Extracted text (via ocr_local)
8251 characters
Amount:
DLLC USE ONLY
Job #:
SPECIAL EVENT LICENSE a
APPLICATION FEE $25.00 PER DAY cal
= . CSR:
Arizona Department of Liquor Licenses and Control
800 W. Washington St, 5" Floor Phoenix, AZ 85007 Uceme #:
P (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 enlity and
authorized by an Officer, Director, or Chairperson of the Organization.
1. Applicant; Salem Edward John, Jr.
(Must be an Officer/Member of the Ni Middle
n city
3. Applicants home/cell — ia Applicant's business ann.
Anthem Days
5. Special Event Name:
6, Name of Non-Profit Organization, Candidate or Political Party/Gov.: Anthem Rotary Foundation
47-0930766 / 26-00640058
7. Non-Profit/IRS Tax Exempt Number:
8, Arizona Corporation Commission File #: 109477921 If out of State please specify:
(Altach 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 nie ne A
DAY 1: 03/22/2025 Saturday 9:00 am 9:00 pm
DAY 2: 03/23/2025 Sunday 9:00 am 9:00 pm
DAY 3:
ony RECEIVED
DAY 5:
eure FEB 0 3 2025
DAY 7: MARICO Ty
ee CLERK BOARD a SUPERVISORS
DAY 9:
DAY10:
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Inaivich ede racuiiringa ANA Ancarmmnadatians nance call [A(YI15A9.2000
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 personne! and type of fencing or control baniers, if applicable.)
Number of Police 10 Number of Security Personnel [Fencing Cobaniers
Must explain security measures: There is a fence around the serving and seating area that is patrolled by
Maricopa County Sheriff's Deputies.
SECTION 3 What is the purpose of this event?
(vJOn-site consumption [off-site (auction/wine/distilled spirits pull) Ceoth
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) [v] 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 currenily 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)
ClPlace 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
Dispense and serve all spirituous liquors under retailer's license — Business operates normally, minimum of 25% of gross
revenue from alcohol sales is donated to licensee
Cobispense 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
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 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?
Dyes 1 No if yes, attach letter of explanation.
2. How many special event days have been issued to this organization during the calendar year? 0
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 alcoho! on behalf of the licensee. If no special event contractor is listed, the licensee is
responsible for the sales and service of alcohol. }
(1 Yes [4] 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)
Dyes [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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Indivichinle ranitiringa ADA ancammaniatinne Manca coll [ANI16A9-2000
Name: Anthem Rotary Foundation Percentage: 100%
Street Clty State lp
Name: Percentage:
Address:
Street City State Tip
Please read A.R.S. § 4-203.02 Special event license; rules and R19-1-205 id iol Event Li a
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.
> ATTACH DIAGRAM qa
It the special event will be held ata 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;
1, (Print Name) Edward John Salem Jr , declare under penalty of perjury that | am
authorized to submit this application. | have read the contents of ig bi gee and to the best of my knowledge
believe all statements made on this application to be true, corr eg S Se
Pa a Signature
LOCAL GOVERNING BODY
Date Received:
(Government Official)
On behalf of
(City, town, County)
The focal governing body (city, town 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 granied.
AZDLLC USE ONLY
CIAPPROVAL CJ DISAPPROVAL BY:
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Indivich inte racing ADA arcammadatians niance call [499165A9.9900
SPEGIAL EVENT LICENSED PREMISES DIAGRAM
(This dlagram must be completed with this application)
Special Event Diagram: (Show dimensions, serving areas, and label type of enclosure and security positions)
NOTE: Show nearest cross Streals, highway, or road if location doesn’t have an address,
Dil of the darearea Is 91ass the white areas
\
tire walkpaths ~ N*
NDICATES THE FENCED AREA WHERE ROTARY SPECIAL EVENT
Edward John Salem Jr
Anthem Rotary Foundation
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 7 ti“‘CSOCSCSC‘*@ you have any questions.
Thank you. Sincerely,
LA), (
‘Edward Jolin Salem Jr.