ST. ROSE PHILIPPINE DUCHESNE ROMAN CATHOLIC PARISH ANTHEM_REDACTED.PDF

Maricopa County — Formal (2022-09-28)

View PDF Item 22 Meeting page

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g )o-2022
cley

CSR:
Amount:

DLLC USE ONLY

SPECIAL EVENT LICENSE Tob
APPLICATION FEE $25.00 PER DAY

Date Accepted:

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

Type or Print with Black Ink

1-10 days consecutive days only, Cash, Checks or Money Orders Only

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: Alicia Gonzales
2. Applicant's mailing address!
ee} City State Tip
3. Applicants home/cell — £——e Applicant's business phone: 823-465-9740 oe
‘St Rose Philippine Duchesne Catholic Church a

7, re A | Puch
SECTION 3 Non-Profit/IRS Tax Exempt Number: 0928 Raman foe he hah ‘ > fires hos
oF th PAINE I

SECTION 4 Arizona Corporation Commission File #: 14588793 If out of State please specify:

4. Applicant's email address:

SECTION 2 Name of Non-Profit Organization, Candidate or Political Party/Goy:

SECTION 5 Event Location Name: St Rose Fall Festival
SECTION 6 Event Address: 2825 W Rose Canyon Cir Anthem AZ 85086

SECTION 7 Dates and Hours of Event. Days must be consecutive but may not exceed 10 consecutive days.

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

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

bavi. OCT 7,2022 FRI 5 PM 10 PM
pay2, OCT 8,2022 SAT 4PM 10 PM
pays. OCT 9, 2022 SUN 12 PM 6 PM

Days Date Day of Week

DAY 4: :
. yen
DAY 5: ae Ye

DAY 6:

DAY 7:

DAY 8:

DAY 9: n

DAY10:

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

SECTION 6 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.)

Number of Police 3 Number of Security Personnel [¥Fencing [ZBarriers

Ex . Police and security personnel will be moving throughout the event. Three officers from
planation:

the Sheriffs department and 3 security personnel from the parish will be on hand.

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

Dyes IZINo If yes, Local Governing Body signature is not required.

Name of Business License Number Phone (Include Area Code)

SECTION 8 How is this special event going to conduct all dispensing, serving, and selling of spirituous liquors? Please read
R-19-318 for explanation and check one of the following boxes.

CPlace license in non-use

Libispense and serve alll spirituous liquors under retailer's license
[Dispense and serve alll spirituous liquors under special event
Cspiit premise between special event and retail location

SECTION 2 What is the purpose of this event?
(en-site consumption [off-site (auction/wine/distilled spirits pull) [Both
SECTION 10

1. Has the applicant been convicted of a felony, or had a liquor license revoked within the last five (5) years?
L1Yes{[¥]No If yes, attach 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 Licensed Contractor?

LyYes YJNo If yes, please provide the Name of the Licensed Contractor:

4. ls the organization using the services of a series 6, 7, 11, or 12 licensee to manage the sale or service of alcohol?

CO Yes YINo if yes, please provide the Name of Licensee: License #:

5. List the name of the Individual or Organizatio: al wile reeeive reve yes ST veh 100%. Aa We. OSG

St.Rose Philippine Duchesne ax154 00%

Name: Seroontase!

Address: 2220 W Rose Canyon a Anthem AZ 85086

Street Cily State Tip
Name: Percentage:
Address:

Street City State Zip
7/21/2022 Page 2 of 3

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

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 11 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 4a

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 government before submission
to the Department of Liquor Licenses and Control. Please contact the local governing board for additional application
requirements and submission deadlines. Additional licensing fees may also be required before approval may be granted. For
more information, please contact your local jurisdiction.

Declaration:

Alicia Gonzales

|, (Print Name) , 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 complefe)

Signature )

Date Received:

F recommend LIAPPROVAL [LI DISAPPROVAL
(Government Official) (Title)

On behalf of q , ,
(City, Town, County) Signature Date Phone

A.R.S. § 41-1030. Invalidity of rules not made according to this chapter; prohibited agency action; prohibited acts by
state employees: enforcement; notice

B. An agency shall not base a licensing decision in whole or in part on a licensing requirement or condition
that is not specifically authorized by statute, rule or state tribal gaming compact. A general grant of authority in statute
does not constitute a basis for imposing a licensing requirement or condition unless a rule is made pursuant to that
general grant of authority that specifically authorizes the requirement or condition.

D. This section may be enforced in a private civil action and relief may be awarded against the state. The
court may award reasonable attorney fees, damages and all fees associated with the license application to a party
that prevails in an action against the state for a violation of this section.

E. A state employee may not intentionally or knowingly violate this section. A violation of this section is cause
for disciplinary action or dismissal pursuant to the agency's adopted personnel policy.

F. This section does not abrogate the immunity provided by section 12-820.01 or 12-820.02.

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

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