KNIGHTS OF COLUMBUS COUNCIL 12144_REDACTED.PDF

CSR:
Amount:

DLLC USE ONLY

Job #:

SPECIAL EVENT LICENSE
APPLICATION FEE $25.00 PER DAY

Date Accepted:

CSR:

Arizona Department of Liquor Licenses and Control
800 W. Washington St. 5"" Floor Phoenix, AZ 85007
(602) 542-5141
Application MUST be submitted to the Department of Liquor 10 days prior to the event.

License #:

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; Macedon, Frank, James

(Must be an Officer/Member of the Non Profit Enti Last First Middle
2. Applicant's mailing “er lla
Street Cily State Zip
3. Applicants home/cell phone: Applicant's business phone: N/A - Retired
4. Applicant's email acicress:i
5. Special Event Name: [Tibute to the Beach Boys Concert

6. Name of Non-Profit Organization, Candidate or Political Party/Gov: Knights of Columbus Council 12144

7. Non-Profit/IRS Tax Exempt Number: 86-0907785

8. Arizona Corporation Commission File #: 23424122 If out of State please specify:
(Attach letter of good standing)

9. Event Location Name; St. Elizabeth Ann Seton Catholic Church

10. Event Address: 9728 West Palmeras Drive, Sun City, Arizona 85373

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

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

Days

DAY 1:
DAY 2:
DAY 3:
DAY 4:
DAY 5:
DAY 6:
DAY 7:
DAY 8:
DAY 9:

DAY10:
11/7/2022

Date

April 15th, 2023

Day of Week

Saturday

Event Start
Time AM/PM

5:00PM

License End
Time AM/PM

11:00PM

OUNTY

MARLCOEA

CLERK BOARD Cf SU!

=RVISORS

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

Page 1 of 3

SECTION 2 What type of security and control measures will you fake to prevent violations of liquor laws at this event?
{List type and number of police/securlty personnel and type of fencing or control barriers, if applicable.)

Number of Police 3 Number of Security Personnel [Fencing Dearrers

Must explain security measures; We Will require idendification in accordance with ARS 4-241

SECTION 3 What is the purpose of this event?

[]on-site consumption [off-site (auction/wine/distilled spirits pull) [oth

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) D&I 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) C1] will this event be held on a 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)

i
»

Name of Business license Number Phone (Include Area Code)

CPlace 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

Dbispense 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

: [Dispense 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

Cospiit 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. )

Clo# 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?
D1 Yes M1 No If yes, attach letter of explanation.

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

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. )

Dyes HI No if yes, please provide the Name of the Special Event Contractor:

4. Is the organization using the services of a series 6, 7, 1 1, 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)

C1 Yes [No if yes, please provide the Name of Licensee: License #:

11/7/2022 Page 2 of 3
Individuals requiring ADA accommodations please call (602)542-2999

5. List the name of the Individual or Organization that will receive revenues, MUST EQUAL 100 PERCENT.
Attach additional sheet if necessary.

Name: Knights of Columbus Council 12144 Percentage: 100
Address: 9/28 West Palmeras Drive, Sun City, Arizona 85373
Street City State Tip
Name: ‘ Percentage:
Address:
Street City 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 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
to the Department of Liquor Licenses and Control. Please contact the local governing board for additional information.

APPLICANT SIGNATURE

Declaration:
|, (Print Name) Frank J. Macedon , 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, “Can complete.
+

Signature

LOCAL GOVERNING BODY

Date Received:

recommend LIAPPROVAL [1] DISAPPROVAL

I,
(Government Official) (Title)

On behalf of

(City, Town, County) Signature

———

AZDLLC USE ONLY

CIAPPROVAL LI DISAPPROVAL BY: DATE:

be

11/7/2022 Page 3 of 3
Individuals requiring ADA accommodations please call (602)542-2999

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