SPECIAL EVENT APP. FOR PATHWAYS TO WORK 2.24.24 - REDACTED.PDF

SPECIAL EVENT LICENSE 
APPLICATION FEE $25.00 PER DAY 
Arizona Department of Liquor Licenses and Control 
800 W. Washington St. 5th Floor Phoenix, AZ 85007 
(602) 542-5141 
DLLC USE ONLY 
Job i : 
Date Accepted: 
CSR: 
Ucense f: 
Application MUST be submitted to the Department of Liquor 10 days prior to the event. 
SEC!!ON 1 AppHcant must be a member of a qualifyfng nonprofit organlzaffon, political party, or Government enttty and 
authorized by an Officer, Diector. or Chairperson of the Organlzatfon. 
1. Applicant: Nancy Claussen 
(Must be an Officer/Member of the Non Prollt Entity) LaJt 
fht 
Middle 
2. Applicant's maifing address: 
 
 
 
 
Street 
City 
Stale 
ZJp 
3. Applicants home/cell phone: 
 
Applicant's business phone: 703-635-0238 
4. Applicanfs email address: 
 
s. Special Event Name: Spokes & Ale 
~;;..._~~~~~~~~~~~~~~~~~~~~~~~~~~~ 
6. Name of Non-Profit Organization. Candidate or Political Party/Gov.: Pathway to Work 
7. Non-Profit/IRS Tax Exempt Number._8_2_-_0_8_5_4_8_3_0 ________________ 
_ 
a. Arizona Corporation Commission File #: 21703064 
If out of State please specify: _____ _ 
(Attach lellef of good standing) 
9. Event Location Name: White Tank Mountain Regional Park 
10. Event Address: 20304 W. White Tank Mountain Road Waddell, AZ 85355 
2/612023 
Oates and Hours of Event • Days must be consecutive and may not exceed 10 consecutive days. 
DAY 1: 
DAY2: 
DAY3: 
DAY4: 
DAYS: 
DAY6: 
DAY7: 
DAYS: 
DAY9: 
DAYlO: 
**SEPARATE APPLICATION FOR EACH "NON-CONSECUTIVE" DAY** 
2-24-24 
Saturday 
Page 1 of3 
Event ·start 
TlmeAM/PM 
J 
- - . 
~ 
9am 
11pm 
--R~E~CEl\-v-tfE-D--­
JUt 2i ioi3 
MARICOPA COUMTY 
CLERK BOARD OF SUPERVISORS 
lncfrviduols requilng ADA accommodations please cdl ( 602)542-2999

-==~~What type of security and control measures will you take to prevent violations of liquor laws at this event? 
(Ust type and number of pollce/security peoonnel and type of fencing «control bamm, If applicable.) 
_O ______ ,Number of Police _2 ______ Number of Security Personnel 
O=encing 
0Borriers 
~explain security measures: lho&111awran1>oorwll1>aoonsumoc111!1dAMldw1111ooonlonodc1J-t11o .... o1mollll-.Tuon1vr111>1cnoonll1rnooncu!l1oti11erea~11--
by event security. No beer \\ii be allowed outside of tile barricaded area. Those who are of legal drinking age will receive a wrist band after age verification by event security. 
SECTION 3 What is the purpose of this event? 
[2'}on-site consumption 
Ooft-site (auction/wine/distiled spirits pull) 
How is this special event going to conduct all dispensing, serving, and selling of spirituous fiquors? 
Check one of the following boxes. (R-19-318) 
Oeoth 
A) 0 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) 0 Will this event be held on a currently licensed premises and within the already approved and licensed area? 
(Must attach a letter from the ncensed premises with an explanation of the option checked below) 
Nome of Business 
UcenseNumber 
D>lace license in non-use - Special Event Ucensee selling all alcohol without retailer involvement 
Must attach letter from the location suspending license for duraHon of special event 
Phone (Include Alea Code) 
Ooispense and serve all spirituous liquors under retailer's license- Business operates normally, minimum of 25% of gross 
revenue from alcohol soles is donated to licensee 
O:>ispense 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 ncense for duration of special event 
Osplit premise between special event and retail location - Both the special event licensee and the retailer wi11 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, Uve or Silent Aucffons - Retailer will still be permitted to conduct all normal sate and 
service of alcohol. 
SECTION4 
1. Has the applicant been convicted of a felony, or had a liquor license revoked within the last five (5) years? 
0 Yes 0 No If yes, attach letter of explanation. 
2. How many special event days have been issued to this organization during the calendar year? _1 _____ _ 
3. Is the Organization using the services of a Special Event Contractor? (A licensee can uhTrze 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. ) 
0 Yes 0 No If yes, please provide the Nome 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) 
0 Yes 0 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 addlHonal sheet If necessary. 
2/6/2023 
Page2 of3 
Individuals requiring ADA accommodations please cdl (602)542-2999

Name: Mangled Momentum 
Address: 
 
Street 
Name: Pathway to Work 
 
Address:
, 
Street 
City 
Percentage: _7_5_'X_0 _______ 
_ 
 
 
Slate 
Zip 
Percentoge: _2_5_% ________ _ 
 
 
Slate 
Zip 
Please read A.R.S. § 4-203.02 Spec I al event license: rules and Rl 9· 1 ·205 Requirements for g Speclql Eyent 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 DISTILLEQ SPIRITS PULL 
SEALEQ CONTAINERS OR THE SPECIAL EVENT LICENSE IS STACKEQ WllH WINE /CRAfT DISTILLERY FESTIVAL LICENSE. 
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 control 
rasuresandsecurit(posifioA TT ACH DIAGRAM 
II 
If the special event wiD be held at a location without a permanent liquor ficense or I the event wiD be on any portion of a locaflon 
that Is not covered by the exlstfng liquor Rc:ense, this application must be approved by the local governing body before submitting 
to the Department of Uquor Uc:enses and Control. Please contact the local govemlng board fa additional Information. 
APPLICANT SIGNATURE 
DeclaraHon: 
1. (Print Name) Nancy Claussen 
declare under penalty of perjury that I am 
authorized to submit this application. I hove read the contents oft · application, and to the best of my knowledge 
believe all statements made on this application to be true. corre ta 
complete. 
LOCAL GOVERNING BODY 
Date Received: _______ _ 
!. ________________________ recommend DAPPROVAL 
0DJSAPPROVAL 
(Government Ollclol) 
(Tiiie) 
On behalf of __________ _, __________ _, ____ __, _______ _ 
(Clly, Town. County) 
Slgnature 
Phone 
The local governing body (city. town or municipality where the fair/festival wlll talce place) may require addlttonal 
applications to be completed and submitted. Please check with local government as to how far in advance they require 
these applications to be submitted. Addfflonal licensing fees may also be required before approval may be granted. 
AZDLLC USE ONLY 
II 
DAPPROVAL D DISAPPROVAL 
BY: ______________ DATE: _______ _ 
2/6/2023 
Page3of3 
lnd'Mduals requi1ng NJA accommodations please cdl (602)542-2999 
II