Bingo License Application - Pueblo El Mirage

ARIZONA DEPARTMENT OF REVENUE 
BINGO LICENSE 
LICENSE INFORMATION 
Pueblo El Mirage RV Resort 
Attention: Bingo Manager 
11201 N. El Mira2e Rd 
El Mirage, Az 85335 
LICENSE NUMBER: 09-045-A 
ADMIN ADDRESS: 1120 I N. El Mirage Rd 
ADMIN PHONE: (623) 583-6092 
LICENSE EXPIRES: 9/30/2025 
Date Mailed: 11/26/2025 
PLACE WHERE GAMES WILL BE HELD: 
I 1201 N. El Mirage Rd 
DAYS AND TIME OF OCCASIONS: 
Tuesday 12 - 2:30 pm and Sat 5-7:30 pm 
DATES OF PROPOSED OCCASION CANCELLATION: 
LICENSED FOR SPECIAL BONUS GAMES: 
No 
DA Yfl'JME OF SBG: 
(If licensed, attach documentation describing how you are conducting the special bonus same program.) 
MANAGER: 
Robin Fischer 
Christine Finocchiaro 
PROCEEDS COORDINATOR: 
Annetta Messina-Carpenter

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T_r1s"._A_pplication for Bingo License Packet includes: 
• Arizona Form 833 -Application for Bingo License 
• Arizona Form 830 -Affidavit 
• Arizona Form 832 -
Endorsement by Local Governing Body 
It is advisable that you obtain and review a copy of the 
Arizona Revised Statutes on "Games of Bingo" and the 
Administrative Rules prior to initiating an application. 
These documents outline qualifications and requirements 
for obtaining a bingo license and may be obtained from: 
• www.azleg.gov/ and 
• www.azsos.gov/public _services/table_ of_ contents .htm 
All forms must be complete and legible. Please type or 
print using black ink only. Forms are available in a fillable 
pdf format at Arizona Department of Revenue (ADOR) 
web site www.azdor.gov. 
Be sure to include on your 
application a telephone number where you (or another 
party responsible for the games) can be reached during 
the day. 
The bingo license package for new license and appropriate 
fees must be sent to and approved by the local governing 
body (the city council for incorporated cities or the county 
board of supervisors for unincorporated areas) prior 
lo submission to the ADOR Bingo Section. Upon their 
approval or disapproval, the local governing body will 
forward the license package to the ADOR Bingo Section. 
Endorsement By Local Governing Body Form 
Complete lines 2, 3, and 4 of Arizona Form 832, 
Endorsement by Local Governing Body and submit to 
your local governing body with the bingo license package. 
A bingo license cannot be issued until this form is 
received by the ADOR Bingo Section. 
As part of the review of your application for a bingo license, 
the ADOR Bingo Section will conduct an analysis of 
any purchase agreement for either equipment and/ 
or real property to determine that such agreement 
is bona fide. 
This analysis is conducted pursuant to 
A.RS. 5-406.F. The Bingo Section does not "approve" 
these agreements as to content or other legal ramifications. 
You are strongly advised to consult with independent legal 
counsel to determine your rights and obligations under 
these agreements. 
If you need additional forms or have any questions, please 
call the ADOR Bingo Section in Phoenix at (602) 716-7801. 
AOOR 10331 (2/20) 
Application for Bingo License Packet 
CHECKLIST: 
Send copies of all documents listed below unless otherwise 
noted. Before mailing, check to make sure that you have 
included the following: 
1181 Original completed Application for Bingo License 
(Arizona Form 833). 
21:B3 Original completed affidavits (Arizona Form 830). 
Class B and Class C applicants must include a 
completed affidavit for each person participating 
in the conduct of your games. Class A applicants 
must include a complete affidavit for each person 
participating as a manager, proceeds coordinator 
and supervisors. 
Rental agreement if more than one licensee is using 
the same rented premises in which to hold bingo. 
~\N□ Application for Special Bonus Game (Arizona Form 
831) available at www.azdor.gov. 
If you do not 
conduct special bonus games do not complete the 
application. 
si:B3 License fee payable to the Arizona Department of 
Revenue: 
License Type 
Class A 
Class B 
Class C 
sO The local governing body fee will be payable to the 
appropriate local governing entity: 
License Type 
Fee 
Class A 
$5.00 
Class B 
$25.00 
Class C 
$50.00 
N\¥D If applying as a qualified organization, a current 
membership list must be submitted and must 
indicate initial membership dates for all members 
of the applicant organization. Any person from any 
branch of the applicant who will be participating in the 
operation of bingo games must be included on the 
1 
membership list. 
~ /t'□ If applying as a qualified organization, the following 
must be submitted: 
charter documents, articles 
of incorporation, corporate bylaws, articles of 
association, minutes of the establishment meeting, 
and minutes of meetings for two years (two months of 
each year) immediately prior to the date of application 
li\,, 
for the applicant, parent and auxiliary. 
~r□ Purchase agreement for real property (where 
~ 
applicable). 
~oD Purchase agreement/bill of sale for bingo equipment 
nd supplies. 
Original local governing body endorsement.

