RISEN SAVIOR LUTHERAN CHURCH_REDACTED.PDF

Arizona Department of Liquor Licenses and Control DLLC USE ONLY

https://www.azliquor.gov Job tt:
(602) 542-5141 Date Accepted:
Lc:
SPECIAL EVENT LICENSE
APPLICATION FEE $25.00 PER DAY Heense#s

MUST be submitted to the Department of Liquor 10 days prior to the event.

SECTION 1

Name of Non-Profit Organization, Candidate or Political Party: Risen Savior Lutheran Church

If the event will be held on anunlicensed premises, it |VIUST be approved and signed by the Local Governing
Body Before submitting to the Arizona Department of Liquor.

LOCAL GOVERNING BODY

Date Received:

C1 approval CI pisapPROVAL

Government Official Title

On behalf of

City, Town, County Signature

SECTION 2
Will the event be at a location with a current liquor license and within the approved and licensed area?
Llves No
If yes, MUST attach a letter of explanation/permission from the licensed location and choose ONE option below.

Name of Licensed Location Risen Savior Lutheran Church Liquor License Number

| Suspend license for the duration of the Special Event; Licensee selling all alcohol without retailer involvement.

[_] _ Dispense and serve all spirituous liquors under retailer’s license — Business operates normally, minimum of 25% of
gross revenue from alcohol sales will be donated to licensee.

O Dispense and serve all spirituous liquors under special event - The special event licensee is in charge of selling alcohol
that was purchased or donated by the special event licensee. The retailers existing alcohol inventory must be kept
separate from any alcohol used during the special event.

oO Split premises between special event and licensed location - Both the special event licensee and the licensed
location will conduct sales of alcohol. (These sales must be done in separate areas. If alcohol is donated or purchased
by the special event licensee, it must be in a separate area from the alcohol that is dispensed by the licensed

location.)

Ol Off Sale only - Wine/Distilled Spirits Pull, Live or Silent Auctions — Retailer will be permitted to conduct all normal
sales and service of alcohol,

5/5/2025 Page 1 of 3
Individuals requiring ADA accommodations please call (602)542-2999

SECTION 3

Applicant MUST be a member of a qualifying nonprofit organization, political party, or Government entity and
authorized by an Officer, Director, or Chairperson of the Organization.

1. Applicant; Lopez, vill Marie

Last

First Middle

23620 S. Alma School Rd Sun Lakes, AZ 85248

2. Applicant’s mailing address:
City State Zip

3. Applicants home/cell — ll Non-profit organization phone; 480-895-6782

5, Has the applicant been convicted of a felony, or had a liquor license revoked within the last five (5) years?

[_]ves (if yes, attach letter of explanation) “| No
Risen Savior Lutheran Church

6, Name of non-profit organization:

Arizona Corporation Commission File #: 07582946

7. Non-Profit/IRS Tax Exempt Number: 86-0724498
Required

Required
8. If Out Of State, specify State (Attach letter of good standing):

9, Special Event Name: Pasta, Praise, & Purpose

10. Event Location Name: Risen Savior Lutheran Church
11. Event Address; 23620 S.Alma School Rd Sun Lakes, AZ 83248
SECTION 4

Must list type of security and control measures will you take to prevent violations of liquor laws at this event.

0 Number of Police 4 Number of Security Personnel LIrencing Larriers

Must explain security measures: 4 adults will ensure age of persons consuming alcohol & monitor

premises to ensure alcohol stays on-site

1. Howis this special event going to conduct all dispensing, serving, and selling of spirituous liquors?
Check one of the following boxes. (R-19-318)

On-site consumption (_loft-site (auction/wine/distilled spirits pull) Lpoth

2. How many special event days have already been issued to this organization during the current year?

Licensed location 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.

Must attach a diagram of your special event showing the area where alcohol will be sold,
served, and consumed. Must include dimensions of event area, fencing, barricades,

or other contro! measures, and positions of security personnel.

ATTACH DIAGRAM

NO ALCOHOLIC BEVERAGES SHALL LEAVE A SPECIAL EVENT UNLESS THEY ARE IN SEALED CONTAINERS FOR AN AUCTION OR
INE/DISTILLED SPIRITS PULL, OR THE SPECIAL EVENT LICENSE IS STACKED WITH A WINE /CRAFT DISTILLERY FESTIVAL LICENS

E.

Ww

Page 2 of 3

5/5/2025
Individuals requiring ADA accommodations please call (602)542-2999

SECTION 5

Dates and Hours of Event - Days must be consecutive and may not exceed 10 days per year.

DAY 1 02/28/2026 Saturday 5:00 pm 8:00 pm

DAY 2

DAY3

DAY 4

DAY5

DAY 6 JAN 2 72026

BAY? MARICOPA COUNTY
CLERK BOARD OF SUPERVISORS

DAY 8

DAY9

DAY 10

SECTION 6

3. Is the Organization using the services of a DLLC approved Special Event Contractor from the list on our website?

[_Wes [Ino if yes, please provide the Name of the Special Event Contractor:

Special Event Contractor Signature:

4. |s the organization using the services of a series 6, 7, 11, or 12 licensee to manage the sale or service of alcohol?
(Licensees who hold a series 6, 7, 11, or 12 license are automatically qualified to be a special event contractor)

[Wes [Z]No if yes, Name of Licensee: Liquor License #:

1, List the name of the Organization/individual that will receive revenues:
MUST EQUAL 100 PERCENT, APPLYING NON-PROFIT MUST RECEIVE A MINIMUM OF 25% OF THE PROCEEDS.

2. Natne: Risen Savior Lutheran Church Percentage: 100%
Address; 23620 S. Alma School Rd. Sun Lakes, AZ 85248
Street City State Zip
Name: Percentage:
Address:
Street city State Zip

Please read A.R.S. § 4-203.02 and R19-1-205 Special event license rules and Requirements.

Declaration: .
|, (Print Name) Jill Lopez , declare under penalty of perjury that | am

authorized to submit this application. | have read the contents and to the best of my knowledge believe all statements

made on this application to be true, correct, and complete.

Signature: CULL, Jojowe,
p U/ Wt UO

5/5/2025 Page 3 of 3
Individuals requiring ADA accommodations please call (602)542-2999

OMCHIS
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total seating
onailab te ~ 202

@) location of securtty
personnel

Approximately 22,441 sq. feet