ST. KATHERINE PARISH GALA_REDACTED.PDF

CSR:

Amount:
DLLC USE ONLY
Job #:
SPECIAL EVENT LICENSE
Date Accepted:
APPLICATION FEE $25.00 PER DAY
: a aw CSR:
Arizona Department of Liquor Licenses and Control ;
800 W. Washington St. 5" Floor Phoenix, AZ 85007 license #:

P , (602) 542-5141
Application MUST be submitted to the Department of Liquor 10 days prior to the event.

SECTION 1 Appitcant 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. Appiicant; Archuleta, Evangelia
{Must be an Gfficer/Member of the Non Profit “Ns tost Fist Middie
2. Applicant's mailing address:
Clty State Bp
3. Applicants home/cel! phone: |. Ee Applicant's business —— i —
4. Applicants emai cccres iin

St. Katherine Parish Gala

5. Special Event Name:

St KatherineGreekOrthodoxChurch

6. Name of Non-Profit Organization, Candidate or Political Party/Gov.:

94-2876533

7, Non-Profit/IRS Tax Exempt Number:

8. Arizona Corporation Commission File #: 01524110 If out of State please specify.
(Attach letter of good standing)

9, Event Location Name: St Katherine Greek Orthodox Church
10. Event Address: 2716 N Dobson Rd Chandler AZ 85224

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

**SEPARATE APPLICATION FOR EACH “NON-CONSEGUTIVE” DAY**

2 Event Start. Ucense End
Pays Dale Day of Week Time AM/PM Time AM/PM

DAY 1: May 3, 2025 Saturday 4:00pm 11:59pm

DAY 2:

DAY 3:

DAY 4:

DAY 5:

DAY 6:

DAY: man eae
DAY 8: PECEIVED

DAY 9:
MAR 1 2 2025

DAY 10:

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SECTION 2 What type of security and contro! 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 contro! banlers, If applicable.)

2

Number of Police Number of Security Personnel [Fencing (lariers

Self police by parish members; 2 security guards to police inside and outside

Must explain security measures:
and check ID's prior to dispensing liquor by certified and experienced bartenders.

SECTION 3 What is ihe purpose of this event?

(on-site consumption Clot-site (auction/wine/distilled spirits pull) Dboth

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

A) 2) Special Event being held on an unlicensed premises will require approval and signature by the Local Governing
Body on page 3. (If checked move to section 4)

B) [[) Will this event be held on a curently licensed premises and within the already approved and licensed area?
(Must attach a letter from the licensed premises with an explanation of the option checked below)

Name of Business Ucense Number Phone (include Area Code)

ClPiace license in non-use - Special Event Licensee seliing all alcohol without retailer involvement
Must attach letter from the location suspending license for duration of special event

[dispense and serve alll spirituous liquors under retaller's license ~ Business operates normally, minimum of 25% of gross
revenue from alcohol sales is donated to licensee

Livispense 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 separated from any alcohol
used during the special event, Must attach letter from the location suspending license for duration of special event

Cispiit premise between special event and retail location - Both the special event licensee and the retailer will conduct
sales of alcohol, (These sales will be done in separate areas. If alcohol is donated or purchased by the special event licensee
if must be in a separate area than the alcohol that is dispensed by the licensed retaller.)

Clott Sate only - Wine/Distiiled Spirits Pull, Live or Silent Auctions — Retailer will still be permitted to conduct all normal sale and
service of alcohol.

SECTION 4

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

(Yes [¢] No If yes, attach letter of explanation.

2. How many special event days have been issued to this organization during the calendar year? 3

3, Is ihe Organization using the services of a Special Event Contractor? {A licensee can utilize the services of a special event
contractor who may purchase and sell alcohol on behalf of the licensee. If no special event contractor is listed, the licensee Is
responsible for the sales and service of alcohol. }

C1 Yes [7] No if yes, please provide the Name of the Special Event Contractor:

4, Is 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 the special event contractor}

(1 Yes [71 No if yes, please provide the Name of Licensee: license #:

5. List the name of the Individual or Organization that will receive revenues, MUST EQUAL 100 PERCENT.
Altach additional sheet if necessary.

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St Katherine Greek Orthodox Church Percentage: 100%

Name:
Address: 2716 N Dobson Rd Chandler AZ 85224
Street City State tip
Name; Percentage:
Address:
Street City State Tip

Please read A.R.S. § 4-203.02 Special event license: rules and R19-1-205 Requirements for a Special Event License.
ALL ALCOHOLIC BEVERAGE SALES MUST BE FOR CONSUMPTION AT THE EVENT SITE ONLY.

SECTION. § 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. Please attach a diagram
of your special event licensed premises. Please show dimensions, serving areas, fencing, barricades, or other control
measures and security position.

If the special event will be held at a location without @ permanent liquor license or if the event wil be on any portion of a location
that is not covered by the existing Iiquor license, thls application must be approved by the local governing body before submitting
to the Department of Liquor Licenses and Control. Please contact the local governing board for additional information.

APPLICANT SIGNATURE

Declaration:
1, (Print Name) Evangelia Archuleta . declore under penalty of perjury that | am
authorized to submit this application. | have read the contents of this application, and to the best of my knowledge
believe all statements made on this application fo be true, ey complete,

Za y]

L

{
. Vi ” ~~ Signature

LOCAL GOVERNING BODY

Date Received:

(Government Officlal) (tie)
On behalf of

(City, Town, County) ° Signature

The focal governing body (city, town or municipality where the falr/festival will take place) may require additional
applications fo be completed and submitted, Please check with local government as to how far in advance they require
these applications to be submitted. Additional licensing fees may also be required before approval may be granted.

AZDLLC USE ONLY

CIAPPROVAL CJ DISAPPROVAL BY:

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SECTION 12 License premises diagran), ihe licensed premisas for your special event is the area in which you ard aulhorized
to sell, dispense or serve alcoholic beverages under the provisions of your license. the following space is to be used to
prepare a diagrara of your special event licensed premises, Please show dimensions, serving areas, fencing, banicades, or
other control measures and security position.

W Comstock Dr