AMENDMENT TO PAGE 1 AND PAGE 3_REDACTED.PDF

[§: •·-
~ 
RECEIVED 
NOV 0 3 2023 
MARICOPA COUNTY 
CLERK BOARD OF SUPERVISORS. 
i\1i1011n llr1 nrl111c111 or Liquor l.i cn sc~ and l'onlr1JI 
~00 \V. \Vn.qhi11gh1 11 SI. 5•h Floor f'hocnix, i\Z 85007 
(60 ) 54 -5141 
OUC USE ONLY 
Job If: 
Dute Accepted: 
CU; 
Ucense I : 
Applknllon l\IUST he suhmlHcd to !he 1>c1JRrl111cnl of Liquor 10 dnys prior to the event . 
...,-.u.:i~...i. Appllcant must be a member of a qualifying nonprom organization, polltlcal party, or Government enffty and 
Ovitt rired by on om er, Dir ct r, or Chairperson of the Organlzallon. 
1. 
Ii ont: 
Y-\C!>V\C\ 
0\-efo.~\ 
Vt V\V\ 
(Must be on Olllc..r/Memb"' ol lho Non Prolll Entity) trulJ 
lhl 
Middle 
2. A, pli anl'smoDingoddress:
Shel 
Stai. 
Dp 
3. Appliconts home/cell phone:
 
 
 
Applicant's business phone: _______ 
_ 
4. Appliconl's emoil oddress: 
5. Special Event Name: Q !'.? e. V 
o. VW\ 
\ V\-\S 
6. Name of Non-Profit Organization, Condidote or Politicol Porty/ Gov.: 0 ilve '(" 
\.--\.V\ \11\C?\ f2.u}. \ V\.~ 
()..J'Av 
7. Non-Profit/IRS Tax Exempt Number. _'1..;.=_:-"[_!_ ... _CS~~
..L...!
-Z:..._1
.!..__:!
'::,
:..._SL...!t>:...___ _____
_ ________ _ 
8. Arizona Corporation Commission File #: l Liv -;'\ 5<5<o If out of State please specify: _____ _ 
(Attach letter of good slandlng) 
9. Event Location Nome: 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 consecutive days. 
**SEPARATE APPLICATION FOR EACH "NON-CONSECUTIVE" DAY* * 
Days 
Date 
Day of Week 
Event Start 
License End 
Time AM/ PM 
Time AM/PM 
DAY I : 
DAY2: 
DAY3: 
DAY4: 
DAYS: 
DAY6: 
DAY 7: 
vt'\ ['"~ 
W\OwlG\j 
5:00pm 
10:00pm 
iv V?'1t.4. I>\ 
5:00pm 
10:00pm 
~tz,.l i rv? 
11'( ~t <i? 
w ~d lf\t£,~~ ~ 
5:00pm 
10:00pm 
\,0 { 1 l "&' 
--(\,.\ v v2 J., t-\ I>\ 
5:00pm 
10:00pm 
{vtd(,l.,y 
( 
= 
5:00pm 
10:00pm 
0<A±vv4~11 
5:00pm 
10:00pm 
' 
l-V{P'{1,:> 
C;vV\~~ 
\ 
5:00pm 
10:00pm 
DAY 8: 
DAY9: 
DAYIO: 
2/6/2023 
Page 1of3 
Individuals requiring ADA occommodaliom please call (602)542-2999 
Amendment to page1 
Section 1-Question 6