Application for Bingo License 
• Type or print in black ink and complete all information requested on this fonn. If you do not, your application will be returned. All 
information is subject to verification. If you need more space, attach additional sheets. 
• All bingo licenses expire one year from the date of issue. To continue conducting live bingo games, you must renew your license 
prior to the expiration date pursuant to A.R.5. §§ 5-403(() and 5-410. 
1 Applicant's Name 
Pueblo El Mirage RV Resort 
2a Mailing Address 
Falsification 
of information 
contained in this application 
11201 N El Miraqe Rd 
constitutes a Class 6 felony. 
2b City 
State 
ZIP Code 
El M iraqe 
AZ. 
85335 
REVENUE USE ONLY. DO NOT MARK IN THIS AREA. 
~ 
3a Administrative Office Location 
11201 N El M iraoe Rd 
lb City 
State 
ZIP Code 
El Miraqe 
AZ. 
85335 
4a Name of Contact Person 
4b Telephone No. 
Christine Finocchiaro 
(602) 920-7936 
4c E-mail Address 
4c Fax No. 
cfinocchiaro@ robertsrc .com 
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RCVD 
5 Class B and Class C license applicants only: If applying as a qualified organization, check one box to indicate the type of 
organization: 
0 Charitable 
D Social 
O Religious 
D Veterans 
0 Fraternal 
O Volunteer Fire Department 
D Homeowners Association 
D Nonprofit Ambulance Service 
6 Class B and Class C license applicants only applying as a qualified organization, provide parent or auxiliary information: 
Sa Parent Name 
Sb Auxiliary Name 
Address - Number and Street, Rural Rt., Apt. No. 
Address - Number and Street, Rural RI., Apt. No. 
City 
State 
ZIP Code 
City 
State 
ZIP Code 
7 Class 8 and Class C license applicants only applying as a qualified organization, list the current officers or Board of 
Directors of the oraanization • 
7a Name 
7b Name 
Title 
Title 
Address - Number and Street. Rural Rt .. Apt. No. 
Address - Number and Street Rural Rt.. Apt. No. 
City 
State 
ZIP Code 
City 
State 
ZIP Code 
7c Name 
7d Name 
Title 
Title 
Address - Number and Street, Rural Rt., Apt. No. 
Address - Number and Street, Rural Rt., Apt. No. 
City 
State 
ZIP Code 
City 
State 
ZIP Code 
8 Class B and Class C license a 
Checking Account Number 
Bin o chec In account information: 
Bank Name 
Bank Branch 
Continued on page 2 -+ 
ADOR 10334 (2/20)

