ST. ROSE PHILIPPINE DUCHESNE ROMAN CATHOLIC PARISH ANTHEM_REDACTED.PDF

DLLC USE ONLY

Job #:
Arizona Department Liquor License and Control
800 W Washington St. 5! Floor Date Accepted:
Phoenix, AZ 85007-2934 CSR:
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. . y ko
— ey } Adi

1. Applicant: St-Rose-Philippine Duchesne Catholic Church DAA tats U0

2. Applicant's mailing cddrs5
City State Zip
3. Applicants home/cell — Applicant’s business phone: 623-465-9740
ya

4, Applicant's email address; y

£
St Rose Philippine Duchesne K ovict

;

SECTION 2 Name of Non-Profit Organization, Candidate or Political Party/Gov.:
0928 EIN 36-4644267  (athoWe Pawsh

SECTION 3 Non-Profit/IRS Tax Exempt Number: Rove ete
SECTION 4 Event Location; 2825 W Rose Canyon Circle Anthem AZ 85086
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 Te a en
DAY 1: 10-15-21 Friday 5:00 PM 10:00 PM
DAY 2: 10-16-21 Saturday 4:00 PM 10:00 PM
DAY 3: 10-17-21 Sunday 2:00 PM 6:00 PM
DAY 4:
DAY 8:
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 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 4 Number of Security Personnel [Fencing MBarriers

Each day, 2 Police Deputies, 4 Security Personnel with enclosed fence and baricades

Explanation:
Members of the security detail will move throughout the event during hours of operation

SECTION 7 Will this event be held on a currently licensed premises and within the already approved premises?

OlyYes [1 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
[M1bdispense 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?
[on-site consumption LO ff-site (auction/wine/distilled spirits pull) [Both
SECTION 10

1, Has the applicant been convicted of a felony, or had a liquor license revoked within the last five (5) years?
ClYes M1No If yes, attach explanation.

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

(Des HI No If yes, please provide the Name of the Licensed Contractor:

4, Is the organization using the services of a series 6, 7, 11, or 12 licensee to manage the sale or service of alcohol?

Yes (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 total liquor sales. List the names
of the individuals or organizations who will rec Ree rest of the wer MUST ry 100%.
e

St Rose Philippine Duches 6%

in val” aj” nh aoe

Name:
Address 2825 W Rose Canyon Cir Anthem AZ 85086
, Street Clty State lp
Name: Percentage:
Address:
Street Clty State Zip
4/9/2021 Page 2 of 3

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 DIAGR

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 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

Fr. Francisco Colasito

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 herein are true and correct to the best of my knowledge.

Applicant Signature:

il

GOVERNING BOARD

Date Received:

recommend CIAPPROVAL [1 DISAPPROVAL

(Government Official) (Title)

On behalf of ,
(City, Town, County) Signature Date Phone

DLLC USE ONLY
SR Soe TT |
CIAPPROVAL C1 DISAPPROVAL BY: DATE:
— _ — ———— —

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 shail 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 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 requiting ADA accommodations please call (602)542-9027

Zone

neon LANG be OP ee

St Rose

Fall Festival 2021

oncert Seating

Vendor Booths

anes
a