KNIGHTS OF COLUMBUS COUNCIL 12144_REDACTED.PDF

DLLC USE ONLY

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

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. Apelieants Frank J. Macedon

Street City State Zip
3. Applicants home/cell phone! Applicant's business phone: N/A - Retired

4. Applicant's email address

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

SECTION 3 Non-Profit/IRS Tax Exempt Number: 86-0907785
SECTION 4 Event Location: St. Elazabeth Seton Church Hall, 9728 W. Palmeras Dr., Sun City, AZ 85373

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 B ssingi an re cao

DAY 1: 10/08/2022 Saturday 5:00PM 11:00PM

DAY 2:

DAY 3:

DAY 4:

DAY 5:

DAY 6: '

DAY 7: MECEIVED nal

DAY 8: JUN 29 2099 a"

DAY 9: CLERK BOM rho :

DAY10: SUPERVISORS
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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.)

Number of Police 3

Number of Security Personnel CFencing DoBarriers
We will require identification in accordence with ARS 4-241.

Explanation:

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

Lodispense and serve alll spirituous liquors under retailer's license
E.1bispense and serve alll spirituous liquors under special event
Dsplit 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) [80th

SECTION 10

1. Has the applicant been convicted of a felony, or had a liquor license revoked within the last five (5) years?
OYes LINo If yes, attach explanation.

2. How many special event days have been issued to this organization during the calendar year? None
3. Is the Organization using the services of a Licensed Contractor?

CO Yes HINo If 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?

C1 Yes 21 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: Knights of Columbus Council 12144  p..coniage: 100
Address 9/28 West Palmeras Drive, Sun City, Arizona 85373

Street City State lip
Name: Percentage:
Address:

Street Cily State Zip
4/9/2021 Page 20 KH

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.

im R R D PIR
ICENSE IS STAC: WITH WINE DISTILLERY FESTIVAL LICENSE

LL SEALED ERS OR THE S TAL EVENT L
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.

SIGNATURE

Frank J. Macedon

1, (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 Cr
+t

Applicant Signature?

GOVERNING BOARD

Date Received:

recommend LCIAPPROVAL [I DISAPPROVAL

(Government Official) (Title)

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

DLLC USE ONLY

DIAPPROVAL LI DISAPPROVAL BY:

dS

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. Astate 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 ¥ Y
Individuals requiring ADA accommodations please call (602)542-9027

SECTION 44 License premises diagram. The

need
vader the
nsec pre:

to sell, dispense or serve alcoholic bevera:
prepare a diagram of your special eve:
other control mesures and secutily rm

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ou ore authorized

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license. The following space js bo be used fo.
thnansions, serving creas, fencing, barricades, or

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Page fot 4
Individuals requiing ADA accomraodations ceil (602)542-9027.

8/3/2015