ST. KATHERINE GREEK ORTHODOX CHURCH_REDACTED.PDF

DLLC USE ONLY

SPECIAL EVENT LICENSE Tob #:

APPLICATION FEE $25.00 PER DAY

Date Accepied:

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

Type or Print with Black Ink

1-10 days consecutive days only, Cash, Checks or Mioney 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, of Chairperson of the Organization.

Evangelia Archuleta

1. Applicant:
2, Applicant's mailing addres

clly
3. Applicants home/cell phone: _. Applicant's business phone:

Up

480-899-3330

4, Applicant's email address:

St,Katherine Greek Orthodox
SECTION 2 Name of Non-Profit Organization, Candidate or Political Parly/Gov.:

94-2876533 Church

SECTION 3 Non-ProfitARS Tax Exernpt Number:

01524110
SECTION 4 Arizona Corporation Commission File #: If out of State please specify:

St.Katherine Community Center
SECTION 5 Event Location Name: y

1 D ’
ECTION.4 Event Adtciress: 2716 N Dobson Rd Chandler AZ 85224 ee ee

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

ie

Event Start License End
Days Date Day of Week Time AM/PM Time AM/PM

DAY 1: Oct 15, 2022 Saturday 4pm 11:59pm

DAY 2:

DAY 3:

DAY 4: . _

DAY 6:

DAY 7:

DAY 8:

DAY ?:

DAY10;

7/212092 Page 1 of 3

SEC What type of security ancl conirol mecisures will you take lo prevent vialations of liquor lcws al this event?
(st type and number of pollce/securlly personnel and lype of fencing or control barriers, If applicable.)

umber of Police Number of Sacurily Personnel [Fencing (ewtiers
bxplanate We will hire two deputies in addition to self-policing the avent. We will hire two licensed
Pxplanakoan
and bonded bartenders.

SECTION 7 Will this event be helcl on a currently licensed premises cing within the already approved premises?

LJres[Z]No it yes, Local Governing Bacly signature is nol required,

Name of Business Ucense Number «Phone (include Reo Code) ~

SECTION 8 How is this special event going to conduc! all dispensing, serving, and selling oF spitituous liquors? Plecise reciel
R-19-318 for exptaination and check one of the following boxes.

CPiace ficense in non-use
[oispense and serve all spirituous liquors Uncier retailer's license
Hoispense and serve all spiriiuaus liquors under soecial event
Lert premise belween special event cand retail location
SECTION ? What is the purpose oi this event?
[Zjonsite consumption [Clottsite (uction/wine/cistited spits pul) [poth

SECTION 10

1. Has the applicant been convicted of a felony, or had ai liquor license revoked within the last five ($5) years?
[es[¥INeo tf yes, attach explanation.
1

2. How many special event days have been issued to this organization curing the calender year? so
3. 1s the Organization using ihe services of a Licensed Contractor?

ClyesNo it yes, plecse provide Ihe Name of the Licensed Contractor: —

4. 1s the organization using the services of a series 6, 7, 11, or 12 icensee to manage the sale or service of alcohol?

ClyesINo if yes, please provide the Narne of Licensee: License i:
5. List the narne of ihe Individual or Organizalion thal will receive revenues, MUST EQUAL 100%,
St.Katherine Greek Orthodox Church 100%
Name: Percentage:
Street City * Stale apf
Narne: Percentage:
Adldress: _ _ . _
Straat lly Skila ip

7f24 72022 Page 2 of3

Please read A.R.S. § 4-203.02 Special event Ilcense; 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 prernises for your special event is the area in which you are
cuithorized to sell, dispense orserve alcoholic beverages under the provisions of your license, Please attach a diagram
of your special event licensed prernises, Please show dimensions, serving areas, fencing, barricades, or olher control
measures and secutily posilion.

If the special event will be held at a location withouf a permanent Ilquor license or It 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 Depariment of Liquor Licenses and Control. Please contact the local governing board for addifional application
requirements and submission deadlines. Additional licensing fees may also be requited before approval may be granted. For
more Information, please contact your local jurisdiction.

Declaration:

|, {Print Name} Evangelia Archuleta __. dectare under penatty of pedury that | arn
| 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 lo be true, correct and complete,

Elgg

“si fertare

Date Received:

4 recommend CIAPPROVAL [1 DISAPPROVAL
(Government Official) (ile)

On behalf of

(Clty, Town, County} Signature

CIAPPROVAL CI DISAPPROVAL BY:

A.RS. § 41-1030. Invalidity of ruies not made according fo this chapter, prohibited agency action; prohibited acts by
state employees: enforcement; notice

8, 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 nol constitute a basis for imposing a licensing requiremenl or condition unless a rule is made pursuant fo that
general grant of authoriiy that specifically authorizes the requirement or condilion,

D, This section may be enforced in a private civil action and relief may be awarded agains! fhe 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 ar knowingly violate this section. A violation of this section is cause
for disciplinary action or disrnissal pursuant to the agency's adopied personnel policy.

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

7424/2022 Page 3 of 3

SECTION 12 License premises ciagram. The licensed premises for your special avent is the area in which you are authorized
to sell, dispense or serve alcoholic beverages under the provisions of your license. the following space is to be usecl to

prepare a diagram of your special event licensed premises. Please show dimensions, serving areas, fencing, boricades, or
other control measures and securily position.

El dit Ke Nt

N Dobson Rd

BAV{2016 Page dof 4
Individuals requiing ADA accommodations call (602)542-9027,