RALPH'S NINO'S PIZZERIA REDACTED.PDF

Maricopa County — Informal (2025-01-27)

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State of Arizona
Department of Liquor Licenses and Control

Created 11/29/2024 @ 08:08:02 AM
Local Governing Body Report

LICENSE
Number: 07070556 Type: 007 BEER AND WINE
BAR

Name: RALPH'S NINO'S PIZZERIA

State: Pending

Issue Date: Expiration Date: 02/28/2026

Original Issue Date: 07/30/1985

Location: 9008 N 99TH AVENUE no
#1 et
PEORIA, AZ 85345 Ss
USA rm

Mailing Address: 9008 N 99TH AVENUE °
#1 m
PEORIA, AZ 85345 a

Phone: LO

Alt. Phone: Oo

Email: i)

Currently, this license has pending applications.

AGENT
Name: RALPH JOHN NEGRETE
Gender: Male
Correspondence Address: 9008 N 99TH AVENUE
#1
PEORIA, AZ 85345
USA
Phone:
Alt. Phone:
Email:
OWNER

oe hey °
\ \28\25
yo Oy:
Page 1 of 3 3hales

Name: RALPH'S PIZZERIA LLC

Contact Name: RALPH JOHN NEGRETE
Type: LIMITED LIABILITY COMPANY
AZ CC File Number: 23706395 State of Incorporation: AZ
Incorporation Date: 07/19/2024
Correspondence Address: 9008 N 99TH AVENUE
#1
PEORIA, AZ 85345
USA
Phone:
Alt. Phone:
Email:
Officers / Stockholders
Name: Title: % Interest:
RALPH JOHN NEGRETE Manager-LLC 100.00
RALPH'S PIZZERIA LLC - Manager-LLC
Name: RALPH JOHN NEGRETE
Gender: Male
Correspondence Address: 9008 N 99TH AVENUE
#1
PEORIA, AZ 85345
USA
Phone:
Alt. Phone:
Email:
MANAGERS
Name: RALPH JOHN NEGRETE
Gender: Male
Correspondence Address: 9008 N 99TH AVENUE
#1
PEORIA, AZ 85345
USA
Phone:
Alt. Phone:
Email:

Page 2 of 3

APPLICATION INFORMATION

Application Number: 319267
Application Type: Owner Transfer
Created Date: 11/22/2024

QUESTIONS & ANSWERS

007 Beer and Wine Bar

1) Are you applying for an Interim Permit (INP)?
Yes
What date are you taking ownership? Please upload the Interim Permit Notary page when you
reach the upload page.
11/29/2024
8) Did the Premises phone number change?
No
10) Provide name, address, and distance of nearest school. (If less than one (1) mile note footage)
SUN VALLEY ELEMENTARY SCHOOL
8361 N 95TH AVE, PEORIA, AZ 85345
1.5 MILES
11) Are you one of the following? Please indicate below.
Property Tenant
Subtenant
Property Owner
Property Purchaser
Property Management Company
TENANT
12) Is there a penalty if lease is not fulfilled?
Yes
What is the penalty?
$2000.00
13) What is the total money borrowed for the business not including the lease?
Please list lenders/people owed money for the business.
$200,000
CHISTINE ANN SISCO
eee
14) _ Is there a drive through window on the premises?
No
15) If there is a patio please indicate contiguous or non-contiguous within 30 feet.
NO PATIO
16) Is your licensed premises now closed due to construction, renovation or redesign or rebuild?
No
17) Total Price paid for Series 6 Bar, Series 7 Beer & Wine Bar or Series 9 Liquor Store (license only)

$35,000

Page 3 of 3

State of Arizona
Department of Liquor Licenses and Control

Created 11/29/2024 @ 08:07:29 AM
Local Governing Body Report

LICENSE

Number: INP070030929 Type: INP INTERIM PERMIT
Name: RALPH'S NINO'S PIZZERIA
State: Active
Issue Date: 11/29/2024 Expiration Date: 03/14/2025
Original Issue Date: 11/29/2024
Location: 9008 N 99TH AVENUE

PEORIA, AZ 85345

USA
Mailing Address: 9008 N 99TH AVENUE

PEORIA, AZ 85345

USA
Phone:
Alt. Phone:
Email:

AGENT

Name: RALPH JOHN NEGRETE
Gender: Male
Correspondence Address: 9008 N 99TH AVENUE

PEORIA, AZ 85345

USA
Phone:
Alt. Phone:
Email:

OWNER

Page 1 of 3

Name: RALPH'S PIZZERIA LLC
Contact Name: RALPH JOHN NEGRETE
Type: LIMITED LIABILITY COMPANY
AZ CC File Number: 23706395 State of Incorporation: AZ
Incorporation Date: 07/19/2024
Correspondence Address: 9008 N 99TH AVENUE
#1
PEORIA, AZ 85345
USA
Phone:
Alt. Phone:
Email:
Officers / Stockholders
Name: Title: % Interest:
RALPH JOHN NEGRETE Manager-LLC 100.00
RALPH'S PIZZERIA LLC - Manager-LLC
Name: RALPH JOHN NEGRETE
Gender: Male
Correspondence Address: 9008 N 99TH AVENUE
#1
PEORIA, AZ 85345
USA
Phone:
Alt. Phone:
Email:
MANAGERS
Name: RALPH JOHN NEGRETE
Gender: Male
Correspondence Address: 9008 N 99TH AVENUE
#1
PEORIA, AZ 85345
USA
Phone:
Alt. Phone:
Email:

Page 2 of 3

APPLICATION INFORMATION

Application Number: 319268

Application Type: New Application
Created Date: 11/22/2024
QUESTIONS & ANSWERS
INP Interim Permit
1) _ Enter License Number currently at location
07070556
2) Is the license currently in use?
Yes
3) Will you please submit section 5, page 6, of the license application when you reach the upload page?
Yes

A Document of type INTERIM NOTARY PAGE is required.

Page 3 of 3

SECTION 4 Interim Permit

If you intend to operate business while the application is pending, you will need an interim permit pursuant to A.R.S.§4-203.01.
For approval of an interim permit: There must be a valid license of the same series currenily issued to the location.

1. Current license number at the Premises: 978670556

2. If the license is NOT currently in use, how long has it been since the license was last used at this location?

| (Print Full Name) Ch aistine A : Si SCO _ hereby declare that | am the Current Owner, Agent, or

Controlling Person on the stated license and location.
Sign in front of Notary:

State of AR lIZona
County of MARICOPA
Signed before me on this_cl{_ day of Novembem0 a¢% LINDA JEAN GUZMAN
NOTARY PUBLIC, ARIZONA’
i MARICOPA COUNTY
Notary Signatur My Co: ston Expires
wo . Januaty 30, 2025
My commission expires on _/_ / 30/_ 2S =
Notary Seal

SECTION 5 Background Check

EACH PERSON LISTED MUST SUBMIT A QUESTIONNAIRE, FINGERPRINT CARD, AND $22 PROCESSING FEE PER CARD.

1. If the applicant is an entity, and not an individual, answer questions 1a-b.

a) Date Incorporated/Organized: Sul \\ son tate where Incorporated/Organized: Ad
a3) OB

b) AZ Corporation or AZ L.L.C. Entity No: Approval Date: Vo \y 14, 02.4

2. List any individual or entity that owns a beneficial interest of 10% or more and/or controls the applicant or licensee. If
the applicant is owned by another entity, attach an organizational chart showing the ownership structure.

Last First Middle Title %Owned Malling Address City State Zip

Noy
Weaedte Raldh Sohn fetieser [100% hentad Are Prorin AZ @S345

(Attach addifional sheet If necessary)

9/21/2022 page 20f 5
Individuals requiring ADA accommodations please call (602)542-2999

SECTION 64 Person to Person Transfer ARS§4-203(C), (D), (G)

1. License #O? O? O55 6

. e \
2. Current Agent Name / Individual Name Ni SCO Chr} st rive A ats
Last t - Apt Middle
3. Current Ownership Name (Legal Entity): Siscas Pi2zerra

(Exacly.os Ht appears on the license)

. \ \ .
4, Premises Name: Che issu N Laos i2zzer 1

{Exactly as # appears on the license)

rn
5, Premises Location Address: Foor IN} al Pure . Penrio, AQ

Steet Cy stole we Dp
the business while this application is pending? dives No

authorize the transfer of this license to the applicant.

6. Does current licensee int

7.1, (Signature):

(Curent Agent/individval as listed on the license certificate)

SECTION 7 Location Transfer- Current Licensee Intormation ARS§4-203(C), (D), (G)

1. License #:

2. Current Business:

Name:

3. New Business:

Address:

SECTION 8 Proximity to School

A.R.S.§4-207 States that no retaller's license shall be issued for any premises which are at the time the license
application is received by the director, within three hundred (300) horizontal feet of a public or private school building
with kindergarten programs or grades one (1) through (12), or within three hundred (300) horizontal feet of a fenced

recreational area adjacent to such school building.