APPLICATION FOR BINGO LICENSE 
9 Class Band Class C license applicants onl : Bin o interest-bearin account information: 
Account Number 
Bank Name 
I 
Bank Branch 
10 Class Band Class C license applicants only: List all officers and/or supervisors authorized to sign checks from the accounts 
listed above. If applying as a qualified organization, all supervisors must be members of the applicant: 
Tille 
l 10bName 
ntle 
11 List the name(s) of the one or two persons who will serve as managers. If applying as a qualified organization, these persons 
must be members of the applicant. Each person must submit an affidavit. 
11a Name 
11b Name 
Christine Finocchiaro 
Robin Fischer 
TIiie 
ntle 
General Manager 
Director of Activities 
12 List lhe name of the one person designated as proceeds coordinator. If applying as a qualified organization, this person must be 
an officer or director s.fil! a member of the applicant. Each person must submit an affidavit. 
Name 
ntle 
Annetta Messina-Carpenter 
Activities Support Staff 
13 Lisi the name(s) of the person(s) who will serve as supervisor. If applying as a qualified organization, each person must be a 
member of the applicant. Each person must submit an affidavit. If additional names are required, please attach affidavits. 
I"' Name 
I""""~ 
Tille 
14 List the name(s) of the person(s) who will serve as assistants. If applying as a qualified organization, each person must be a 
member or new member of the applicant. Except for "Class A" licensees, each person must submit an affidavit. 
14c Name 
15 Street address of the PHYSICAL location where live bingo will be played. 
11201 N El Mirage Rd, El Mirage, AZ. 85335 
16 Games of Bin o must not exceed 5 da s a week. Indicate the time on each res 
clive da 
SUN 
MON 
TUE 
WED 
THUR 
A0OR 10334 (2120) 
Oa.m. 
D .m. 
Dam. 
O p.m_ 
12-2:3( 
O a.m. 
c.m., 
Oa.m. 
D .m. 
Arizona Form 833 
O a.m. 
D .m. 
that live bin o will be 
la ·ed: 
FRI 
SAT 
Oa.m. 
Oa.m. 
O .rn.l 5-7:30 181 .m. 
Continued on page 3 ➔ 
Page2 of5

pp Icant s Name as s own on page 1 
APPLICATION FOR BINGO LICENSE 
17 Indicate the type of premises where bingo will be played. Check one box: 
a 
~ Neither rent nor mortgage will be paid from bingo funds. 
b =, Rented or leased. Attach rental affidavit and copy of rental agreement. 
Landlord's Name 
Address - Number and Street. Rural Rt., Apt. No. 
Telephone Number (with area code) 
City 
State 
ZIP Code 
c 
□ Owned solely by the organization. Attach £Qfil of mortgage, deed of trust, purchase agreement, escrow agreement, or 
other related document 
Holder of Mortgage 
Address - Number and Street. Rural Rt .. Apt. No 
Telephone Number (with area code) 
City 
State 
ZIP Code 
d O Owned jointly with other organization. Attach £QJ2!L of mortgage, deed of trust, purchase agreement, escrow agreement, or 
other related document: 
1) Holder of Mortgage 
Address - Number and Street. Rural Rt., Apt. No. 
Telephone Number (with area code) 
City 
State 
ZIP Code 
2) Co-Owner Holder: 
Address - Number and Street. Rural Rt., Apt. No. 
Telephone Number (with area code) 
City 
State 
ZIP Code 
3) Co-Owner Holder: 
Address - Number and Street, Rural Rt., Apt. No. 
Telephone Number (with area code) 
City 
State 
ZIP Code 
18 List bingo licensees who are or will be conducting bingo in the same premises as you and those licensees located within 1,000 
feet of your premises: 
18a Name 
18b Name 
Address - Number and Street, Rural Rt., Apt. No. 
Address - Number and Street. Rural RI .. Apt No. 
City 
State 
ZIP Code 
City 
State 
ZIP Code 
Continued on page 4 ~ 
ADOR 10334 (2/20) 
Arizona Form 833 
Page Jots

