SOUTHWEST WILDLIFE CONSERVATION CENTERAL_REDACTED.PDF

CSR:

Amount:
P DLLC USE ONLY
seal Job #:
oe Ore | SPECIAL EVENT LICENSE —
Ss peareees > APPLICATION FEE $25.00 PER DAY ,
A (OITAT DEUS] lo) y :
ey = CSR:
«>_< « Arizona Department of Liquor Licenses and Control ~ r
bono 800 W. Washington St. 5" Floor Phoenix, AZ 85007 License #:
ee 602) 542-5141
Rizon> (602) 542-

Type or Print with Black Ink

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; Nolan Michael_ Patrick

2. Applicant's mailing address: Tt i Uae
3. Applicants home/cell phone: Applicant's business phone: 480-471-9109

4: Apaiseri=-<rmcl aciirss

Southwest Wildlife Conservation Center

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

6. Non-Profit/IRS Tax Exempt Number: 86-0765249

7. Arizona Corporation Commission File #: 07187250 If out of State please specify:
(Attach letter of good standing)

8. Event Location Name: McDowell Mountain Regional Park

9. Event Address; 16300 McDowell Mountain Park Drive, Fort McDowell, AZ 85264

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

Event Start License End
Time AM/PM Time AM/PM

BYE 12/03/22 Saturday 8am 12am

DAY 2:

Days Date Day of Week

DAY 3:

DAY 4:

DAY 5:

DAY 6:

DAY 7:

DAY 8:

DAY 2:

DAY10:

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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 contro! barriers, if applicable.)

Number of Police 1 Number of Security Personnel [Fencing [Barriers
Explanation: ID check and wristbands to those 21 years of age and older. Security

personnel will remain at the entrance/exit of the fenced in beer garden for the
duration of the event to ensure no alcohol leaves the designated beer garden.

Will this event be held on a currently licensed premises and within the already approved and licensed area?

Cyes [¥] No - if No, Local Governing Body signature is required.

Name of Business License Number Phone (Include Area Code)

SECTION 3 What is the purpose of this event?

[Ylon-site consumption Llott-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)

(Place 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

Libispense 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
[Vibispense and serve alll spirituous liquors under special event - The retailer 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

L4plit 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.)

(Clo# 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?
Cl yes [YINo If yes, attach letter of explanation.

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

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 alcohol on behalf of the licensee. If no special event contractor is listed, the
licensee is responsible for the sales and service of alcohol.)

Aravaipa Running, LLC

Yes[_]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)

Clyes[VJNo if yes, please provide the Name of Licensee: License #:

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5. List the name of the Individual or Organization that will receive revenues, MUST EQUAL 100 PERCENT.
Attach additional sheet if necessary.

Name: Southwest Wildlife Conservation Center Percentage: 60
Address: 8711 E Pinnacle Peak Rd PMB 115 Scottsdale, Arizona 85255
Name: seine Roto: LLC _ percentage: 40 .
Address: 2401 S 24th St. Phoenix, Arizona 85034
Sheet Cily 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 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.

==> Ce

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) Michae |} Patricl Nel. , declare under penalty of perjury that | am
authorized to submit this application. | have read the contents of pry jon, and tothe best of my knowledge

believe all statements made on this application to be true, correct’and co oe ,
“luc ~) ——
“Signature

LOCAL GOVERNING BODY

Date Received:

I, recommend CIAPPROVAL [1 DISAPPROVAL
(Government Official) (Title)

On behalf of

(City, Town, County) Signature

AZDLLC USE ONLY

DIAPPROVAL LD DISAPPROVAL _ BY:

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Individuals requiring ADA accommodations please call (602)542-2999