RISEN SAVIOR LUTHERAN CHURCH_REDACTED.PDF

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SPECIAL EVENT LICENSE
APPLICATION FEE $25.00 PER DAY

Arizona Department of Liquor Licenses and Control
800 W. Washington St. 5" Floot Phoenix, AZ 85007
(602) 542-5141]

Application MUST be submitted to the Department of Liquor 10 days prior to the event.

DLLC USE ONLY

Job #:

Date Accepted:

license #:

SECTION 1 Applicant must be a member of a qualifying honprofit organization, political parly, or Government entity and
authorized by an Officer, Director, or Chairperson of the Organization,

aya

1, Applicant: Le yoe Z..

(Must be an Officer/Member of the Nony

2. Applicant's mailing address:

3. Applicants home/cell phone:

Applicani's business phone: _Y80-¥9£- 677 7

4. Applicant's email address:

5. Special Event Name: Chure OW\ ow

6 Name of Non-Profit Organization, Candidate or Political Porty/Gov.: Risen Savioe Lutheran Cheereh,

7, Non-Profit/IRS Tax Exempt Number: EIN ' 36 — OZZUYUIR /4 3- O65 R15¥

8. Arizona Corporation Commission File #: O75* 24 4é If out of State please specify:
(Allach letter of good standing)

9. Event Location Name: Ri sen Savior Luther an C houureh

10. Event Address; 23620 S, Alona. School Ref Sun Lalees AZ. SS2UE

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

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

Days Pate Pay of Week time "AMM time AMPA
» DAYI: 416 /QOZY Saturday 4 2m 4am
DAY 2: ;
DAY 3:
DAY 4:
DAY 5:
DAY 6:
ECEWED—
DAY 7: R
DAY 8: FEB ~ 6 2024
DAY 9: - a en uanicora COUNTY ons
DAYIO:

2/6/2023 _ Page I of 3

Amount: & ZS 22

278 DIC USE ONLY

SPECIAL EVENT LICENSE i ie

Date Accepted:

APPLICATION FEE $25.00 PER DAY \jzzl2y
CSR:
Arizona Department of Liquor Licenses and Control - W's
License #:

800 W. Washington St. 5'* Floor Phoenix, AZ 85007
(602) 542-5141
Ww 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: Lo yoe 2 Si Il
(Must be an Officer/Member of the Non i

2. Applicant's mailing address:
fale Zip

3. Applicants home/cell phone: Applicant's business phone: 48O-¥ 9 S- 6 78 2

4. Applicant's email address:

5. Special Event Name: Chure Ol ow

6. Name of Non-Profit Organization, Candidate or Political Party/Gov.: Ri sen Savioe Jiucharon Church.
7. Non-Profit/IRS Tax Exempt Number: FIN) B36 -QO724U49% /4 3- O6S5K1S86
8. Arizona Corporation Commission File #: (75% 24 YE If out of State please specify:

(Attach letter of good standing)
9. Event Location Name: Ri sen Savior Lutheran Chusech

10. Event Address: ZS 620 SS, A le Schoo! Rd

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
mig pale Bay of Week Time AM/PM Time AM/PM

DAY 1: U1 /2024Y Saturday a| em 4pm

DAY 2:

DAY 3:

DAY 4:

DAY 5:

DAY 6:

DAY 7:

DAY 8:

DAY 9:

DAY10:

2/6/2023 Page 1 of 3

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.)

O _ Number of Police | Volunteers Number of Security Personnel [Fencing EXBarriers

Must explain security measures: _]. Professional har tenders 4o_mondoc Cansumyh on and age,

A. Volunteers walle site +> ensure aleshol che not leave event site.

SECTION 3 What is the purpose of this event?

[kjOn-site consumption (off-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) Nspecial 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) CJ 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)

LoPlace 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

L1dispense and serve all spirituous liquors under retailer's license — Business operates normally, minimum of 25% of gross
revenue from alcohol sales is donated to licensee

Lobdispense and serve all 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

Ospiit 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?

CyYes KI No If yes, attach letter of explanation.

2. How many special event days have been issued to this organization during the calendar yeare O

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. )

OYes [XINo 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)

11 Yes KXINo 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

Name: (Qisen Savior Lutheran Church Percentage: loo ~
Address: 234 S$ Alma Schoolkd Chander AZ. S25

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

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) Ji U Loocz , 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.

Uv g Signature

LOCAL GOVERNING BODY

Date Received:

I, recommend CIAPPROVAL [1] DISAPPROVAL
(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

DAPPROVAL LI DISAPPROVAL BY:

2/6/2023 ; ; Page 3 of 3

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