MIRACLE RYKER FOUNDATION_REDACTED.PDF

DLLC USE ONLY

Job #:
Arizona Department Liquor License and Control
800 W Washington St. 5'» Floor Date Accepted:
Phoenix, AZ 85007-2934 ek
azliquor.gov 3
602-542-5141 License #:

SPECIAL EVENT LICENSE APPLICATION
FEE $25.00 PER DAY

A service fee of $25.00 will be charged for all dishonored checks (A.R.S § 44-6852
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; Rachel Warner
City State Tip
3. Applicants home/cell — | Applicant's business phone: 480-826-7866

4.Appicen's emai! occ hn

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

Miracle Ryker Foundation

SECTION 3 Non-Profit/IRS Tax Exempt Number: 47-4370565
SECTION 4 Event Location: Mi Hacienda Events Venue 7644 S 27th Ave Laveen, AZ 85339

SECTION _5 Dates and Hours of Event. Days must be consecutive but may not exceed 10 consecutive days.
See A.R.S. § 4-244(15) and (17) for legal hours of service.

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

Days Date Day of Week es AE . babapeeye
payi. 9/18/2022 Sunday 2:00pm 10:00pm
DAY ‘ mS 00 a
DAY 5: .
DAY 6:
DAY?: =
DAY 8:
DAY 9:
DAYI0:
4/9/2021 Page 1 of 3

Individuals requiring ADA accommodations please call (602)542-9027

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.)

o-1 ) Number of Police 1 0-20 Number of Security Personnel MFencing Dbariers

. 3-5 security personnel will be placed at the main event entrance and 3-5 security personnel will be placed at each of the 3 bars.
Explanation:

Security personnel will check and verify ID's, and using a custom ink stamp, they will stamp the hand of individuals 21 years of age and older

Off duty police officers will roam and move freely throughout the interior and exterior of the event to ensure the safety of event goers and community

members. A permanent stationary fence surrounds the event venue and provides a single entrance/exit point that will be staffed with security.

SECTION 7 Will this event be held on a currently licensed premises and within the already approved premises?
ClyesM1 No 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

Dbispense and serve all spirituous liquors under retailer's license
Mispense and serve all spirituous liquors under special event
Dspiit premise between special event and retail location

SECTION 92 What is the purpose of this event?

[on-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?
OyYes MINo 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?

Ll yYes 1 No ff yes, please provide the Name of the Licensed 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?

LJ Yes [7] No if yes, please provide the Name of Licensee: License #:

5. The applying non-profit organization must receive 25% of the gross revenues of the total liquor sales. List the names
of the individuals or organizations who will receive the rest of the proceeds, MUST EQUAL 100%.

Name: Miracle Ryker Foundation Percentage: 29

Address: 839 E Cherrywood Place Chandler AZ 85249

Name: Aleantar Music LLC om Percentag 75 ”

Address: 1001 N 7th St#320 Phoenix AZ 85006
Street City State lip

4/9/2021 Page 2 of 3

Individuals requiring ADA accommodations please call (602)542-9027

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, baricades, 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 govemment before submission
to the Department of Liquor Licenses and Control. Please contact the local goveming 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.

SIGNATURE

Rachel Warner .
I, (Print Full Name) hereby swear under penalty of perjury and in compliance

with A.R.S. § 4-210(A)(2) and (3) that | have read and understand the foregoing and verify that the information and
statements that | have made herein are true and correct to the best of my knowledge.

Applicant Signature: ay ner

GOVERNING BOARD

Date Received:

recommend DIAPPROVAL (I DISAPPROVAL

(Govemment Official)

On behalf of

(City, Town, County) Signature

——

DLLC USE ONLY

CIAPPROVAL C1] DISAPPROVAL BY:

—
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 arule 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

teasonable attomey 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.

4/9/2021 Page 3 of 3
Individuals requiring ADA accommodations please call (602)542-9027

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