\ 'IHll l)f "''' l 
t t1r1r 
tu~t 1 1'K'lfr'"' rHt n11" t 
• 
yn11 111\:t• In prr1vnril vl,.,f,-1t'''rl'i ,,( ~qt lt/f ,,,.,..n ,.,, lt1li t11ot11''1 
(lftf) . ""' "" 
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.,.,,rnrf 111'! per!"<TWll t of thf' l!V"nl W'I w!ll 
11 
"'tily" mtritj th<! fYt 11 
r.rl 
n' miptton 
[Jon. lie (ouctlon/wlne/dlstmed 1pfr11s pull) 
Ho\ I\ lhi1 ~rr•d I v nt polnn r conduct oH diif1or1sir _ , sorving, and soiling of spiriluous liquors? 
h<-l ~ one ol th . f llo\\;ng bo os. (R 19 
18) 
~th 
A) 0 'pc- 'al Lvcnl eing lield non unllcqnsod premises will require approval and signature by tho Local G<:-,vsrr.ing 
Body n 
e 3. (II he 1-ed move lo seclion 4) 
6) 0 
'I this ev nt be t1eld on 0 currenlly licensed premises and wilhin lhe already approved and licensed oreo:J 
(Must attach o le~r from the licensed premises with an explanation of the option checked below) 
Nam• ol tknln... 
Ucense Numl>9r 
Groce license in non-use - Special Event Ucensee selling all alcohol wilhoul ret011er involvement 
Must attach letter from the locotlon suspending license for duration of special event 
0Dispense and serve all spirituous liquors under retailer's license - Business operates normally. minimum of 25% of gross 
revenue from alcohol soles is donated lo licensee 
Cbispense and serve all spirituous liquors under special event - The special event licensee is in charge of selling alcohol that was 
purchosed or donated by the special event licensee. The retailers existing alcohol inventory must be separated from any clcohol 
used during the special event. Must attach letter from the location suspending Dcense for duraflon of speclol event 
Osplit premise between special event and retail location - Both the special event licensee and the retailer will conduct 
soles of alcohol. (These soles will be done in separate areas. If alcohol is donated or purchased by lhe special event licensee 
it must be in a separate area than the alcohol that is dispensed by the licensed retailer.} 
CJott Sale only - Wine/Distilled Spirits Pull, Uve or Silent Auctions - Retailer will still be permitted to conduc t all n01T11al sole and 
service of alcohol. 
SECTION 4 
I . Hos the applicant been convicted of a felony, or hod a liquor license revoked within the last five (5) years? 
0 Yes [»No If yes. attach letter of explanation. 
2. How many special event days have been issued to this organization during the calendar year? 
<:/> 
-~------
3. Is the Organiza tion using the services of a Special Event Contractor? (A licensee con utilize the services of a special event 
contractor who may purchase and sell alcohol on behalf of the licensee. If no special event c ontractor is listed, the licensee is 
responsible for lhe soles and service of alcohol. ) 
0 Yes D No If yes, please provide lhe Name of the Special Event Contrac tor. Pour Masters 
--------- ------
4. Is lhe 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 lic ense are a utomatically q ualified to be the special event contractor) 
0 Yes 0 No if yes, please provide the Name of Licensee:---------- License #: --------
5. Lisi the name of the Individual or Organization tha t will receive reve nues, MUST EQUAL 100 PERCENT. 
Attach additional sheet If necessary. 
2/6/2023 
Page2 of 3 
Individuals requiring ADA accommodolions pleaso call (602)542-2999

I ('111!'1 rn1d Mr 1k1llt1g, 11 ; 
1'1 « tinl<1q 
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dA.R . . §4-2 ~.02 
e lal eve 
lie 
ondR 1 9 - 1 -20SRegulreme n!J lo~Jal,Jve nlLk:~os 
Al l ALC H IC EVERAGE SALES MUST BE FOR CONSUMPTION AT THE EVENT SITE ONLY. 
tlQ AlCOHOl!C BEVERAGES SHALL LEAYE A SPECIAL EVENT UNLESS TH EY ABE IN AUCI!ON WINE OR Q!SljLLEP SPjBijS PULL 
s.EALEQ CONTAINERS OR THE SPECIAL EVENI LICENSE IS STACKED WIJH WINE /CRAfl PISJILLEBY FESIIYAL LICENSE 
SECI18N ~ LI ensc 
remises diagram. The licensed premises for your special evenl is the area in which you ore 
~th zed I . sell, di pensc or serve alcoholic beverages under the provisions of your license. Please att9ch a diagram 
0 yours ecio\ event licensed premises. Please show dimensions. serving areas, fencing, barricades. or olher control 
r·~'~ aod ··~ po•Woo 
< II I 
If the special event will be held at a location without a permanent liquor license or ff the event will be on any portion of o locotlon 
that Is not covered by the exlsting liquor license, this oppllcatlon must be approved by the local governing body before submitting 
to the Deportment of Liquor licenses and Control. Please contact the local governing board for addltionol information. 
APPLICANT SIGNATURE 
Declaration: 
I, (Print Name) 0-\" t ~to\ 
\ V\ OV\ 
declare under penalty of perjury that I am 
authorized to submit this application. I have rea lhe contents of this application, and to the best of my knowledge 
believe all statements made on this application to be true, co_rr_c;f
_t__,,.n_!:
-rc-o_~_pl_W
=te~.'-"--A--------
~ Sise 
LOCAL GOVERNING BODY 
Date Received: ___
_ __ _ 
I,--------- --- ---------- recommend DAPPROVAL 0 DISAPPROVAL 
(Government Ol!lclol) 
(Tlfte) 
On behalf of ________
_ ~ 
_ _ _____ _ __ _, ___________ _ 
(City, Town, County) 
Slgnolure 
Dote 
Phone 
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 wilh local govemment as to how for in advance they require 
these applications lo be submitted. Additional licensing fees may also be required before approval may be granted. 
AZDLLC USE ONLY 
\I OAPPROVAL 0 DISAPPROVAL " ------- ---- -- DATE:--------
2/6/2023 
Page 3 of 3 
Individuals requiring ADA occommodolions please coll (602)542-2999 
II 
Amendment to page 3 
Section 4-Name