VULTURE CITY PRESERVATION, INC._REDACTED.PDF

DLLC USE ONLY

dob #:
Arizona Department Liquor License and Control
800 W Washington St. 5!" Floor Date Accepted:
Phoenix, AZ 85007-2934 SR:
azliquor.gov .
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: ROBIN MORIARTY

2. Applicant's mailing address: ——————eee
Clly State Ip
3. Applicants home/cell — ae Applicant's business phone:
_ VULTURE CITY PRESERVATION, INC.

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

SECTION 3 Non-Profit/IRS Tax Exempt Number: 85-087056
SECTION 4 Event Location; 36610 N 355TH AVE, WICKENBURG, AZ 85390

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 TINE BNUPAA ine aen
DAY 1: OCT 21 2022 FRIDAY NOON 10PM
DAY 2: OCT 22 2022 SATURDAY NOON 10PM
DAY 3: OCT 23 2022 SUNDAY NOON 10PM
DAY 4:

DAY 5:

DAY 6:

DAY 7:

DAY 8:

DAY ?:

DAY10:

4/9/2021 Page 1 of 3

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

y-) Morel mot.
Sevedes SB

DLLC USE ONLY

Arizona Department Liquor License and Control
800 W Washington St. 5! Floor
Phoenix, AZ 85007-2934

azliquor.gov
602-542-5141

Date Accepted:

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

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.

ROBIN MORIARTY,

1. Applicant:

2. Applicant's mailing address

Applicant’s business phone:

3. Applicants home/cell phone

4, Applicant's email address:
VULTURE CITY PRESERVATION, INC.

SECTION 2 Name of Non-Profit Organization, Candidate or Political Party/Gov.:
SECTION 3 Non-Profit/IRS Tax Exempt Number So7O84096- 6 S- ig} g 1 bO Ske
36610 N 355TH AVE, WICKENBURG, AZ 85390

SECTION 4 Event Location:

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 Dale Day of Week sO AMEM fe a/eM

DAY 1: OCT 21 2022 FRIDAY NOON 10PM

DAY 2: OCT 22 2022 SATURDAY NOON 10PM

DAY 3: OCT 23 2022 SUNDAY NOON 10PM

DAY 4:

DAY 5:

DAY 6:

DAY 7:

DAY 8:

DAY 9:

DAY10: -
4/9/2021 Page 1 of 3

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

SECTION 4 What type of security and control measures will you take to prevent violations of liquor laws at this event?
(List type and number of pollce/security personnel and type of fencing or control barriers, If applicable.)

Number of Police 2 Number of Security Personnel [Fencing Lbarriers
Explanation: THERE WILL BE 2 STAFF MEMBERS TENDING BAR WITH 2 ADDITIONAL

SECURITY VOLUNTEERS, ALL STAFF WILL BE TRAINED ACCORDING TO THE POLICIES
AND PROCEDURES OUTLINED BY THE ARIZONA DEPARTMENT OF LIQUOR LICENSES
AND CONTROL

SECTION 7 Will this event be held on a currently licensed premises and within the already approved premises?
DYesE1 No If yes, Local Governing Body signature is not required.

Name of Business Ucense Number Phone (Include Area Code)

SECTION 8 How's 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
Dobispense and serve alll spirituous liquors under retailer's license
Elbispense and serve all spirituous liquors under special event
Dsplit premise between special event and retail location
SECTION 9 What is the purpose of this event?
Elon-site consumption [off-site (auction/wine/distilled spirits pull) [180th
SECTION 10

1, Has the applicant been convicted of a felony, or had a liquor license revoked within the last five (5) years?
(Yes HI No If yes, attach explanation.

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

D Yes 1 No 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?
(Yes 1 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 fotal liquor sales. List the names
of the individuals or organizations who will receive the rest of the proceeds, MUST EQUAL 100%.

Name: VULTURE CITY PRESERVATIONS ING Percentage:_100%
aderew, B40 S WEST ROAD, UNIT 22, WICKENBURG, AZ 85390
Street Clty State Up
Name: Percentage:
Address:
Street City Stale Up
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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, 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
ROBIN MORIARTY . ,
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 hereln are true and correct to the best of my ane
7
Bs
Applicant Signatvre<=

GOVERNING BOARD

Date Received:

|
\, recommend LIAPPROVAL [1 DISAPPROVAL
(Government Official) {Tite)

On behalf of ‘ ‘ .
(Clty, Town, County) Signature Date Phone

DLLC USE ONLY

CIAPPROVAL CJ DISAPPROVAL BY:

A.R.S. § 41-1030. Invalidity of rules not made according to thls 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 d 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.

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

Open Bar / Serving Area

(Note, 2 attendants at bar at all times)

TENT/SEATING AREA

Secu’? Check

Entrance

e Security

Fencing
/barrier

Special Event Space