WISCONSIN CLUB OF SUN CITY _REDACTED.PDF

RECEIVED

DEC 08 2023

MARICOPA! COUNTY
CSR: CLERK BOARD OF SUPEF
UP)
Amount: ERVISORS

DLLC USE ONLY

dob #:

SPECIAL EVENT LICENSE

Date Accepted:

APPLICATION FEE $25.00 PER DAY

CSR:

Arizona Department of Liquor Licenses and Control
Si 800 W. Washington St. 5"" Floor Phoenix, AZ 85007
4RizO} (602) 542-5141

wo 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 parly, or Government entily and
authorized by an Officer, Director, or Chairperson of the Organization.

1. Applicant: Lund Daryl Bert
(Must be an Officer/Member of the Noi
2. applcan's ming ie: Ai
3, Applicants home/cell phone Applicant's business phone:
4. Applicant's email — —es

5. Special Event Name: Wisconsin Picnic of Sun City

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

7. Non-Profit/IRS Tax Exempt Number: 61-1849230

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

9, Event Location Name: Sun Bowl Sun City AZ
10. Event Address: 19220 N 107th Avenue Sun City AZ 85351

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 Dols boy chWeer Time AM/PM Time AM/PM

DAY 1: 3/14/2024 Thursday 10:00AM 3:30PM

DAY 2:

DAY 3:

DAY 4:

DAY 5:

DAY 6:

DAY 7:

DAY 8:

DAY 9:

DAY10:

11/7/2022 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 type and number of police/security personnel and type of fencing or control barriers, if applicable.)

1 (LES) Number of Police 2 Number of Security Personnel (Fencing [Barriers

Must explain security measures: We will hire one Law Enforcement Specialist (see attached confirmation)and have

two Sun City Posse members present for the entire event.

SECTION 3 What is the purpose of this event?

[4JOn-site consumption (Cloft-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) Ed 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 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)

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

Lbispense 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 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

Lisplit 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 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?

(CyYes [Z] No If yes, attach letter of explanation.

2. How many special event days have been issued fo 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. }

(1 Yes [INo ff yes, please provide the Name of the Special Event Contractor:

4. ls 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)

(1 Yes [INo 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: Wisconsin Club of Sun City Percentage: 100%

Address:

Street Cily State Zip
Name: Percentage:
Address:

Street Cily 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:

1, (Print Name) Daryl Lund , 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 Aanyh Loon A

Signature

LOCAL GOVERNING BODY
Date Received:

L, 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

CIAPPROVAL CI DISAPPROVAL BY:

2/6/2023 Page 3 of 3
Individuals requiring ADA accommodations please call (602)542-2999

Aerial View Sun Bowl Sun City AZ
10220 N 107th Avenue Sun City AZ 85351
Site of the Wisconsin Picnic March 14, 2024

Applicant for Special Event Liquor License

Daryl Lund, Past President WI Club of Sun City
11815 N 97" Avenue Sun City AZ

ped satide)