SPECIAL EVENT LICENSE FOR SILVER LINING RIDING PROGRAM_REDACTED.PDF

RECEIVED

NOV 08 2023
MARICOPA COUNTY
CSR: ; CLERK BOARD OF SuP ERVISORS
| Amount:
____ DUC USE ONLY _
Job &:
SPECIAL EVENT LICENSE _
Date Accepted:
APPLICATION FEE $25.00 PER DAY
= - CSR: q
Ani Department of Li Li id Control ee

(602) 542-5141 ~
Application MUST be submitted to the Department of Liquor 10 days prior to the event.

SECTION.] Applicant must be a member of a qualifying nonprofit organization, political party, or Government entity and
authorized by an Officer, Director, or Chatrperson of the Organization.
LYun

Wona EteCan

1. Applicant:
{Must be an Officer/Mamber of the Non

2. Applicant's mailing address:

3. Applicants hame/cell phone: plicont's business phone:

4. Applicant's email address:
5. Special Event Nome: _Veoevt favww \tey Wrxe
6. Name of Non-Profit Organization, Candidate or Political Porty/Gov: Q aI vey Vinin A & a AM1g,
7. Non-Profil/iRS Tax Exempt Number._@1l - 64171 9SO

8. Arizona Corporation Commission File #:\ &b YASSO If out of State please specify;
(Attech ietter of good standing)

9. Event Location Name: Desert Farm Lights
10. Event Address: 14629 W Peoria Avenue Waddell, AZ 85355

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

* * SEPARATE APPLICATION FOR BACH “NON-CONSECUTIVE® DAY’?

Days Date Day of Week paawn tes seen
oar: = M25 [2% Gakurday 5:00pm 40:00pm
DAY 2: AN rua 2) vada 5:00pm 10:00pm
DAY 3: 5:00pm 10:00pm
DAY 4: 5:00pm 10:00pm
DAY 5: 5:00pm 10:00pm
DAY 6: 5:00pm 10:00pm
DAY 8:

DAY 9:

DAY10:

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Individuals requiring ADA accommodations please cal (602}542-2999

SECTION 2 What tyne of security and contro! measures will you take to prevent violations of liquor laws at this event?
{Ust type and number of pollce/security personnel and type of fencing of contro! bariers, It appicabie.)

2

Number of Police __ ___.... Number of Security Personnel (Fencing Olsaniers

Must explain security measures; We have tencing around the peremeter of the event. We will have security roaming the event and

at the enterance and exit

SECTION 3 Whol is the purpose of this event?

[on-site consumption (Clof--site (auction/wine/distilled spirits pull) Dsoth
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) (2] Special Event being held on an unlicensed premises will require approval and signature by the Local Goveming
Body on page 3. (If checked move to section 4)

8) [2] wil this event be held ona currently licensed premises and within the already approved and licensed area?
(Must attach a letter from the flcensed premises with an explanation of the option checked below)

Name of Business Ucente Number Phono (include Area Code)

ClPlace license in non-use - Special Event Licensee selling all alcoho! without retailer involvement
Must attach letter from the tocation suspending IIcense for duration of special event

(Dispense 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

[dispense and serve all spirituous liquors under special event - The special event licensee is in charge of selling alcoho! that was
purchased or donated by the special event licensee. The retailers existing alcohol inventory must be separated from any alcoho!
used during the special event. Must attach letter from the tocation suspending license for duration of special event

Cspiit premise between special event and retail location - Both the special event licensee and the retailer wil conduct
sales of alcohol. (These sales will be done in separate areas. If alcoho! 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.)

[of Sate onty - Wine/Distilled Splits Pull, Live or Sitent Auctions - Retaier will stil 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 wilhin the last five (5) years?
QO Yes o No If yes, attach letter of explanation.

2, How many special event days have been issued to this organization during the calendar year? 0)

3.1s the Organization using the services of a Special Event Contractor? (A licensee can ulilze the services of a special event
contractor who may purchase and sell alcohol on behalf of the ficensee. If no special event contractor is listed, the licensee is
responsible for the sales and service of alcohol. )

Yes (INo If yes, please provide the Name of the Special Event Contractor, Pour Masters

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}

Cl yYes MI No 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.

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

_ Steet —_ City State Tp
nome: @ \\Vev Lama, Prdwig Percentage: 25%
Street City Stato tip
Please read A.R.S. § 4-203.02 Special event license: rules and R19-1-205 Reavirements 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 ore
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 contro!
measures and security position.

It the special event will be held at a location without a permanent fiquor license or t the event will be on any portion of a location
that Is not covered by the existing liquor ticense, this application must be approved by the local governing body before submitting
to the Department of Liquor Licenses and Control. Please contact the local goveming board for additional information.

APPLICANT SIGNATURE

Declaration:

1, (Print Name) St eLan \ W QVC) declare under penalty of perjury that | am
auihorized to submit this application. | have read’the contents of this application, and to the best of my knowedge

believe all staternents made on this application to be true, a's MES

\ Signatured

LOCAL GOVERNING BODY
Date Received:

t, recommend CJAPPROVAL (©) DISAPPROVAL
(Government Octal)

On behalf of

(Cty, Town, County)

The local goveming 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 ako be required before approval may be granted.

AZDLLC USE ONLY

CAPPROVAL [1 DISAPPROVAL BY: __

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

parking lot

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First Off-Duty Police Stationed