KNIGHTS OF COLUMBUS COUNCIL 12144_REDACTED.PDF

| DLLC USE ONLY
SPECIAL EVENT LICENSE

Date Accepted:
APPLICATION FEE $25.00 PER DAY

CSR:

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

License #:

A 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; Macedon, Frank James

i Middle
2. Applicant's mailing — i (ists—sSsSsisSzr
Cily State Tip
3. Applicants home/cell — ia Applicant's business phone: N/A - Retired
4. Applcents emi oderes
. Knights of Columbus Council 12144

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

6. Non-Profit/IRS Tax Exempt Number: 86-0907785

7. Arizona Corporation Commission File #: 23424122 If out of State please specify:
(Attach letter of good standing)

8. Event Location Name: St. Elizabeth Ann Seton Church Hall

9. Event Address: 9728 West Palmeras Drive, Sun City, AZ 85373

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
Bays Dote Pay onWeek Time AM/PM Time AM/PM
DAY 1: Feb. 4th, 2023 Saturday 5:00PM 11:00PM
DAY 2:
DAY 3:
DAY 4:
DAY 5: )
VU
DAY 6: oY ae a Ni
RECEIVED
DAY 7:
DAY 8: OCT 18 2020
MARIC! UNTY
DAY 9: CL AED Gee
EB HQ ERVISORS
DAY10:
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Individuals requiring ADA accommodations please call (602)542-2999

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.)

3

Number of Police _______s Number of Security Personnel Fencing Cbarriers

: _ We will require identification in accordance with ARS 4-241.
xplanation:

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

Dyes 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?
[4Jon-site consumption Clott-site (auction/wine/distilled spirits pull) Cisoth

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)

Cplace 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

Dbispense 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

[dispense and serve alll spirituous liquors under special event - The special event licensee is in charge of selling alcoho! 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

Ospiit 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 wil 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?
Dyes I No If yes, attach letter of explanation.
One

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. }

C1 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)

CO Yes HINo 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.

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

Attach additional sheet if necessary.

Name: Knights of Columbus Council 12144 Percentage: _100
Address 2/28 West Palmeras Drive, Sun City, AZ 85373
Street City State Zip
Name: Percentage:
Address:
Street City State Tip

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.

[ => ATTACH DIAGRAM

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) Frank J : Macedon , 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.

(Ane) N War Qian

Sig nature

LOCAL GOVERNING BODY

Date Received:
li recommend CIAPPROVAL [L] DISAPPROVAL |
(Government Official) (Title)
On behalf of i i ,
(City, Town, County) Signature Date Phone

—— |

AZDLLC USE ONLY

DIAPPROVAL EL] DISAPPROVAL BY:

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

B/ABI2O1S

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