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CSR:
Amount:
DLLC USE ONLY
Job #:
SPECIAL EVENT LICENSE
Date Accepted:
APPLICATION FEE $25.00 PER DAY
Arizona Department of Liquor Licenses and Control
800 W. Washington St. 5" Floor Phoenix, AZ 85007 Hcense #
(602) 542-5141
Application MUST be submitted to the Department of Liquor 10 days prior to the event.
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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: Eastburn, Rachel
2. Applicant’s mailing address:
Sheet City State Zip
3. Applicants home/cell phon: Applicant's business phone:
4, Applicant's email cccress ll
Desert Farm Lights
5. Special Event Name:
6. Name of Non-Profit Organization, Candidate or Political Party/Gov.: Honor Dance \ NC.
88-2494849
7. Non-Profit/IRS Tax Exempt Number:
g. Arizona Corporation Commission File #: 23369595 If out of State please specify:
(Aitach letter of good standing)
9. Event Location Name: Desert Farm Lights
44629 W Peoria Avenue, Waddell, AZ 85355
10. Event Address:
Dates and Hours of Event - Days must be consecutive and may not exceed 10 consecutive days.
“SEPARATE APPLICATION FOR EACH “NON-CONSEGUTIVE” DAY**
Days Date Day of Week Tec AMPM Tee anyent
DAY I: 12/6/24 Friday 5:00pm 10:00P.M
DAY 2: 12/7124 Saturday 5:00pm 10:00P.M
DAY 3: 12/8/24 Sunday 5:00pm 10:00P.M
DAY 4: 12/9/24 Monday 5:00pm 10:00P.M
DAY 5: 12/10/24 Tuesday 5:00pm 10:00P.M
DAY 6: 12/11/24 Wednesday 5:00pm 10:00P.M
DAY 7: 12/12/24 Thursday 5:00pm 10:00P.M
DAY 8: _
DAYS; RECEIVED _
DAY10: __ SEP-4-0-9924-——_—
MARICOPA COUNTY
CLERK BOARD OF SUPERVISORS
SECTION 2 What type of security and control measures will you take to prevent violations of liquor laws at this event?
(ust type and number of police/security personnel and type of fencing or control barriers, If applicable.)
2 Numberof Police. == Number of Security Personnel [Fencing Cbaniers
Must explain security measures: We will have fencing around the peremeter of the event. We will have seci
roaming the event and both the entrance and exits.
SECTION 3 What is the purpose of this event?
[2l0n-site consumption Clot-site (auction/wine/distilled spirits pull) Clsoih
How is this special event going to conduct all dispensing, serving, and selling of spirituous liquors?
Check one of the following boxes. (R-19-318)
A) [2] Special Event being held on an unlicensed premises will require approval and signature by the Local Governing
Body on page 3. (If checked move fo section 4)
8) [1 Will this event be held on a curently licensed premises and within the already approved and licensed area?
(Must attach a letter from the licensed premises with an explanation of the option checked below)
Name of Business LUicense Number Phone (Include Area Code)
(Clpiace license in non-use - Special Event Licensee selling all alcoho! without retailer involvement
Must attach letter from the location suspending license for duration of special event
[bispense and serve alll spirituous liquors under retailer's license ~ Business operates normally, minimum of 25% of gross
revenue from alcohol sales is donated to licensee
Lbispense and serve all spirituous liquors under special event - The special event licensee is in charge of selling alcohol that was
purchased or donated by the special event licensee. The retailers existing alcohol inventory must be separated from any alcohol
used during the special event. Must attach leiter from the locaiion suspending license for duration of special event
Cspiit premise between special event and retail location - Both the special event licensee and the retailer will conduct
sales of alcohol. (These sales will be done in separate areas. If alcohol is donated or purchased by the special event licensee
it must be in a separate area than the alcohol! that is dispensed by the licensed refailer.)
(loft sale only - Wine/Distilled Spirits Pull, Live or Silent Auctions — Retailer will still be permitted to conduct all normal sale and
service of alcohol.
SECTION 4
1. Has the applicant been convicted of a felony, or had a liquor license revoked within the last five (5) years?
(C1 Yes [2] No If yes, attach letter of explanation.
2. How many special event days have been issued to this organization during the calendar year? 0
3. is the Organization using the services of a Special Event Contractor? (A licensee can utilize the services of a special event
contractor who may purchase and sell alcoho! on behalf of the licensee. If no special event contractor is listed, the licensee is
responsible for the sales and service of alcohol. }
[2] Yes No If yes, please provide the Name of the Special Event Contractor: Jordan Kunz
4. 1s the organization using the services of a series 6, 7, 11, or 12 licensee to manage the sale or service of alcohol?
{Licensees who hold a seties 6, 7, 11, or 12 license are automatically qualified to be the special event contractor}
(les [2] No if yes, please provide the Name of Licensee: License #:
5. List the name of the Individual or Organization that will receive revenues, MUST EQUAL 100 PERCENT.
Attach additional sheet if necessary.
Name: West Valley Events and Marketing LLC Percentage: /5%
Address: 14963 W Tasha Drive _ Surprise AZ 85374
Street Clty State Zip
Name: Honor Dance IWC. Percentage: 20%
Address: 14211 W Windrose Drive, Surprise AZ 85379
Street Clty State ap
Please read A.R.S. § 4-203.02 Special event license; ules and R19-1-205 Requirements for a Special Event License.
ALL ALCOHOLIC BEVERAGE SALES MUST BE FOR CONSUMPTION AT THE EVENT SITE ONLY.
NA ON WINE OR D
SECTION_5 License premises diagram. The licensed premises for your special event is the area in which you are
authorized fo 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 governing body before submitting
fo the Department of Liquor Licenses and Control. Please contact the local governing board for additional information.
APPLICANT SIGNATURE
| Declaration:
I 1, (Print Name) Rachel Eastourn _ declare under penalty of perjury that | am
| quthorized fo submit this application. | have read the contenis of this application, and to the best of my knowledge |
"Signature —~
I believe all statements made on this application to be true, corect and epmplete.
(Goverment Official) {Tiley
On behalf of
{City, Town, County) ° Signature
The local governing body (city, town or municipolity where the fair/festival will take place) may require additional
applications fo be completed and submitted. Please check wilh local government as fo how far in advance they require
these applications te be submifted. Addifional licensing fees may also be required before approval may be granted.
AZDLLC USE ONLY
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