The above paragraph DOES NOT apply to:
Series 01 Producer Series 11 Hotel/motel license

Series 03 Microbrewery Series 12 Restaurants that do not sell gowess

Series 04 Wholesaler/Distributor Series 13 Farm Winery
Series 05 Govemment license Series 18 Cratt Distillery
Playing area of a golf course

Distance to nearest School: ) 2 5 may les Name of School: Sun Viales El amon sity Schoo |

(if less than one (1) mite, note footage)
School Address: $36 | h) gets Ave. Prot a AZ. %S 34S

9/21/2022 page 3o0f 5
Individuals requiring ADA accommodations please call (602)542-2999

BILL OF SALE

Christine A. Sisco and Sisco’s Pizzeria, LLC in
consideration of the sum of Two Hundred Thousand Dollars

($200,000.00), paid by Purchaser- Ralph J. Negrete and Ralph's
Pizzeria LLC, receipt of which is hereby acknowledged, do grant,

sell, transfer and deliver to Purchaser the following:

Approximate Worth

Furniture $4,462.00
Equipment $71,045.00
Leasehold Improvements $38,962.00
Liquor License #07070556 $35,000.00
Goodwill $25,000.00
Covenant not to compete $10,000.00
Inventory $15,531.00

Seller is the lawful owner of the above listed items
and has good right to sell the same and warrants and defends
the right against the lawful claims and demands of all persons.

IN WITNESS WHEREOF Seller has executed this Bill of

Sale on the 25 day of @crwter , 2024.
wC heccdcia tt Synur a» ELLE.
Christine A. Sisco Ralph J Negrete

SIGNED AND SWORN BEFORE ME THIS &5§ DAY OF OcrwBek 2024.

’ , )
LINDA JEAN GUZMAN Dan hea f /
NOTARY PUBLIC, ARIZONA » 4 hee.

MARICOPA COUNTY 4
NOTARY PUBIC

My commission expires 1/30/2025

Department of Liquor Licenses and Control

License Number: 07070556

[License Number: [07070556 status: _ [Active
Business Name: ICHRISSY'S NINO'S PIZZERIA
Location Address [9008 N 99TH Avenue # 1

PEORIA | Arizona 85345
County Maricopa Bus. Phone 602-972-1993
Licensee/Agent/Tel: Sisco, Christine 602-972-1993
Owner: Sisco's Pizzeria Lic _ Exp Date: 02/28/2025
Issue Date: 07/30/1985 [Status Date: 01/30/2024

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STATE OF ARIZONA

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DLLC USE ONLY

Arizona Dept. of Liquor Licenses and Control

https://www.azliquor.gov Fee:
(602) 542-5141 EDV A701
. Date Accepted 2444
Personal Information _ el 1

Questionnaire

Sa ae

THE COMPLETED QUEST!

ATTENTION APPLICANT: This is a legally binding document. An investigation of your background will be conducted.
Incomplete applications will not be accepted. False or misleading answers may result in the denial or revocation
of a license or permit and could result in criminal prosecution.

|ONNAIRE NEEDS TO BE SUBMITTED TO THE DEPARTMENT ALONG WITH A $22. FEE, AND FD-258 FINGERPRINT CARD,

THAT HAS BEEN SEALED IN AN ENVELOPE, AND SIGNED OR INITIALED BY THE FINGERPRINT TECHNICIAN, MUST INCLUDE THE FINGERPRINT
VERIFICATION FORM. MUST BE COMPLETED BY A RECOGNIZED FINGERPRINT SERVICE OR LAW ENFORCEMENT AGENCY. \\

Agent: a person who
is designated by an
applicant or licensee
to receive
communications from
the department and to
file and sign
documents submitted
to the department on
behalf of the applicant
or licensee. An agent
is not a manager.

A.R.S. §4-202(A).

. Name: Ne rele:
Last
. Social Security

. Driver's License #5

Controlling Person:
person directly or
indirectly possessing
control of an applicant
or licensee.

ARS, §4-101(10).

. Are you a resident of Arizona? CINo

. Email address.

Manager: An
individual (not an
entity) approved by
the Department of
Liquor who has the
authority to organize,
direct, carry out,
control or to
otherwise operate the
day-to-day operations
of a liquor-licensed
business.

