ANTHEM ROTARY FOUNDATION_REDACTED.PDF

Amount:
‘k 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 license.

(602) 542-5141
Application MUST be submitted to the Department of Liquor 10 days prior to the event.

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: Salem Edward John, Jr.

(Must be an Officer/Member of the Non Profit _ Last First Middle
2. Applicant's mailing address:

Street Cily State Zip

3. Applicants home/cell phone: Applicant's business phone: 823-900-1001

4, Applicant's email citron

Anthem Rotary Golf Tournament

5. Special Event Name:

.Anthem Rotary Foundation

6. Name of Non-Profit Organization, Candidate or Political Party/Gov.:

47-0930766 / 26-00640058
4, 109477921

7. Non-Profit/IRS Tax Exempt Number:

If out of State please specify:

8. Arizona Corporation Commission File
(Attach letter of good standing)

9. Event Location Name: [ronwood Golf and Country Club
41551 N Anthem Hills Dr, Phoenix, AZ 85086

Dates and Hours of Event - Days must be consecutive and may not exceed 10 consecutive days.

10. Event Address:

**SEPARATE APPLICATION FOR EACH “NON-CONSECUTIVE” DAY**

payi. 05/18/2024 Saturday 7:00AM 10:00PM
DAY 2:
DAY 3:

DAY 4: worl - YZ
RECEIVED

DAY 5:

DAY 6: MAR 1 1 2024

DAY 7: MARICOPA GOUNTY

CLERK BOARD OF SUPERVISORS

DAY 8:

DAY 9:

DAY 10:

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 ype and number of police/securily personnel and type of fencing or conirol baniers, if applicable.)

2

2 Number of Police Number of Security Personnel [Fencing [ZBaniers

Off duty law enforcement and security personnel with be at the event

Must explain security measures:

at entrances and exits.

SECTION 3 What is the purpose of this event?

(7On-site consumption (Clott-site (auction/wine/distilled spirits pull) [Both

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) [21 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) EJ will this event be held on a currently licensed premises and within the already approved and licensed area?
(Must attach a efter from the licensed premises with an explanation of the option checked below)

Name of Business license Number Phone (Include Area Code)

place 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

[Ibispense 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

Cbispense 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 lefter from the location suspending license for duration of special event

split 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.)

(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?
(1 Yes [7] No If yes, attach letter of explanation,

2. How many special event days have been issued to this organization during the calendar year? 6

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. }

(1 ves [7] No If yes, please provide the Name of the Special Event Contractor:

4. \s 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 series 6, 7, 11, or 12 license are automatically qualified to be the special event contractor)

(Clyes I 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.

2/6/2023 Page 2 of 3
Individuals recuiirina: ADA accammadatians lease call 14N21549-2999

Anthem Rotary Foundation Percentage: 100%

Name:
Address
Street City State Tip
Name: Percentage:
Address:
Street Clty State Zip

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 MAUST BE FOR CONSUMPTION AT THE EVENT SITE ONLY.

RA A fa ASP fs N N mis AK NLA ON Wink OR D

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) Edward John Salem Jr _ declare under penalty of perjury that | am
authorized to submit this application. | have read the contents of this application, and to ihe best of my knowledge 4
believe all statements made on this application to be true, com

LOCAL GOVERNING BODY
Date Received:

L

(Government Official) (Title)
On behalf of

(City, Town, County) Signature

The local governing body (city, town or municipality where the fair/festival will take place) may require additional
applications fo be completed and submiited. 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

CIAPPROVAL CJ DISAPPROVAL BY:

2/6/2023 Page 3 of 3
Individuals recuirina ADA accammoadatians nlease call (4071549-2999

Edward John Salem Jr

Anthem Rotary Foundation

March 7, 2024

Arizona Department of Liquor Licenses and Control
800 W Washington St, 5" Floor

Phoenix, AZ 85007

To whom it may concern,

With regard to section 3 of the Special Event License Application, | am including the following
information:

For our upcoming “Anthem Rotary Golf Tournament” special event, all spirits and beverages are
supplied to the Anthem Rotary Foundation by a wholesale distributor. The company is Crescent Crown
Distributing, 1640 W Broadway Rd, Mesa, AZ 85202

Thank you. Sincerely,

Pludy Flu Z

a ard John Salem Jr.