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DLLC USE ONLY Job #: SPECIAL EVENT LICENSE Date Accepted: APPLICATION FEE $25.00 PER DAY CSR: Arizona Department of Liquor Licenses and Control 800 W. Washington St. 5" Floor Phoenix, AZ 85007 (602) 542-5141 Application MUST be submitted to the Department of Liquor 10 days prior to the event. license #: SECTION 1 Applicant must be a member of a qualifying nonprofit organization, political parly, or Government entity and authorized by an Officer, Director, or Chairperson of the Organization. 1. Applicant: Achuff, Tila (Must be an Officer/Member of the N Middle City State Tp 3. Applicants home/cell — — Applicant's business phone: 4, Applicant's email addres: Stunner Night Runs 5. Special Event Name: 6. Name of Non-Profit Organization, Candidate or Political Party/Gov.: Transplant Community Alliance Inc. 86-0618929 21994 7. Non-Profit/IRS Tax Exempt Number: #,,02083585 If out of State please specify: 8. Arizona Corporation Commission File (Attach letter of good standing) 9. Event Location Name: Usery Mountain Regional Park 3939 N Usery Pass Rd. Mesa, Az. 85207 10, Event Address: Dates and Hours of Event - Days must be consecutive and may not exceed 10 consecutive days. **SEPARATE APPLICATION FOR EACH “NON-CONSECUTIVE” DAY** mye pals LEE: He REM ion ae DAY 1: July 12th 2025 Saturday 6am 11:59pm DAY 2: DAY 3: DAY 4: _RECEIV ED - . FEB 7 § 2025 DAY 7: seat Soe SURERS DAY 8: DAY 9: DAY10: 2/6/2023 Page 1 of 3 Individuals requiring ADA accommodations please call (602}542-2999 ADMEN DMENT #443 SECTION 2 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.) 1 Number of Security Personnel lZlFencing CoBarrers 0 Number of Police Must explain security measures: | post to connect scrim around 20x20 tent. Have 1 entrance/exit. We will have 1 employee that will check IDs and serve the alcohol. SECTION 3 What is the purpose of this event? [Z10n-site consumption (CO t-site (auction/wine/distilled spirits pull) Lboth How is this special event going to conduct all dispensing, serving, and selling of spirituous liquors? Check one of the following boxes. (R-19-318} A) [Z)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) CIWill this event be held on a currently 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 license Number Phone (Include Area Code) LoPlace license in non-use - Special Event Licensee selling all alcoho! without retailer involvement Must attach letter from the location suspending license for duration of special event Lbispense and serve alll spirituous liquors under retailer's license — Business operates normally, minimum of 25% of gross revenue from alcohol sales is donated to licensee Lidispense and serve alll spirituous liquors under special event - The special event licensee is in charge of selling alcohol that was purchased or donaied 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 Ospiit 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 it must be in a separate area than the alcohol that is dispensed by the licensed retailer.) Loft sale only - Wine/Distilled Spirits Pull, Live or Silent Auctions — Retailer wil 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? (1 Yes fZ] No If yes, attach letter of explanation. 2. How many special event days have been issued to this organization during the calendar year? 3 Is the 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. } fZ1 Yes LINo If yes, please provide the Name of the Special Event Contractor; Aravaipa Running LLC 4. ls 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) (Yes IZINo 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. Attach additional sheet if necessary. 2/6/2023 Page 2 of 3 Individuals requiring ADA accommodations please call (602)542-2999 SECTION 2 Whal type of security and control measures will you take fo prevent violations of liquor laws at this event? (Ust type and number of police/security personnel and type of fencing or control barriers, if applicable.) 0 Number of Police 1 Number of Security Personnel Fencing Carriers Must explain security measures: | Post to connect scrim around 20x20 tent. Have 1 entrance/exit. We will have 1 employee that will check IDs and serve the alcohol. SECTION 3 What is the purpose of this event? On-site consumption (Cloft-site (auction/wine/distilled spirits pull) Cboth How is this special event going to conduct all dispensing, serving, and selling of spirituous liquors? Check one of the following boxes. (R-19-318) A) &41 Special Event being held on an unllcensed 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 currently 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 license Number Phone (Include Area Code) ClPiace license in non-use - Special Event Licensee selling al! alcoho! without retailer involvement Must attach letter from the location suspending Ilcense for duration of special event [dispense and serve all spirituous liquors under retailer's license — Business operates normally, minimum of 25% of gross revenue from alcohol sales is donated fo licensee Cdispense 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 spectal event Csplit 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 alcoho! is donated or purchased by the special event licensee it must be in a separate area than the alcoho! that is dispensed by the licensed refaller.) Clof# sate only - Wine /Distilled Spirits Pull, Live or Silent Auctions — Retailer will stil! be permitted fo conduct all normal sale and service of alcohol. SECTION 4 1. Has the applicant been convicted of a felony, or had a liquor ticense revoked within the last five (5) years? (2 Yes IZINo If yes, attach letter of explanation. 3 2. How many special event days have been issued fo this organization during the calendar year? 3. 1s the Organization using the services of a Special Event Contractor? (A licensee can ulilize 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. } WZ] Yes CINo If yes, please provide the Name of the Special Event Contractor: Jon Bullock 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 §Z] 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. Attach additional sheet if necessary. 2/6/2023 Page 2 of 3 Individuals requiring ADA accommodations please cal! (602)542-2999 Name: Eransplant Community Alliance Percentage: 85 re Stree? Clty State Up Name: Aravaipa Running Percentage: 35 cress Street Clty State Zp 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 5 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. Hf 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, thls application must be approved by the local governing body before submitting to the Department of Liquor Licenses and Control. Please confact the local governing board for additional information. APPLICANT SIGNATURE Declaration: L (Print Name) Tila Achuff declare under penally of perjury that | am authorized to submit this application. | have read the contents of this application, and to + of my knowledge believe all statements made on this application to be true, — (Cea Signatike) e LOCAL GOVERNING BODY Date Received; iF recommend [CIJAPPROVAL [1 DISAPPROVAL (Govemment Official) On behalf of (City, Town, County) The local governing body (city, fown or municipality where the fair/festival will take place) may require additional applications to be completed and submitted. Please check with local government as fo 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 DIAPPROVAL CJ DISAPPROVAL BY: 2/6/2023 Page 3 of 3 Individuals reauiring ADA accommodations please call (6021542-2999 SHUTTLE @ Pickup Soak Station GENERATOR GENERATOR