KIWANIS CLUB OF NEW RIVER_REDACTED.PDF

I CSR: 
Amount: 
SPECIAL EVENT LICENSE 
APPLICATION FEE $25.00 PER DAY 
Arizona Depat1ment of Liquor Licenses and Control 
800 W. Washington St. 5111 Floor Phoenix, AZ 85007 
(602) 542-5141 
RECEIVED 
10/17/2023 
MARICOPA COUNTY 
CLERK BOARD OF SUPERVISORS 
DLLC USE ONLY 
Job#: 
Date Accepted: 
CSR: 
License#: 
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. 
l. Applicant: Bostdorff 
Sarah 
Emily 
(Must be an Officer/Member of the Non Protit Entity) Last 
First 
Mid die 
2. Applicant's mailing address: 
Street 
City 
Stale 
Zip 
3. Applicants home/cell phone: 
 
Applicant's business phone: 480-369-6374 
4. Applicant's email address: 
 
5. Special EventName : _L_o_b_s_te_r_F_e_s_t~~~~~~~~~~~~~~~~~~~~~~~~~~~-
6. Name of Non-Profit Organization, Candidate or Political Party/Gov.: Kiwanis Club Of New River 
7.Non-Profil/IRSTaxExemptNumbe~_7_4_-2_5_6_5_2_6_0 ________ ~--~------~---~ 
8. Arizona Corporation Commission File#: 02051862 
If out of State please specify:_N_IA _____ _ 
(Attach letter of good standing) 
9. Event Location Name: New River Kiwanis Park 
10. Event Address: 48606 N 17th Ave 
New River, AZ 85087 
Dates and Hours of Event - Days must be consecutive and may not exceed 10 consecutive days. 
Days 
DAY l : 
DAY2: 
DAY3: 
DAY 4: 
DAY 5: 
DAY 6: 
DAY7: 
DAYS: 
DAY9: 
DAYlO: 
2/6/2023 
**SEPARATE APPLICATION FOR EACH "NON-CONSECUTIVE" DAY** 
Date 
Day of Week 
11/18/23 
Saturday 
Page 1of3 
Event Start 
Time AM/PM 
5:00 PM 
Individuals requiring ADA accommodations please call (602)542-2999 
license End 
Time AM/PM 
10:00 PM

SECTIO N 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 _2_-4 ______ Number of Security Personnel 
bZIFencing 
bZIBarriers 
Must explain security measures: Fencing & barriers in place around serving/eating area. Located in an en~ 
No off duty police will be present but there will be minimum of 2 kiwanis board members familiar wit6i 
SECTION 3 What is the purpose of this event? 
QJon-site consumption 
Oott-site (auction/wine/distilled spirits pull) 
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) 
DBoth 
A) bZJ 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) D 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) 
Nome of Business 
License Number 
DPlace 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 
Phone (Include Area Code) 
0Dispense 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 
0Dispense 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 
Osplit 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.) 
Doff 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 
l. Has the applicant been convicted of a felony, or had a liquor license revoked within the last five (5) years? 
D Yes bZl No If yes, attach letter of explanation. 
2. How many special event days have been issued to this organization during the calendar year? _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. ) 
D Yes bZl No If yes, please provide the Name of the Special Event Contractor: ____________ _ 
4. Is 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) 
D Yes bZl 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. 
2/6/2023 
Page 2 of 3 
Individuals requiring ADA accommodations please call (602)542-2999

Name: Kiwanis Club Of New River 
Percentage: _1_0_0_°/c_o ________ _ 
Address: 48606 N 17th Ave 
New River, AZ 85087 
Street 
City 
Stale 
Zip 
Name: ________________________ Percentage: ___________ _ 
Address: _______________________________________ _ 
Street 
City 
State 
Zip 
Please read A.R.S. § 4-203.02 Special event license: rules and Rl 9-1-205 Requirements for a Special Event License. 
ALL ALCOHOLIC BEVERAGE SALES MUST BE FOR CONSUMPTION AT THE EVENT SITE ONLY. 
NO ALCOHOLIC BEVERAGES SHALL LEAVE A SPECIAL EVENT UNLESS THEY ARE IN AUCTION WINE OR DISTILLED SPIRITS PULL 
SEALED CONTAINERS OR THE SPECIAL EVENT LICENSE IS STACKED WITH WINE /CRAFT DISTILLERY FESTIVAL LICENSE 
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. 
II I... ATTACH DIAGRAM +-1 
II 
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: 
I, (Print Name) Sarah Bostdorff 
, declare under penalty of perjury that I am 
authorized to submit this application. I 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. sJ ~ 
Signature 
LOCAL GOVERNING BODY 
Date Received: ________ _ 
I, _____________ _ 
_ __________ recommend 
DAPPROVAL 0 DISAPPROVAL 
(Government Official) 
(rrtle) 
On behalf of ____________________________________ _ 
(City, Town, County) 
Signature 
Date 
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 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 
II 
DAPPROVAL D DISAPPROVAL BY:--- ----------- DATE:--------
2/6/2023 
Page 3 of 3 
Individuals requiring ADA accommodations please call (602)542-2999 
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