ST. ROSE PHILIPPINE DUCHESNE ROMAN CATHOLIC PARISH ANTHEM_REDACTED.PDF

CSR:
Amount:

DLLC USE ONLY

Job #:

SPECIAL EVENT LICENSE Date Accepted:

APPLICATION FEE $25.00 PER DAY

CSR:

Arizona Department of Liquor Licenses and Control
800 W. Washington St. 5"" Floor Phoenix, AZ 85007
(602) 542-5141
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 party, or Government entity and
authorized by an Officer, Director, or Chairperson of the Organization.

1, Applicant: Colasito Francisco
(Must be an Officer/Member of the Non Profit Enti Last First Middle
City State Zip
Applicant's business phone: 623-465-9740

3. Applicants home/cell phone:

4. Applicant's email address:

St Rose Chili Fest

5. Special Event Name:
_ St Rose Philippine Duchesne Roman Catholic Parish Anthem

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

36-4644267

7. Non-Profit/IRS Tax Exempt Number:

8. Arizona Corporation Commission File #: 14588793 If out of State please specify:
(Attach letter of good standing)

9. Event Location Name: St Rose property
2825 W Rose Canyon Cir, Anthem AZ 85086

10. Event Address:
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
eps alla Daye Welt Time AM/PM Time AM/PM
DAY I: Nov 4, 2023 Saturday 12:00 PM 8:00 PM
DAY 2:

DAY 3:

DAY 4: as
=

DAY 5: oe)
WS
au

DAY 6:

DAY7: =

DAY 8: no

DAY 9:

DAY10:

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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 Number of Police 2 Number of Security Personnel MFencing Loarriers

Must explain security measures: Contracted for one Maricopa County Sherif uniformed officer also have two parishioners that

are officers and will patrol the event as plain clothes security

SECTION 3 What is the purpose of this event?

(On-site consumption Cott-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) 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) CJ 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 alcoho! without retailer involvement
Must attach letter from the location suspending license for duration of special event

Libispense and serve alll spirituous liquors under retailer's license — Business operates normally, minimum of 25% of gross
revenue from alcohol sales is donated fo licensee

W 1, Dispense and serve alll 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

Dsplit 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.)

Llo# 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

1. Has the applicant been convicted of a felony, or had a liquor license revoked within the last five (5) years?

DO Yes [YJ 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. 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 alcoho! on behalf of the licensee. If no special event contractor is listed, the licensee is
responsible for the sales and service of alcohol. }

(Yes I 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}

(Yes [I 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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Individuals requiring ADA accommodations please call (602)542-2999

St Rose Philippine Duchesne Parish Anthem Percentage: 100%

Name:
Address:
Street City 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 a

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) Alicia Gonzales , 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, oe A Th
¢ 7 mad

Signatdre

————
— ——— = —— ——

LOCAL GOVERNING BODY

Date Received:

I, recommend LIAPPROVAL LI DISAPPROVAL
(Government Official) (Title)

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 fo 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 LI DISAPPROVAL BY: DATE: |

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

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