own on page 1) 
APPLICATION FOR BINGO LICENSE 
19 Expected bingo expenses: 
a 
Mortgage: 
$ 
per month 
Payable to 
Address - Number and Street. Rural Rt.. Apt. No. 
Telephone number (with area code} 
State 
ZIP Code 
b Rent· 
$ 
per O month O hour O occasion 
Payable to 
Address - Number and Street, Rural Rt., Apt. No. 
Telephone number (with area code} 
City 
Slate 
ZIP Code 
c 
Janitorial Services· 
$ 
per O month O hour O occasion 
Payable to 
Address - Number and Street, Rural Rt .. Apt. No. 
Telephone number (with area code} 
City 
State 
ZIP Code 
d 
Accounting Services· $ 
per D month O hour O occasion 
Payable to 
Address - Number and Street, Rural Rt , Apt. No. 
Telephone number (with area code i 
City 
State 
ZIP Code 
e 
Security Services· 
$ 
per O month O hour O occasion 
Payable lo 
Address - Number and Street, Rural Rt.. Apt. No. 
Telephone number (with area code) 
City 
State 
ZIP Code 
f 
Bingo Supplies· 
$ 2 000 00 
per Year 
Payable to 
Address - Number and Street, Rural Rt., Apt. No. 
Cactus Bingo Supply 
3210 E Roeser Rd, Su ite 15 
Telepnone number (with area code) 
City 
State 
ZIP Code 
(800) 544-0984 
Phoenix 
AZ. 
85335 
20 Who is your live bingo supplier? (For all bingo supplies). Do you foresee purchasing/renting machines as "technological aids for 
your live bingo games? 
N/A No 
Continued on page 5 ➔ 
AOOR 10334 (2/20) 
Arizona Form 833 
Page4 of 5

APPLICATION FOR BINGO LICENSE 
I, Christine Finocchiaro 
, under penalty of perjury and upon oath, declare that I am duly authorized to sign 
and file this application. I hereby swear or confirm that 1 have read the foregoing application and know the contents thereof and that 
all information provided has been fully, accurately, and truthfully completed to the best of my knowledge. 
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TITLE 
Please mail to: 
Arizona Department of Revenue 
1600 W Monroe Street, Division Code 22 
Phoenix, AZ 85007 
ff (602) 716-7801 
REVENUE USE ONLY. DO NOT MARK IN THIS AREA. 
□Approved 
0 Disapproved 
D Class A License 
0 Class B License 
Reviewer's Name (please print) 
I 
Date 
License Number 
I 
Effective Date 
ADOR 10334 (2/20) 
Arii.ona Form S33 
0 Class C License 
I 
Expiration Date 
Page 5 of 5

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• 
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Affidavit 
Bingo 
This affidavit must be completed by each person who wishes to assist 1n the conduct of any game of bingo. lf any information is blank or incorrect, th2 
affida11it will be returned ro you. All 1nformat1on is subject: :o verification. Disclosure of your Social Security Number (SSN) 1s voluntary. This 1nformat100 
n1ay be useo to establish positi11e identificaaon for purposes of criminal background checks pursuant to A.R.S. § 5-404. 
Licensees Name 
"'I L..,.ic_e_n-se_,,.,N,....u_m.,..b-er-------------, 
Pueblo El Mira e RV Resort 
. 09-045-A 
Position (check the appropriate boxes)" 
~---------------~ 
C!sl Mana er D Su ervisor O Proceed Coordinator D Assistant 
REVENUE USE ONLY. DO NOT MARK IN THIS AREA. 
@fil 
'"A,...,ffi,e-1a-n""'t''""s..,.N,...a_m_e---------------------------~ 
Christine Finocchiaro 
Date of Birth 
~RCVD 
If licensee is a qualified organization, complete the following section: 
Member? 
Date Joined Organization 
D Yes 
0 No 
Officers? 
Officer Title 
0 Yes 
0No 
Do you have an affidavit on file for any other licensee? 
□Yes 
0No 
If "Yes', list license number(s J: 
I, Christine Finocchiaro 
, the above-named affiant, under penalty of perjury, upon oath, depose 
AFFIANJ'SNAF.tE 
and say that I will conduct or assist in conducting all bingo games in compliance with the terms of the license, Arizona Re,ised 
Statutes, Title 5. Chapter 4, and che mies of thice licensing authority. I am of good moral character and have never been convicted of 
any misdemeanor involving moral rurpitudc or felony. I have not and shall not receive any reward, compensation or rccompen~ 
for my part1c1pation in the conduct of bingo games e"(cept as proYided for hy law. I hereby swear or confirm chat I have read 
and understand the foregoing ,1nd verify that the infonnahon and statements made herein are true and correct to the best of my 
knowledge. 
ACOR 10327 (2120) 
S19Niture of Afliant 
Date 
Please mail to: 
Arizona Departmentof Revenue 
1600 W Monroe Street, Division Code 22 
Phoeni><, AZ 85007 
ft (602) 716-7801