ST KATHERINE GREEK ORTHODOX CHURCH_REDACTED.PDF

CSR:

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

Ze . (602) 542-5141
ee 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. Appiicant: Achuleta, Evangelia

(Must be an Officer/Member of the Non Profit Enti Last First Middle
2. Applicant's mang cri
City dp
3. Applicants home/cell phone} Applicant's business —

4, Applicant's email address:
Greek Independence Day Celebration

St Katherine GreekOrthodox Church

5. Special Event Name:

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

7. Non-Profit/IRS Tax Exempt Number: 94-2876533

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

9. Event Location Name: St Katherine Greek Orthodox Church

10. Event Address: 27 16 N Dobson Rd Chandler, AZ 85224

t 2
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 Seep hopal license ~
DAY 1: Mar 29, 2025 _— Saturday 5:00 pm 11:59 pm
DAY 2:
DAY 3:
DAY 4:
DAY 6: FEB 1 0 2025
DAY 7: pA
DAY 8: CLERK BOARD OF SUPERVISORS
DAY 9:
DAYI0:
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Indivicials racniirina ANA accoammoadiatians nlacse ceil [AN7\549-2999

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/security personnel and type of fencing or control barriers, if applicable.)

Number of Police 2 Number of Security Personnel [Fencing LoBarriers

Must explain security measures: Self police by parish members; 2 security guards to police premises inside and

outside and check ID's prior to dispensing liquor by certified and experienced bartenders.

SECTION 3 What is the purpose of this event?

[Z1On-site consumption (Co#-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) MSpecial 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 License Number Phone (Include Area Code)

LoPlace 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

LIDispense 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

Lbispense 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

Lisplit 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?
(Yes WINo If yes, attach letter of explanation.

2. How many special event days have been issued to this organization during the calendar year? 1
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 (YI No If yes, please provide the Name of the Special Event Contractor:

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)

(1 Yes 7] 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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Individuals requiring ADA accommodations please call (602)542-2999

St. Katherine Greek Orthodox Church Percentage: 100%

Name:
Address: 2716 N Dobson Rd Chandler, AZ 85224
Street City Stale ip
Name: Percentage:
Address:
Street City Slate ip

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.

TACH

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) Evangelia Archuleta , declare 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 to be true, correct and complete.

Vl
3

Signature

Date Received:

1, recommend CIAPPROVAL [1] DISAPPROVAL

(Government Official) (Title)

On behalf of

(City, Town, County) Signature

The local 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 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 EJ DISAPPROVAL BY:

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Indivictials recuiirina ANA accammarciations nlease call (4071542-2999

SECTION 12 License premises diagram, ihe licensed prernises for your special event is the area in which you are aulhorized
fo sell, dispense or serve alcoholic beverages under {he provisions of your license. The following space is to be used ta
prepare a diagrany of your special event licensed premises. Please show dimensions, serving areas, fencing, barricades, or
other coniral measures and securily position.

S/V/2016 Page 3 of 4
individuals requiring ADA accommodations call (602)542-90297,