HEARTSTRINGS FOUNDATION_REDACTED.PDF

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Arizona Department of Liquor Licenses and Control 
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800 W. Washington St. 5111 Floor Phoenix, AZ 85007 
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(602) 542-5141 
APPLICATION FEE $25.00 PER DAY 
SPECIAL EVENT LICENSE 
DLLC USE ONLY 
Job#: 
Date Accepted: 
CSR: 
License#: 
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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. 
1. Applicant: Pickering 
Rowan 
(Must be an Officer/Member of the Non Profll Entity) last 
First 
Mid die 
2. Applicant's mailing address: 
Street 
City 
Stale 
Zip 
3. Applicants home/cell phone: 
 
Applicant's business phone: 480-507-9140 
4. Applicant's email address: 
 
5. Special Event Name: Live Life A Songwriters Music Festival 
6. Name of Non-Profit Organization. Candidate or Political Party/Gov.: Heartstrings Foundation 
7. Non-Profit/IRS Tax Exempt Number: 82-4626170 
~-----------------------------
8. Arizona Corporation Commission File #: 22444325 
If out of State please specify:. ______ _ 
(Attach letter of good standing) 
9. Event Location Name: Ranco del Pacifico 
---------------------------------
10. Event Address: 15225 E. Riggs Rd. Gt\\ ber+ 1 AZ. 
2/6/2023 
Dates and Hours of Event - Days must be consecutive and may not exceed 10 consecutive days. 
Days 
DAY 1: 
DAY 2: 
DAY 3: 
DAY4: 
DAY 5: 
DAY 6: 
DAY 7: 
DAY 8: 
DAY9: 
DAY IO: 
**SEPARATE APPLICATION FOR EACH "NON-CONSECUTIVE" DAY** 
Date 
Day of Week 
11/11/2023 
Saturday 
Page I of 3 
Event Start 
Time AM/PM 
1:00PM 
Individuals requiring ADA accommodations please call {602)542-2999 
License End 
Time AM/PM 
11:45PM 
RECEIVED
10/19/2023
MARICOPA COUNTY
CLERK BOARD OF SUPERVISORS

Name: 
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Address: 3 L{ 5 Ll N Ser. t-k.<ra;- Pl )ud:e l '2.. 
Street 
City 
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t hanc.Llec Az 8'522 '>-
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Percentage: 
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Please read A.R.S. § 4-203.02 Special event llc:ense: rules and R 19-1-205 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 QISI!LLEQ SPIRIT$ PUU 
SEAU:p CONTAINERS OR THE SPECIAL EVENT LICENSE IS STACKEQ WITH WINE /CRAFT QISTILLERY FESTIVAL LICENSE., 
SECTION S. 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. 
I a 
~ ATTACH DIAGRAM < ] I 
If the speclal event wfD be held at a location without a permanent fiquor Rcense or If the event wfD be on any portfon of a location 
that Is not covered by the existing lquor license, this appllcatton must be approved by the local govemlng body before submltflng 
to the Department of Liquor Licenses and Control. Please contad the local governing board for additional infotmation. 
APPLICANT SIGNATURE 
Declaration: 
I. (Print Name)-=----<--. ov.J~ 
e-r-
. dec
hat 
am 
authorized to submit this application. I have read the 
ntents of this apP,)icqtion, and to the best of my knowledge 
believe all statements mode on this application to be true. correct and~~
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LOCAL GOVERNING BODY 
Date Received: _______ _ 
I, _________________________ 
recommend DAPPROVAL 0 DISAPPROVAL 
(Government Ollldol) 
(TIHe) 
On behalf of ___________ 
~------------ ____ _ __, ---------
(City, Town, County) 
Slgnoture 
Phone 
The local governing body (city, town or municipality where the fair/festival wlll 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 appllcaffons to be submitted. Additional Hcenslng fees may also be required before approval may be granted. 
AZDUC USE ONLY 
0APPROVAL 0 DISAPPROVAL 
BY: _ _______ ___ ___ DATE: _____ __ 
_ 
2/6/2023 
Page 3 of 3 
Individuals requiring ADA accommodations please call {602)542-2999