Extracted text (via ocr_local)
7215 characters
DLLC USE ONLY
Job #:
Arizona Department Liquor License and Control
800 W Washington St. 5" Floor Date Accepted:
Phoenix, AZ 85007-2934 nae
azliquor.gov .
602-542-5141 Hcense #2
SPECIAL EVENT LICENSE APPLICATION
FEE $25.00 PER DAY
A service fee of $25.00 will be charged for all dishonored checks (A.R.S § 44-6852
1-10 days consecutive days only, Cash, Checks or Money Orders Only
SECTION 1 Applicant must be a member of a qualifying nonprofit organization, political party, or Government entity and
authorized by an Officer, Director, or Chairperson of the Organization.
1. Applicant:
2. Applicant's mailing address:
[EE business phone:
uss Lacan’ sin Pei
3. Applicants home/cell phone
4. Applicant's email address:
SECTION 2 Name of Non-Profit Organization, Candidate or Political Party/Gov.:
SECTION 3 Non-Profit/IRS Tax Exempt Number: Ble- ASS AAA
SECTION 4 Event Location: Risen S Gy iok Louder C larch, 23als S$ Dima Schoo! Rd
Sun ales, AZ BSF
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**
Event Start License End
Days oie Day of Week Time AM/PM Time AM/PM
DAY 1: Cela \4 Qo Sahut day 8:00 Pm Area Pm
DAY 2:
DAY 3:
DAY 4:
DAY 5:
DAY 6:
DAY 7:
DAY 8:
DAY 9:
DAY10:
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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 Number of Security Personnel (Fencing CoBariers
Explanation: ‘Ne. x91 \\ he anit a2 Rarhendage ago W Princes Oe.
“Tevpe he. 89233 Whritkey Winasield
Owner Coram thes venevn bets will also WON item rhe cole od
\ \q wer an
SECTION 7 Will this event be held on a currently licensed premises and within the already approved premises?
Dyes 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
Lobispense and serve alll spirituous liquors under retailer's license
Nibispense and serve alll spirituous liquors under special event
Cisplit premise between special event and retail location
SECTION 2 What is the purpose of this event?
fflOn-site consumption Cloft-site (auction/wine/cistilled spirits pull) [Both
SECTION
1. Has the applicant been convicted of a felony, or had a liquor license revoked within the last five (5) years?
CyYes BY No If yes, attach explanation.
2. How many special event days have been issued to this organization during the calendar year? [ v OW E
3. Is the Organization using the services of a Licensed Contractor?
WYes CINo If yes, please provide the Name of the Licensed Contractor: Q
Watney W
A
doe * sal
4. ls the organization using the services of a series 6, 7, 11, or 12 licensee to manage the sale or s&rvice of alcohol?
yes EBNo if yes, please provide the Name of Licensee: License #:
5. The applying non-profit organization must receive 25% of the gross revenues of the tofal liquor sales. List the names
of the individuals or organizations who will receive the rest of the proceeds, MUST EQUAL 100%.
Name: any dn \n aeas C\ us Percentage:___ 190 ey
Address: Welle rd S ‘ Gi \e QI Gta. Sunales Az. 85243
Street City State
Name: Percentage:
Address:
Street City State Zip
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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.
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 Conirol. 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
1, (Print Full esac Malet WN Gh opgel hereby swear under penalty of perjury and in compliance
with A.R.S. § 4-210(A)(2) and (3) that | have and understand the foregoing and verify that the information and
statements that | have made herein are true and correct to the best of mee
Applicant Signature:
GOVERNING BOARD
Date Received:
recommend CIAPPROVAL [1 DISAPPROVAL
(Government Official)
On behalf of
(City, Town, County) Signature
DLLC USE ONLY
CIAPPROVAL CI] 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 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 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. 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 3
Individuals requiring ADA accommodations please call (602)542-9027
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