correct and
622---?(2141
fe5 -td-e4 7 3a /5
'II iovirrirt Date Phone #
The foregoing instrument was acknow edged before me this 3 ZO)5
State AVCTOvt. ei County of 0 1 Cerc-, Day Mortth Year
BEN 8E AL
Notary Public- SlatelotArizona
My Commission Expires on: (DirglIV NIARICOPA C NTY
Date Signature of Notary Pu 191TCDT-M rirn ssion Expires
June 24, 2018
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: http://www.azliauor.gov/assets/documents/homepage docs/spec event links.pdf.
SECTION 15 Local Governing Body Approval Section
recommend 0APPROVAL 0 DISAPPROVAL
(Government Official) (Title)
on behalf of
(City, Town, County) Signature Date Phone
FOR DEPARTMENT OF LIQUOR LICENSES AND CONTROL USE ONLY
0APPROVAL 0 DISAPPROVAL 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.
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Individuals requiring ADA accommodations call (602)542-9027.