Application For Special Event License Form. This is a Arizona form and can be use in Liquor Licenses And Control Statewide.
Tags: Application For Special Event License, LIC 0106, Arizona Statewide, Liquor Licenses And Control
ARIZONA DEPARTMENT OF LIQUOR LICENSES & CONTROL 400 W Congress #521 Tucson AZ 85701-1352 (520) 628-6595 800 W Washington 5th Floor Phoenix AZ 85007-2934 (602) 542-5141 APPLICATION FOR SPECIAL EVENT LICENSE Fee = $25.00 per day for 1-10 day events only A service fee of $25.00 will be charged for all dishonored checks (A.R.S.§ 44-6852) NOTE: THIS DOCUMENT MUST BE FULLY COMPLETED OR IT WILL BE RETURNED. PLEASE ALLOW 10 BUSINESS DAYS FOR PROCESSING. **Application must be approved by local government before submission to Department of Liquor Licenses and Control. (Section #20) 1. Name of Organization: 2. Non-Profit/I.R.S. Tax Exempt Number: 3. The organization is a: (check one box only) Charitable Fraternal (must have regular membership and in existence for over 5 years) Civic Political Party, Ballot Measure, or Campaign Committee Religious 4. What is the purpose of this event? 5. Location of the event: Address of physical location (Not P.O. Box) City County Zip Applicant must be a member of the qualifying organization and authorized by an Officer, Director or Chairperson of the Organization named in Question #1. (Signature required in section #18) 6. Applicant: Last First Middle Date of Birth 7. Applicant’s Mailing Address: Street 8. Phone Numbers: ( ) ( Site Owner # 9. Date(s) & Hours of Event: Date Day Day Day Day Day Day Day Day Day Day Lic 0106 05 2006 City ) State Zip ( Applicant's Business # ) Applicant's Home # (Remember: you cannot sell alcohol before 10:00 a.m. on Sunday) Day of Week Hours from A.M./P.M. To A.M./P.M. 1: 2: 3: 4: 5: 6: 7: 8: 9: 10: *Disabled individuals requiring special accommodations, please call (602) 542-9027 American LegalNet, Inc. www.FormsWorkflow.com 10. Has the applicant been convicted of a felony in the past five years, or had a liquor license revoked? YES NO (attach explanation if yes) 11. This organization has been issued a special event license for days this year, including this event (not to exceed 10 days per year). 12. Is the organization using the services of a promoter or other person to manage the event? YES NO If yes, attach a copy of the agreement. 13. List all people and organizations who will receive the proceeds. Account for 100% of the proceeds. THE ORGANIZATION APPLYING MUST RECEIVE 25% OF THE GROSS REVENUES OF THE SPECIAL EVENT. Name Percentage Address Name Percentage Address (Attach additional sheet if necessary) 14. Knowledge of Arizona State Liquor Laws Title 4 is important to prevent liquor law violations. If you have any questions regarding the law or this application, please contact the Arizona State Department of Liquor Licenses and Control for assistance. NOTE: ALL ALCOHOLIC BEVERAGE SALES MUST BE FOR CONSUMPTION AT THE EVENT SITE ONLY. "NO ALCOHOLIC BEVERAGES SHALL LEAVE SPECIAL EVENT PREMISES." 15. What security and control measures will you take to prevent violations of state liquor laws at this event? (List type and number of security/police personnel and type of fencing or control barriers if applicable) # Police # Security personnel Fencing Barriers 16. Is there an existing liquor license at the location where the special event is being held? If yes, does the existing business agree to suspend their liquor license during the time period, and in the area in which the special event license will be in use? YES NO YES NO (ATTACH COPY OF AGREEMENT) ( Name of Business ) Phone Number 17. Your licensed premises is that area in which you are authorized to sell, dispense, or serve spirituous liquors under the provisions of your license. The following page is to be used to prepare a diagram of your special event licensed premises. Please show dimensions, serving areas, fencing, barricades or other control measures and security positions. American LegalNet, Inc. www.FormsWorkflow.com SPECIAL EVENT LICENSED PREMISES DIAGRAM (This diagram must be completed with this application) Special Event Diagram: (Show dimensions, serving areas, and label type of