FRANCISCAN RENEWAL CENTER - REDACTED(2).PDF

ARIZONA DEPARTMENT OF LIQUOR LICENSES & CONTROL
sooMok Floor
Ph001,1!4:::- ,07-2934
Fee = .gnts only
A service fee of $25.00 will be checks (A.R.S.§ 44-6852)
NOTE: THIS DOCUMENT m BE pi,: R IT WILL BE RETURNED.
PLEASE ALLOWOlen OCESSING.
**Application must be approved by local government befaN s(ii5m . .
Department of Liquor Licenses and control. (Section #20) ." F -
1. Name of Organization: neo,t(
2. Non-Profit/I.R.S. Tax Exempt Number.
3. The organization is a: (check one box only)
0 Charitable IDFraternal (must have regular membership and in existence for over 5 years)
0 civic Religious Political Party, Ballot Measure, or Campaign Committee
4. What is the purpose bf this event? n-site consumption E off-site consumption (auction) 0 both
5. Location of the event: 2492—T77i— 7)747-;-/t/
Address of physical location (Not P.O. Box) City County Zip
A !cant must be a member of the quali fying in or anlzation and authorized b an Officer. Director or Chair e in of
the ontanization named In Question #1, (Sit:mature required in section #18)
6. Applicant: °13-re ) k)f..)
Last Firstci Middle
7. Applicant's Mailing Address: 5V2- C. ZIA/Cde.4.7 p/L. 87575—
Shea City State 7i
8. Phone Numbers: 00 0?)9.690 (40 )9a 24/4D
he Owner* Applicant's Business*
9. Date(s) & Hours Of Event: (see ATCS. 4-244(15) and (17) for legal hours of service)
Day of Week Hours from A.M./P.M. To A.M./P.M.
Day 1: /172- .40
Day 2: /0/1,2122__
Day 3:
Day 4:
Day 5:
Day 6:
Day 7:
Day 8:
Day 9:
Day 10:
September 201'1 *Disabled individuals requiring special accommodations, please call (602) 542-9027

10. Has the applicant been convicted of a felony in the past five yearsr h3 liquor license revoked?
El YES 0ttach (aAanaterayss) o
11. This organization has been issued a special event license for 0 this year, including this event
(not to exceed 10 days per virtar).
12, Is the organization using the services of a promoter or other person to manage the event?t: 'ES NO
If yes, attach a copy of the agreement. 4.
13, 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,
Name t lkVa 1k7 .1L /a.)7cc
Address ,Ft)f\—L_
Name
Percentage
Addre
(Attach additional sheet if necessary)
14. Knowledge of Arizona State Liquor Laws Title 4 is important to prevent liquor law violations. If you have
any questions regarding the law or this application, please contact the Arizona State Department of Liquor
Licenses and Control for assistance.
NOTE: ALL ALCOHOLIC BEVERAGE SALES MUST BE FOR CONSUMPTION AT THE EVENT SITE ONLY.
"NO ALCOHOLIC BEVERAGES SHALL LEAVE, SPECIAL EVENT PREMISES."
15. What security and control measures will you take to prevent violations of state liquor laws at this event?
(List type and number of security/police personnel and type of fencing or control barriers if applicable)
1;2,— # Police Etfencing
Security personnel GErarriers
16. Is there an existing liquor license at the location where the special event is being held? 1=1 YEsti:14(15''-
If yes, does the existing business agree to suspend their liquor license during the time
period, and in the area in which the special event license will be in use? yEs NO
(ATTACH COPY OF AGREEMENT)
i1-1131 an —ffiTar-- iess ( Phone Number
17 Your licensed premises is that area in which you are authorized to sell, dispense, or serve spirituous liquors
under the provisions of your license. The following page 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 positions.

SPECIAL EVENT LICENSED PREMISES DIAGRAM
(This diagram must be completed with this application)
Special Event Diagram: (Show dimensions, serving areas, and label type of enclosure and security positions)
NOTE: Show nearest cross streets, highway, or road if location doesn't have an address.
_PLR,

THIS sEc jacigimTED ONLY BY AN cEnoqL DI RECTOR.OR CHAIRPERSON OF THE
ORGANIZATION NAMED IN QUESTION
18. declare that I an an Officer/Director/Chairperson appointing the
(Print full name)
applicant listed in Question 5, to apply on behalf of the foregoing organization for a Special Event Liquor License,
f.7441Zgt7;:c 64A. 13ZOf.3 ( q50 )(feig. 7460
(Signature (Title/Position) 0 (Date) (Phone It)
State of County of se2,2tWee,„—:—.
1-+ i ng instrument was acknowledged before me this
SUSAN M. FORCE
Notary PLOW!, alga of Arlo
MitioOpa COunty Day Month Year
My Commission expires on: My Cornmission - Explrae
14—
(Sdnature of NOTARY p
THIS SECTION TO BE COMPLETED °NIA BY THE APPLICANT NAMED IN QUESTION #6
19 declare that I am the APPLICANT sling this application as
(Print full name)
st•8. I read the ppfication and the contents and all statements are true, correct and complete.
it 4,45,
_ State of 4-7.1Z.er,,t-44._ County of,
" fling instrument was acknowledged before me this
(Signature) SUSAN M. FORCE
Notary Publiu,etsto of ArIxo
7 My DeMmiaelon Merfoope County Expires Day Year
My commission expires e- _L
(Date) C.-----1,6111ature of NOTARY R2 LIC
You must obtain local oovernment approval. City or County MUST recommend event a_nd complete Item #20.
The local govemino body may require additional applications to be completed and submitted 60 days
in advance of the event. Additional licensing fees may also be required before approval may be granted.
LOCAL GOVERNING BODY APPROVAL SECTION
20, hereby recommend this special event application
(Government Official) (Title)
on behalf of
(Crty, Town or County) (Signature of OFFICIAL) (Date)
11I4.
FOR DLLC DEPARTMENT USE ONLY
Department Comment Section:
(Employee) (Date)