ARIZONA LUTHERAN ACADEMY FEDERATION_REDACTED.PDF

DLLC USE ONLY

Job #:
SPECIAL EVENT LICENSE ——
} APPLICATION FEE $25.00 PER DAY
yi CSR:
AS Seizone We} 4q Arizona Department of Liquor Licenses and Control : -
jug ssn 4 800 W. Washington St. 5" Floor Phoenix, AZ 85007 Ucense #
*~ “4apzon> (602) 542-5141 a

4 Application MUST be submitted to the Department of Liquor 10 days prior to the event,
X PP F

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.

Meyer Douglas Neil

1. Applicant:
(Must be an Officer/Member of the No!

2. Applicant's mailing address:
ly State Tip

3. Applicants home/cell phone: Applicant's business phone; 602-268-8686 x115

5. Special Event Name: Arizona Lutheran Academy Gala

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

86-0340614

7. Non-Profit/IRS Tax Exempt Number:

8. Arizona Corporation Commission File #: 01088302 If out of State please specify:
(Attach letter of good standing)

9. Event Location Name: _ Arizona Lutheran Academy

6036 S. 27th Ave. Phoenix, AZ 85041

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**

Event Start License End
Pays Date povierwaeK Time AM/PM Time AM/PM
DAY 1: March 22, 2024 Friday 6:00pm 10:00pm
DAY 2:
DAY 3: s 13
DAY 4: mom
iss]
DAY 5: 1
AS
DAY 6: x=
DAY 7: S
aw *
DAY 8: ~~
DAY 9:
DAY10:
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Individuals requiring ADA accommodations please call (602)542-2999

SECTION 2 Whai 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 [Barriers

jt

Must explain security measures: This event takes place in our school gym. Alcohol is served in one area that is set off with barriers,

No alcohol can be taken from the gym. Security is stationed al both main exits, and there is also a gym lobby with outer doors that provides more barriers.

SECTION 3 What is the purpose of this event?

(on-site consumption LO f-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) 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 ona 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)

ClPlace 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

[dispense 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

DDispense 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

Cispiit 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.)

Cof sate 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?

Yes [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. }

C1 Yes 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)

OYes HINo 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: Arizona Lutheran Academy Percentage: 100

Address: 6036 S. 27th Ave. Phoenix AZ 85041
Street City State Zip
Name: Percentage:
Address:
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.

ATTACH DIAGRAM <a

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:

|, (Print Name) Doug Meyer , 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 cor plete.

i} ignature

LOCAL GOVERNING BODY

Date Received:

I, recommend [CIAPPROVAL Dossapprovar |
(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 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

= — <a SS —=—
DIAPPROVAL C1] DISAPPROVAL BY: DATE: |
———— ———

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Individuals requiring ADA accommodations please call (602)542-2999

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