enclosure and security positions) NOTE: Show nearest cross streets, highway, or road if location doesn't have an address. N↑ American LegalNet, Inc. www.FormsWorkflow.com THIS SECTION TO BE COMPLETED ONLY BY AN OFFICER, DIRECTOR OR CHAIRPERSON OF THE ORGANIZATION NAMED IN QUESTION #1 18. I, declare that I am an Officer/Director/Chairperson appointing the (Print full name) applicant listed in Question 6, to apply on behalf of the foregoing organization for a Special Event Liquor License. X ( (Signature (Title/Position) State of (Date) ) (Phone #) County of The foregoing instrument was acknowledged before me this Day Month Year My Commission expires on: (Date) (Signature of NOTARY PUBLIC) THIS SECTION TO BE COMPLETED ONLY BY THE APPLICANT NAMED IN QUESTION #6 19. I, declare that I am the APPLICANT filing this application as (Print full name) listed in Question 6. I have read the application and the contents and all statements are true, correct and complete. State of X County of The foregoing instrument was acknowledged before me this (Signature) Day Month Year My commission expires on: (Date) (Signature of NOTARY PUBLIC) You must obtain local government approval. City or County MUST recommend event and complete item #20. The local governing body may require additional applications to be completed and submitted 60 days in advance of the event. Additional licensing fees may also be required before approval may be granted. LOCAL GOVERNING BODY APPROVAL SECTION 20. I, hereby recommend this special event application (Government Official) (Title) on behalf of (City, Town or County) (Signature of OFFICIAL) (Date) FOR DLLC DEPARTMENT USE ONLY Department Comment Section: (Employee) APPROVED DISAPPROVED (Date) BY: (Title) (Date) American LegalNet, Inc. www.FormsWorkflow.com SERIES: 15 SPECIAL EVENT LICENSE (Temporary) Non-transferable On-sale retail privileges PURPOSE: Allows a charitable, civic, fraternal, political or religious organization to sell and serve spirituous liquor for consumption only on the premises where the spirituous liquor is sold, and only for the period authorized on the license. This is a temporary license. ADDITIONAL RIGHTS AND RESPONSIBILITIES: The applicant for a special event license must request a special event application from the Department and file the application with the governing body of the city or town, or Board of Supervisors of an unincorporated area of a county (where the special event is to take place) for approval or disapproval. Some local governing bodies may require approximately 60 days prior notice. If the application is approved by the local authority, and the event meets the requirements for granting the license, the Director will issue a special event license to the qualifying organization. Qualifying organizations will be granted a special event license for no more than ten (10) days in a calendar year. Events must be held on consecutive days and at the same location or additional licenses will be required. The license is automatically terminated upon closing of the last day of the event or the expiration of the license, whichever occurs first. The qualified organization must receive at least twenty-five percent (25 %) of the gross revenues of the special event. A person selling spirituous liquor under a special event license must purchase the spirituous liquor from the holder of a license authorized to sell off-sale; except that, in the case of a non-profit organization which has obtained a special event license for the purpose of charitable fund raising activities, a person may receive the spirituous liquor from a wholesaler as a donation. AVERAGE APPROVAL TIME: One (1) to seven (7) days. PERIOD OF ISSUANCE: Issued for no more than a cumulative total of ten (10) days in a calendar year. A special event may be held for more than one (1) day, but it must be held on consecutive days and at the same location or additional licenses will be required. FEES: $25.00 per day. ARIZONA STATUTES AND REGULATIONS: ARS 4-203.02, 4-244, 4-261; Rule R19-1-228, R19-1-235, R19-1-309. Disabled individuals requiring special accommodations please call (602) 542-9027 American LegalNet, Inc. www.FormsWorkflow.com