FRANCISCAN RENEWAL CENTER, INC._REDACTED.PDF
Extracted text (via ocr_local)
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DLLCUSEONLY
Job #:
Atizona Department Liquor License and Control a
800 W Washington St. 5! Floor Date Accepted:
Phoenix, AZ 85007-2934 ciRO
azliquor.gov
| License #: —
602-542-5141
SPECIAL EVENT LICENSE APPLICATION
FEE $25.00 PER DAY
Aservice 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.
% row
1. Applicant:
2. Applicant's mailing address
Street City
3. Applicants home/cell phone: (02- fo7 2” 4 S26 ) Applicant's business phon
4. Applicant's email address:
SECTION 2 Name of Non-Profit Organization, Candidate or Political Party/Gov.: Franciscan Ve newdal Cauree, Tay,
SECTION 3 Non-Profit/IRS Tax Exempt Number: ¥o~ 072. C9 Bb
SECTION 4 Event Location: _ S KO2. E dt Cota De. fagaods vACLey 253
625
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-CONSEGUTIVE” DAY**
. Event Start License End
Days Date Day of Week Time AM/PM Time AM/PM
DAY 1; 4-4 -2Z. Salil dl AN G ma74e
DAY 2:
DAY 3:
DAY 4:
DAY 5S:
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 police/security personnel and type of fencing or control barriers, if applicable.)
sa _Number of Police ___ _ Nurnber of Security Personnel Fencing Carriers
Explanation: - Wl L Weae @ Weel bab. “They will
Onluy bee fieovested 2 tickets foe a _alsé& of Wine. The sev
hen tay dol le far These aHend eds. JOue. fastens Fre cei,
bps peal Cerra clad to S¢ee The_Wive- :
SECTION 7 Will this event be held on a currently licensed premises and within the already approved premises?
y
Olyes No if yes, Local Governing Body signature is not required.
“Name of Business "License Number Phone (include Area Cade) :
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.
CPlace license in non-use
meense and serve all spirituous liquors under retailer's license
Dispense and serve all spirituous liquors under special event
(split premise between special event and retail location
SECTION 2 What is the purpose of this event?
7
[On-site consumption LIOff-site (auction/wine/distilied spirits pull) (Both
SECTION 10
1. Has Make vce been convicted of a felony, or had a liquor license revoked within the last five (5) years?
ClYes if yes, attach expianation
2. How many special event days have been issued to this organization during the calendar year? ¢ 2 ee
3. Is the Organization using the services of a Licensed Contractor? Pour mecler
Yes CINo If yes, please provide the Name of the Licensed Contractor: Da Vi A oemMa
4, Is the organization using the services of a series 6, 7, 11, or 12 licensee to manage the sale or service of alcohol?
Poue. MaGees Leprol!
Wes CINo if yes, please provide the Name of Licensee: License #: 1
5, The applying non-profit organization must receive 25% of the gross revenues of tne total liquor sales. List the names
of the individuals or organizations who will receive the rest of the proceeds, MUST EQUAL 100%.
Name: FRAN SCan Perewbl Cervie@R. Percentage: 1007... -
races: SUX E. Linc de __Sevhkdale._4g SQSB
Street City
Name: . _ __. Percentage:
Address; __ . . -
Street City Stale Zip
419/202) Page 2 of 3
Individuals requiring ADA accommodations please Cai: 1602)542-9027
ad 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.
DALG > BEVERAGES §) CIAL EVENT UN HEY ARE IN
PULL SEALED CONTAINERS OR THE SPECIAL EVENT LICENSE IS STACKED WITH WIN.
Please re
AUCTIO INE OR DISTILLED SPIRITS
E /CRAFT DISTILLERY FESTIVAL LICENSE
P ARE
SECTION 11 License premises diagram. The licensed premises for your speciai 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 eveni licensed premises. Please show dimensions, serving areas, fencing, barricades, or other control
measures and security position.
ATTACH DIAGRA:
Ifthe 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 focal 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 lecal jurisdiction. :
SIGNATURE
= SR Sj
t, (Print Full Name) ¥ N 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 verifyAfiat the information and
statements that | have made herein are true and correct to the best of my knoweep
£9
Sa ARSE ee jaune saeco
4
Applicant Signature:
GOVERNING BOARD
Date Received: |
recommend CIApPROVAL [1 DISAPPROVAL
(Government Official) : “(litle) i
On behalf of _ een cen wm Sas ee ae “ Shon |
DLLC USE ONLY _
TDOAPPROVAL C1 DISAPPROVAL BY: DATE: a
—— —
ARS. § 41-1030. Invalidity of rules not made according to this chapter, prohibited agency action; prohibited acts by
state employees: enforcement, notice
8. An agency shall not base a “censing decision in whc's or in part on a licensing requirement ar condition that is not specifically
authorized by statute, rule or state tribal gaming compact. A general grant of ai:thority in siatute does not constitute a basis for imposing a
censing requirement or conaition unless a rule is made pursuant fo thai general grant of authority that specifica'ly authorizes the requirement
or condition.
D. This section may be enforced in a privaie civil action and relief may be awarded agains! the state. The court may award
réasonable attorney fees, damages and all fees associated with the license appiicaiion to a party that prevails in ar action against the state
for a violation of this section.
£. A state empioyee may net intentionally or knowingly violate this section, A violation of this section is cause for disciplinary action
or dismissal pursuant fo the agency's adopted personnel policy.
F, This section does not abrogate the immunity provided by section 12-820.01 or 12-820.52.
4/9/2902) Page 3 of 3
individuals requinng ADA aecommedations please cal (602)542-9927
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