A.R.S, §4-101(22) and
ARS. §4-202(C)

6/21/2024

. Daytime phone

cw
eS 0)

SECTION - 1 INDIVIDUAL INFORMATION 0"

racenn

[] MANAGER

Sohn

State Issued: AZ.

Date of residency: /O\/ 3034

EconTROLLING PERSON

Qalely

(NOT a ppblic record)

SECTION 2 — LICENSED BUSINESS INFORMATION

. Liquor License #: OQ? QO? 0) 55 &

. Business Name (doing business as): Rol phys Wh abs Pi ZL vO
. Business Address: AD OY 1) qath Ive Sel Peoria Az Kes) 45

Page 1 of 2
Individuals requiring ADA accommodations please call (602)542-2997

SECTION 3 — DAY TO DAY OPERATION OF BUSINESS

Must attach copies of Basic and Management Title 4 training certificates for person managing the day to day
operation of the licensed business.

Who is managing the day to day operations? heen Cicontrolling Person CJManager

Name of persons who will be handling the day to day operations: Roles Sohn Regge.

SECTION 4 — BACKGROUND

If you answer “YES” to any Question 1 through 5 YOU MUST attach a signed statement. Give complete details including
dates, agencies involved and dispositions. CHANGES TO QUESTIONS 1-5 MAY NOT BE ACCEPTED

1. Have you owned, or been a controlling person of any entities that held a liquor Yes [] No
license in Arizona, or any jurisdiction, in the past 5 years?

2. Have you been cited, arrested, indicted, convicted, or required to appear in Yes [] No
court for violation of ANY criminal law or ordinance, regardless of the
disposition, even if dismissed or expunged, within the past 5 years?

3. Has an entity in which you are or have been a controlling person had an Yes ( No
application or license rejected, denied, revoked, or suspended in or outside of
Arizona within the last 5 years? A.R.S.§4-202(D

S 8 RM

4. Have you had ANY administrative law citations, compliance actions, or Yes [] No
consents, in any jurisdiction in the past 5 years? (Do not include civil traffic
tickets)
A.R.S,§4-202,4-210
*Administrative Law Violations are any civil penalties, fines, suspension,
or revocations of your liquor license.

5. Has anyone EVER obtained a judgement against you the subject of which Yes [] No uw
involved fraud or misrepresentation?

1, (Print Full Name) Qo GN Saar Pearel za hereby swear under penalty of perjury and in
compliance with A.R.S. § 4-210(A)(2) and (3) that I have read and understand the foregoing and verify that
the information and statements that I have made herein are true and correct to the best of my knowledge.

Signature: LLL LE pate:_A)ov g ama4

6/21/24 Page 2 of 2
Individuals requiring ADA accommodations please call (602)542-2999

ALIEN STATUS

ees ae

Arizona Dept. of Liquor Licenses and Control
800 W. Washington St. 5'* Floor Phoenix, AZ 85007
(602) 542-5141

Type or Print with Black Ink

Title IV of the federal Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (the "Act'), 8 U.S.C. §
1621, provides that, with certain exceptions, only United States citizens, United States non-citizen nationals, non-
exempt "qualified aliens" (and sometimes only particular categories of qualified aliens), nonimmigrant, and certain
aliens paroled into the United States are eligible to receive state, or local public benefits. With certain exceptions, a
professional license and commercial license issued by a State agency is a State public benefit.

Atizona Revised Statutes § 41-1080 requires, in general, that a person applying for a license must submit
documentation to the license agency that satisfactorily demonstrates the applicant's presence in the United States
is authorized under federal law.

Directions: All applicants must complete Sections |, II, and IV. Applicants who are not U.S. citizens or nationals
must also complete Section Ill.

Submit this completed form and a copy of one or more documeni(s) from the attached "Evidence of U.S. Cifizenship,
U.S. National Status, or Alien Status" with your application for license or renewal. If the document you submit does not
contain a photograph, you must also provide a government issued document that contains your photograph. You
must submit supporting legal documentation (i.e. marriage certificate) if the name on your evidence Is not the same
as your current legal name.

SECTION I — APPLICANT INFORMATION

APPLICANT NAME (Print ortype) Role RCANS Hegre

SECTION 11 — CITIZENSHIP OR NATIONAL STATUS DECLARATION

Are you a citizen or national of the United States? Aves | No - If yes, indicate place of birth:
cily Crna state Nebraska coumey United States

If you answered Yes, 1) Attach a legible copy of a document from the list below,

2) Nameof document: A2. Devers LA CLNSO-

If you answered No, you must complete Sections Ill.

