JANGOVER NIGHT RUNS_REDACTED.PDF

CSR:

Amount:
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 Ucense #:

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

SECTION 1 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: Achuff, Tila
(Must be an Officer/Member of the N Middle
2. Applicant's mailing —€ #£#&#8#&#8#8=|——.lUd
City State Zip
3. Applicants home/cell — Applicant's business phone:

4. Applicant's email addre

5. Special Event Name: Jangover Night Runs

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

8. Arizona Corporation Commission File If out of State please specify:

(Attach letter of good standing)
9. Event Location Name: McDowell Mountain Regional Park

16300 McDowell Mountain Park Dr. Fort Mc Dowell, Az. 85264

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**

Days Date Day of Week ig aon rig 2
DAY 1: Sept. 20th anes Saturday 6am 41:59pm
DAY 2:
ons RECEIVED
DAY 4:
DAY 5: __ FEB? 520%
DAY 6: MARICOPA COUNTY
CLERK BOARD OF SUPERVISORS
DAY 7:
DAY 8:
DAY 9:
DAY10:
2/6/2023 Page 1 of 3

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

fain
lla N\¢ : 7
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.)

0 Number of Police 1 Number of Security Personnel Fencing LBarriers

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?

[Zlon-site consumption Cott-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) CWill 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)

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

LDispense 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

L1bispense and serve alll 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

Lsplit 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?
(Yes ZI No If yes, attach letter of explanation.

2. How many special event days have been issued to this organization during the calendar year? 5
(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. }

fZ Yes CINo If yes, please provide the Name of the Special Event Contractor: Aravaipa Running LLC

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 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 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/secuiity personnel and type of fencing or control baniers, if applicable.)

0 Number of Police 4 Number of Security Personnel VWiFencing Clearrers

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 (Cot-site (auction/wine/distilled spirits pull) Copoth

How is this special event going to conduct alt dispensing, serving, and selling of spirituous liquors?
Check one of the fallowing boxes. (R-19-318}

A) 2] Special Event being held on an unlicensed premises will require approval and signature by the Local Governing
Bady 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 Ucense Number Phone (Include Area Code)

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

Libispense 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

Lobispense and serve alll spirituous liquors under special event - The special eveni 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 locatlon 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
it must be in a separate area than the alcoho! that is dispensed by the licensed retailer.}

(of sale only - Wine /Distilled 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?

(2 Yes (71 No if yes, attach letter of explanation.

2. How many special event days have been issued fo this organization during the calendar year? 5

3. 1s 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. }

M1 Yes CINo If yes, please provide the Name of the Special Event Contractor: Jon Bullock

4. |s ihe organization using the services of a series 4, 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 WI 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 call (602}542-2999

Name: Hransplant Community Alliance Percentage: 85

ro

Street City State Ip
Name: Aravaipa Running Percentage: 35
cress

Stree! City State Zip

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, baricades, or other control
measures and security position.

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 governing body before submitting
to the Department of Liquor Licenses and Control. Please contact the local governing board for additional information.

APPLICANT SIGNATURE

Declaration:

|, (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 ft of my knowledge

believe all statements made on this Gpplication to be true, (— SO Bake

Signatixe) e

LOCAL GOVERNING BODY

Date Received:

L recommend CIAPPROVAL [1] DISAPPROVAL
(Govemment Official) {Title)

On behalf of

(Clty, Town, County) ‘ Signature

The local governing body (city, town or municipality where the falr/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 fo be submitted. Additional licensing fees may also be required before approval may be granted.

AZDLLC USE ONLY

CIAPPROVAL [1 DISAPPROVAL BY:

2/6/2023 Page 3 of 3
Individuals requiring ADA accommodations please call (602]542-2999