Extracted text (via ocr_local)
8325 characters
DLLC USE ONLY
Job #:
SPECIAL EVENT LICENSE
Date Accepted:
APPLICATION FEE $25.00 PER DAY
CSR:
Arizona Department of Liquor Licenses and Control
800 W. Washington St. 5" Floor Phoenix, AZ 85007
(602) 542-5141
Application MUST be submitted to the Department of Liquor 10 days prior to the event.
License #:
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: Holdaway Melissa Ruth
(Must be an Officer/Member of the No) Middle
City State Zip
3. Applicants home/cell — Applicant's business phone: 623.974.4959
4. Applicants eri! acres
ACA Holiday Celebration at Desert Farm Lights
5. Special Event Name:
6. Name of Non-Profit Organization, Candidate or Political Party/Gov.: Success School
86-1023123
7. Non-Profit/IRS Tax Exempt Number:
8. Arizona Corporation Commission File #: 09811352 If out of State please specify:WA
(Attach letter of good standing)
9. Event Location Name: Desert Farm Lights
14629 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-CONSECUTIVE” DAY**
DAY 1: 11/22/2024 Friday 5:00pm 10:00PM
DAY 2: 11/23/2024 Saturday 5:00pm 10:00pm
DAY 3: 11/24/2024 Sunday 5:00pm 10:00pm
DAY 4: 11/25/2024 Monday 5:00pm 10:00pm
DAY 5: 11/26/2024 Tuesday 5:00pm 10:00pm
DAY 6: 11/27/2024 Wednesday 5:00pm 10:00pm
DAY?: 11/28/2024 Thursday 5:00pm 10:00pm
DAY 8:
DAY 9:
DAY10:
2/6/2023 Page 1 of 3
Individuals requiring ADA accommodations please call (602)542-2999
SECTION 2 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.)
2 Number of Police Number of Security Personnel [Fencing LBarriers
Must explain security measures: We will have fencing around the perimeter of the event and will have
police roaming the event and at both the exit and enterances.
SECTION 3 What is the purpose of this event?
WZlon-site consumption (lof-site (auction/wine/distilled spirits pull) Lboth
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) [Z)Special Event being held on an unlicensed premises will require approval and signature by the Local Governing
Body on page 3. (If checked move to section 4)
B) [Will this event be held on a currently 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 License Number Phone (Include Area Code)
Lplace license in non-use - Special Event Licensee selling all alcohol without retailer involvement
Must attach letter from the location suspending license for duration of special event
LDispense 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
Libispense and serve alll 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 letter from the location suspending license for duration of special event
Lsplit 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 retailer.)
Co# sale only - Wine/Distilled Spirits Pull, Live or Silent Auctions — Retailer wil 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?
Yes fZ) 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 alcohol on behalf of the licensee. If no special event contractor is listed, the licensee is
responsible for the sales and service of alcohol. }
WZ Yes No If yes, please provide the Name of the Special Event Contractor: Jordan Kunz
4, ls ihe 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 series 6, 7, 11, or 12 license are automatically qualified to be the special event contractor)
Yes MZINo 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.
2/6/2023 Page 2 of 3
Individuals requiring ADA accommodations please call (602)542-2999
Name: Desert Farm Lights Percentage: i)
Address: 14629 W Peoria Avenue Waddell, AZ 85355
Street Cily State Tip
Name: Success School Percentage: 29
Address: PO Box 1929 Surprise AZ 85378
Street City State Tip
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_5 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 governing body before submitting
to the Department of Liquor Licenses and Control. Please contact the local governing board for additional information.
APPLICANT SIGNATURE
Declaration:
|, (Print Name) Melissa Holdaway , declare under penalty of perjury that | am
authorized to submit this application. | have read the contents of this application, and to the best of my knowledge
believe all statements made on this application to be true, correct and complete. {Glog —
Sighature
LOCAL GOVERNING BODY
Date Received:
I, recommend LIAPPROVAL [LI DISAPPROVAL
(Government Official) (Title)
On behalf of , ,
(City, Town, County) Signature Date Phone
The local governing body (city, town or municipality where the fair/festival will take place) may require additional
applications to be completed and submitted. Please check with local government as to how far in advance they require
these applications to be submitted. Additional licensing fees may also be required before approval may be granted.
AZDLLC USE ONLY
DIAPPROVAL LI DISAPPROVAL BY:
2/6/2023 Page 3 of 3
Individuals requiring ADA accommodations please call (602)542-2999
“Mepunog Jo yoalqo ‘aunjeay
Aue Jo uonedo} asioaid ay} Jo) anyeyoujne Ayje6a) Guiag se
uodn paljai 8q jou pjnoys pue sauepunog Jo sjoafgo ‘saunjea}
40 Suojed0| pazijesauab AJUO sjuasaidas yonposd yom siyL
BNO 39V1d34 YO 38 O1 G3GNALNI LI SI YON ‘ASAUNS 1937 V LON SI SIHL
SBYNOV 6L-/+ uejd ays siyj Uo UMoYs ease “xolddy
(s3¥Ov L109) 4S $00'1Z9'2 Basy 107 UIEWN |
SdONO 'SWYY4
TWwanLinowoy asm puey
900-2b-L0S (Nd) ‘ON [seg
ud bXub b@Z1S
ssese ‘Zv ‘eppem
| 40 | Joaus poOs-oLOsed 00 b=.) :8129S BAY BMOSd M 6Z9¢L
lA Soe eur Apadoig-
| 968 ‘S39VdS ONIMYVd WLOL
senujuog aur Auadoly—]
nag "3'd 'NOSUBONY " GUYHORS
:MBNIONS
$00-ZP-105
‘senuquod aur es
youd Guns. Fas
=
xa
/
Jt
e\s |: t
& | |
PN
g|j i" |
f\~N WG GQ
|’ TN a
nineaa=| 1 . iS WINS sence
a a ae
: ——~- SANSAV-EStSL N— - Sa ——t. —3ANSAV-LSIST-N—/-
( ssoo0y, ‘eur Apedoud: youd Gunsixa. eS Oni eae