NATIONAL MULTIPLE SCLEROSIS SOCIETY_REDACTED.PDF

CSR:

Amount:

SPECIAL EVENT LICENSE _ DLLC USE ONLY

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

v 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. Applieants Kate Scotece

2. Applicant's mailing address}

City State Zip

Applicant's business phone: 509-481-703

3. Applicants home/cell phoney

4. Applicant's email address:

SECTION 2 Name of Non-Profit Organization, Candidate or Political Party/Gov.: National Multiple Sclerosis Society

SECTION 3 Non-Profit/IRS Tax Exempt Number: 13-5661935

SECTION 4 Arizona Corporation Commission File #: FO7718786 _If out of State please specify:

SECTION 5 Event Location Name: McDowell Mountain Regional Park

SECTION 6 Event Address; 16300 McDowell Mountain Drive, Fort McDowell, AZ, 85264

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**

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

DAY 1: 10/7/2022 Friday 4pm 10pm
DAY 2: 10/8/2022 Saturday 11am 10pm
DAY 3: 10/9/2022 Sunday 11am 2pm

DAY 4:

Days Date

DAY 5:

DAY 6:

DAY 7:

DAY 8:

DAY 9:

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 1

Explanation, We will have 1 hired security onsite during the event. The beer
garden will be fenced off from the rest of the event and alcohol will be
contained within. Bartenders will be hired to check for proper identification
and pouring alcohol.

Number of Security Personnel [Fencing Lbarriers

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

Dyes WINo 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.

(Place license in non-use

Lbispense and serve all spirituous liquors under retailer's license
[Dispense and serve alll spirituous liquors under special event
Lspiit premise between special event and retail location

SECTION 2 What is the purpose of this event?

[on-site consumption [off-site (auction/wine/distilled spirits pull) [Both

SECTION 10
]. Has the applicant been convicted of a felony, or had a liquor license revoked within the last five (5) years?
[Yes [JNo If yes, attach explanation.
0

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?

Hay Bartender LLC

MYes CINo If yes, please provide the Name of the Licensed Contractor:

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

[1 Yes YINo 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%.

Name: National Multiple Sclerosis Society Percentage: 100
address: DO25 E. Washington St. Ste. 102 Phoenix, AZ 85034
, Street Clty State Zip
Name: Percentage:
Address:
Street Clty State Zip
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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

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:

Kate Scotece
|, (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 complete.

Aate Seotice

Signature

Date Received:

recommend CIAPPROVAL [1] DISAPPROVAL

(Government Official) (Title)

On behalf of , , ,
(City, Town, County) Signature

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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