RISEN SAVIOR LUTHERAN CHURCH_REDACTED.PDF

CSR:
Amount __|
ip BLLC USE ONLY
Job #:
SPECIAL EVENT LICENSE :
= Date Accepled:
“a 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, polifical party, or Government entity and
authorized by an Officer, Director, or Chairperson of the Organization,

1. Applicant: Me lls Su SOre

(Must be on Officer/Member of the Not
2, Applicant's mailing address:

aplicant's business phone: 480 §95-b 722

3. Applicants home/cell phone!

4. Applicant's email address:

5. Special Event Name: A Naa
6, Name of Non-Profit Organization, Candidate or Political Party/Gov. Ok; S0n Sa vide ludhe Cow 4 Ih au cok
7. Non-Profil/IRS Tax Exempt Number: EIN - Slo “OTZYUUUE / 43 -DO5B 19S

8. Arizona Corporation Commission File #: ra) P58 2RU bit out of State please specify:

p25 Santa

9. Event Location Name: “Rs S2re Xa ViIOL Lief he CON Ch iva coh

lo, Event Address: 23020 9, Alma Shoal fed Sun lakes AZ ‘& 2 ¢

Dates and Hours of Event - Days must be consecutive and may not exceed 10 consecutive days.

ae 2

**SEPARATE APPLICATION FOR EACH “NON-CONSECUTIVE” DAY **

Event Start license End
Days Day of Week Time AM/PM Time AM/PM
DAY]: Seducclay - A: 00.em §:0 Qom
DAY 2: a
DAY 3: -
DAYa ee _ RECEIVED
DAY 5: _.
AUG 1 12025 -~
DAY 6:
DAY 7: MARICOPA COUNTY
> CLERK BOARD OF SUPERVISORS
DAY 8:
DAY 9:
DAY10:

2/6/2023 Page lof3

SECTION 2 What type of security and control measures will you take to prevent violations of liquor laws at this event?
(ist type and number of police/secuiity personnel and type of fencing or control baniers, if applicable.)

5 Number of Police 1 Vola n ke ec Number of Security Personnel [JFencing Xfbories
; “> 7 *
Must explain security measures: ZL. Pra Docs anc) Dactencte CS ks MX itor CONSu nw) hs

Gad aCe. <2. Valinteecs walk. site pb ensure abohot doesrt
° Stave 2yond .

SECTION 3 What is the purpose of this event?

Khon-site consumption (Cot-site (auction/wine/distilled spirits pull) Clsoth
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) 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 License 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

Clbispense 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

Eldispense 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 fetter from the location suspending license for duration of special event

Csplit 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.}

Clot sate only - Wine/Distilled Spirits Pull, Live or Silent Auctions — Retailer will sfill 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?

Clves Px(No If yes, attach letter of explanation.

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

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 alcehol. }

Cl Yes ci 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 io 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 [XI No if yes. please provide the Name of Licensee: License #:

5. List the name of the Individual or Organization that wil receive revenues, MUST EQUAL 100 PERCENT.

Attach additional sheet if necessary.

2/6/2023 Page 20f3

omer KiSn Savies Cc Lernecrin Ch LA Cho reroenage 100%
Address: 3G) uf S& Alaa ahedl Ka zt oun Lakes KE 9 S24E

Sheet city State Up
Name: Percentage:
Address:

Sheet city Sate Up

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 fo 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, thls application mus! 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: S ell
1, (Print Name) “SGN allo , declare under penalty of perjury that | am
authorized to submit this application. | have vend the contents of this er and to the best of my knowledge

believe all statements made on this application to be true, correct and plete.

WADDLE D

Signature

LOCAL GOVERNING BODY

Date Received:

I, —\—recdmmend LIAPPROVAL C1] DISAPPROVAL

{Government Offictal)

On behalf of

(City, Town, County)

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

DIAPPROVAL EI DISAPPROVAL BY:

2/6/2023 Page 3 of 3

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JPEG 80 1 tds

YEW NORTH CHURCH BUILDING
36 SF. (INCLUDES