7/21/2022 Page 1 of 3
Individuals requiring ADA accommodations please call (602)542-2999

iy fp
“i

EVIDENCE OF U.S. CITIZENSHIP, U.S. NATIONAL STATUS, OR ALIEN STATUS

You must submit supporting legal documentation (i.e. marriage certificate) if the name on your evidence
is not the same as your current legal name.

Evidence showing authorized presence in the United State includes the following:

1. An Arizona driver license issued after 1996 or an Arizona non-operating identificationcard.
2. A driver license issued by a state that verifies lawful presence in the United States.

3. A birth certificate or delayed birth certificate showing birth in one of the 50 states, the District of
Columbia, Puerto Rico (on or after Jan. 13, 1941), Guam, the U.S. Virgin Islands (on or after January 17,
1917), American Samoa, or the Northern Mariana Islands (on or after November 4, 1986, Northern

Mariana Islands local time)

4, A United States certificate of birth abroad.

5, AUnited States passport. ***Passport must be signed***
6. A foreign passport with a United States visa.

7. An |-94 form with a photograph.

8. AUnited States citizenship and immigration services employment authorization document or

refugee travel document.
9. AUnited States certificate of naturalization.
10. A United States certificate of citizenship.
11. A tribal certificate of Indian blood.
12. A tribal or bureau of Indian affairs affidavit of birth.
13. Any other license that is issued by the federal government, any other state government, an agency of

this state or a political subdivision of this state that requires proof of citizenship or lawful alien status

before issuing the license.

7/21/2022 Page 2 of 3
Individuals requiring ADA accommodations please call (602)542-2999

[ SECTION Ill — QUALIFIED ALIEN DECLARATION

Applicants who are not citizens or nationals of the United States. Please indicate alien status by checking the
appropriate box. Attach a legible copy of a document from the attached list or other document as evidence

of your status.

Name of document provided

Qualified Alien Status (8 U.S.C.§§ 1621(a}(1),-1641(b) and (c})

i 1. An alien lawfully admitted for permanent residence under the Immigration and Nationality Act (INA)
2. An alien who is granted asylum under Section 208 of the INA.

3, Arefugee admitted to the United States under Section 207 of the INA.

4 Analien paroled into the United States for atleast one year under Section 212(d)(5) of the INA.

5, An alien whose deportation is being withheld under Section 243(h} of the INA.

6. An alien granted conditional entry under Section 203(a)(7) of the INA as in effect prior to April 1, 1980.

. An alien who is a Cuban/Haitian entrant.

8. An alien who has, or whose child or child's parent is a "battered alien" or an alien subject to extreme

OOOOH

cruelty in the United States

Nonimmigrant Status (8 U.S.C. § 1621(a)(2))

9, Anonimmigrant under the Immigration and Nationality Act [8 U.S.C § 1101 et seq.] Non-immigrants
are persons who have temporary status for a specific purpose. See 8 U.S.C § 1 101 {a)(15).

Alien Paroled into the United States for Less Than One Year (8 U.S.C. § 1621(a)(3))
10. An alien paroled into the United States for less than one year under Section 212(d) (5) of theINA

Other Persons (8 U.S.C § 1621{c)(2}(A) and (C)
11. Anonimmigrant whose visa for entry is related to employment in the United States, or
12. A citizen of a freely associated state, if section 141 of the applicable compact of free association

approved in Public Law 99-239 or 99-658 (or a successor provision} is in effect [Freely Associated States
include the Republic of the Marshall Islands, Republic of Palau and the Federate States of Micronesia, 48

U.S.C. § 1901 etseq.];
13. A foreign national not physically present in the United States.
14. Otherwise Lawfully Present
15. Aperson not described in categories 1-13 who is otherwise lawfully present in the United States.

PLEASE NOTE: The federal Personal Responsibility and Work Opportunity Reconciliation Act may make persons who fall

into this category ineligible for licensure. See 8 U.S.C. § SOE
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“ Signature” Date

7/21/2022 Page 3 of 3
Individuals requiring ADA accommodations please call (602)542-2999

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“On-sale
Certificate of Completion O Off-sale
For Ol On- and off-sale

Title 4 BASIC Liquor Law Training

Certificate # AZB-ON-01239740

A Certificate of Completion must be on a form provided by the Arizona Department of Liquor. Certificates are completed by a state-
approved training provider and, when issued, the Certificate is signed by the course participant.

