ANTHEM ROTARY 3RD OF JULY SPECIAL EVENT_REDACTED.PDF

CSR:

Amount:
DLLC USE ONLY
Job #:
SPECIAL EVENT LICENSE nn
APPLICATION FEE $25.00 PER DAY ,
——_ — Csr:
Arizona Department of Liquor Licenses and Control
800 W. Washington St. 5" Floor Phoenix, AZ 85007 license #:

(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; Salem Edward John, Jr.
(Must be an Officer/Member of the Non Profit Entity) Last First Middle
2. Applicant's mailing address

ir ~ ‘
3. Applicants home/cell — Ul Oe Applicant's business —_— Ul

4. Applicant's email address

Anthem Rotary 3rd of July Special Event

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

47-0930766 / 26-00640058

5. Special Event Name:

7. Non-Profit/IRS Tax Exempt Number:

8. Arizona Corporation Commission File #: 109477921 If out of State please specify:
(Attach letter of good standing)

9. Event Location Name: 41703 N Gavilan Peak Pkwy, Phoenix, AZ 85086

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 eluaes agp pepe
DAY 1: 07/03/2025 Thursday 12:00 pm 11:00 pm
DAY 2:
DAY 3:
DAY 4: REECE
DAY 5: VED
DAY 6: FEB p 3 2005
DAY 7: M,
DAY 8: CARD Of SCUNTY
DAY 9: “Sor,
DAY10:
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Indiviaiiinte racuiiring ADA accammnamtions nlanca call (ANNKA9.2009

a a ag a a Ai a ge a mm SR mA la ee ae

Name: Anthem Rotary Foundation Percentage: 100% |
Address: |
Street City State Zip
Name: Percentage: |
Address:
Street Clty Stote 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 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.

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 goveming 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) Edward John Salem Jr , declare under penalty of perjury that | am

authorized to submit this application. | have read the contents of this gpplication, and to the best of my knowledge
believe all statements made on this application to be true, correct. t

Signature

LOCAL GOVERNING BODY

Date Received:

(Government 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 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 CI DISAPPROVAL BY:

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Indlivini inde race iiring ANA Arcammnadatiane nianca ccd) 1ANN6GAI.9000

SECTION 2 What type of security and control measures will you take fo 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.)

Number of Police 19 Number of Security Personnel [4lFencing Cleaners

Must explain security measures; There is a fence around the serving and seating area that is patrolled by

Maricopa County Sheriffs Deputies.

SECTION 3 What is the purpose of this event?

[ZlOn-site consumption (Lloff-site (auction/wine/distilled spirits pull) Cloth

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

A) [21 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)

ClPlace 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

Cbispense and serve alll spirituous liquors under retailer's license — Business operates normally, minimum of 25% of gross
revenue from alcohol sales is donated fo licensee

[dispense 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

Cspiit 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.)

[loft sate 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?

ves 2] 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. ls 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. }

(ves INo If yes, please provide the Name of the Special Event Contractor:

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 the special event contractor)

OyYes YI 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.

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Indiviaiinde raniirinn ANA AecAMMacintanc nlanca call [ANNVEAI-2009

FeOTIAM 4 q is i thorize
SECTION 42 License premises diagram. The licensed premises for your special event is the area in which you are au
to sell, dispense or serve alcoholic beverages under the provisions of your license. The following space is to be used ¢
prepare a diagram of your special event licensed premises. Please show dimensions, serving areas, fencing, barricades, «

other control measures and security position.

Location: Park Stadium Softball Field. N T
Red line depicts perimeter fencing 6’ high (standard softball field).

: Blue area depicts entry/exit points ~ to be guarded by Maricopa County Sheriff's
Office deputies and private security guards,
Star represents serving locations.

1

3/1/2016 Page 3 of 4
Individuals requiring ADA aécommodations call (602)542-9027.

fe

Edward John Salem Jr (y h Fwd (( af ; "VA
RECEIVED

FEB 0 3 2025

Anthem Rotary Foundation

MARICOPA COUNTY
CLERK BOARD OF SUPERVISORS

January 28,2025

Arizona Department of Liquor Licenses and Control
800 W Washington St, 5" Floor

Phoenix, AZ 85007

To whom it may concern,

With regard to section 3 of the Special Event License Application, | am including the following
information:

For our upcoming “Anthem Days in Anthem special event, the Anthem Rotary Golf Tournament special
event and the Anthem Rotary July 3” special event, all spirits and beverages are supplied to the Anthem
Rotary Foundation by a wholesale distributor, The company is Crescent Crown Distributing, 1640 W
Broadway Rd, Mesa, AZ 85202

Please contact me ii i _ you have any questions.

a k you. meet

Gee - n oe Jr.