Extracted text (via ocr_local)
3562 characters
P\ mend ment
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CSR:
Amount:
DLLC USE ONLY
Job #:
SPECIAL EVENT LICENSE —
APPLICATION FEE $25.00 PER DAY ;
CSR:
Arizona Department of Liquor Licenses and Control - -
800 W. Washington St. 5" Floor Phoenix, AZ 85007 license #:
eh (602) 542-5141
we 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: Gates Lisa Rene’
(Must be an Officer/Member of the No:
n_ Profit Enti Last First Middle
2. Applicant's mailing address: iS
3. Applicants home/cell phon Applicant's business phone: 480-435-7335
4. Aopiconts ent cc
Nashville Nights, Christmas in the Desert
5. Special Event Name:
6. Name of Non-Profit Organization, Candidate or Political Party/Gov: Golden Roller Skates
7. Non-Profit/IRS Tax Exempt Number: 88-1097917
8. Arizona Corporation Commission File #: 23343049 If out of State please specify:
(Attach letter of good standing)
9. Event Location Name: Rancho del Pacifico
10. Event Address: 15225 E. Riggs Road, Gilbert, AZ 85298
Dates and Hours of Event - Days must be consecutive and may not exceed 10 consecutive days.
**SEPARATE APPLICATION FOR EACH “NON-CONSECUTIVE” DAY**
Event Start License End
Days Date Dey. of Week Time AM/PM Time AM/PM
bavi. 12-47-22 Saturday 12:00 PM 10:00 PM
DAY 2:
DAY 3:
DAY 4:
DAY 5:
DAY 6:
DAY 7:
DAY 8:
DAY 9:
DAY10:
11/7/2022 Page 1 of 3
Individuals requiting ADA accommodations please call (602)542-2999
A Wend Ment
abs
5. List the name of the Individual or Organization that will receive revenues, MUST EQUAL 100 PERCENT.
Attach additional sheet if necessary.
Name: Golden Roller Skates Percentage: 25
Adcress: 3001 S. Salt Cedar Street, Chandler, AZ 85286
Name: DDP Worldwide _ percentage: 73 °
acces, 1067 E Everglade Ln, Gilbert, AZ. 85298
Street City State Zip
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_S 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 aind security position.
IED SE EE as
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:
L (Print Name) Lisa Gates , 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 wa
Signature
LOCAL GOVERNING BODY
Date Received:
\, recommend DIAPPROVAL [1] DISAPPROVAL
{Govemment Offical) (Title)
On behalf of
(City, Town, County) Signature Date Phone
AZDLLC USE ONLY
DATE:
STS SSS SS SSS PSS
11/7/2022 Page 3 of 3
Individuals requiring ADA accommodations please call (602)542-2999