The State requires BASIC Title 4 training only as a prerequisite for MANAGEMENT Title 4 training or as a result of a liquor law violation, Persons
required to have BASIC Title 4 training are listed at the base of this Certificate. Licensees sometimes require BASIC Title 4 Training a condition of

employment.
Areplacement Certificate of Completion for Title 4 training must be available through the training provider for two years after the training
completion date.

Student Information

Ralph Negrete

ELLE.

Sigrflure
11/22/2024 11/22/2027

Training Completion Date Certificate Expiration Date
(three years from completion date)

Training Provider Information

360training.com Inc.

Company Name

6504 Bridge Point Parkway, Suite 100, Austin, TX 78730
Mailing Address

(877) 881-2235

Daytime Contact Phone Number

I, Samantha Montalbano , certify that the above named individual did successfully complete

Instructor Name (please print)
Title 4 BASIC Training in accordance with A.R.S. §4-112(G)(2) and Arizona Administrative Code [A.A.C.)R19-1-103

using training course content and materials approved by the Arizona Department of Liquor Licenses and Control.
| understand that misuse of this Certificate of Completion can result in the revocation of State-approval for the Title
4 Training Provider named in this section as provided by A.A.C. R19-1-103(E) and (F).

11/22/2024
Instructor signature Day Mo Year

Persons required to complete BASIC & MANAGEMENT Title 4 training: 1) owner(s) actively involved in the daily business operations of a liquor-
licensed business of a series listed below
2) licensees, agents and managers actively involved in the daily business
operations of a liquorticensed business of a series listed below

In-state Microbrewery (series 3) Government [series 5) Bar (series 6) Beer & Wine Bar (series 7)
Conveyance (series 8) Liquor Store (series 9) Private Club (series 14) Hotel/Motel w/restaurant (series 11)
Restaurant (series 12) In-state Farm Winery (series 13) Beer & Wine Store (series 10}

Liquor license applications (initial and renewal) are not complete until valid Certificates of Completion for all required persons have been
submitted to the Department of Liquor.

The questionnaire (which designates a manager to a location} and the agent change form (which assigns a new agent to active liquor
licenses) are not complete until valid Certificates of Completion for all required persons have been submitted to the Department of Liquor.

July 11, 2013

Certificate # AZM-ON01207432
Certificate of Completion
For
Title 4 MANAGEMENT Liquor Law Training

Basic Title 4 training is a prerequisite for MANAGEMENT Title 4 training. A valid Certificate of Completion for BASIC Title 4 training must be on fite
at the Department of Liquor and satisfactory completion of a State-approved BASIC Title 4 course must be verified by the training provider prior
fo issuing a Certificate of Completion for MANAGEMENT Title 4 training.

Areplacement Certificate of Completion for Tile 4 training must be available through the training provider for two years after the training
completion date.

Student Information
Ralph Negrete
Le
Signals
11/08/2024 11/08/2027

Training Completion Date Certificate Expiration Date
(three years from completion date)

Training Provider Information

360training.com Inc.

Company Name

6504 Bridge Point Parkway, Suite 100, Austin, TX 78730
Mailing Address

(877) 881-2235

Daytime Contact Phone Number

I, Samantha Montalbano _ ceftify that the above named individual did successfully complete
Instructor Name (please print)

Title 4 MANAGEMENT Training in accordance with A.R.S. §4-112(G)(2) and Arizona Administrative Code
(A.A.C.}R19-1-103 using training course content and materials approved by the Arizona Department of Liquor
Licenses and Control. | understand that misuse of this Certificate of Completion can result in the revocation of
State-approval for the Title 4 Training Provider named in this section as provided by A.A.C. R19-1-103(E} and (F).

11/08/2024

Instructor Signdfure Day Mo Yeor

In-state Microbrewery (series 3) Government (series 5) Bar (series 6) Beer & Wine Bar (series 7)
Conveyance (series 8) Liquor Store (series 9) Private Club (series 14) Hotel/Motel w/restaurant (series 11)
Restaurant (series 12) (in-state Farm Winery (series 13) Beer & Wine Store (series 10)

Liquor license applications (initial and renewal) are not complete unfil valid Certificates of Completion for all required persons have been
submitted fo the Department of Liquor.

The questionnaire (which designates a manager to a location) and the agent change form (which assigns a new agent to active liquor
licenses) are not complete until valid Certificates of Completion for all required persons have been submitted to the Department of Liquor,

July 11, 2013