Application For Special Event License
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4FOR DLLC USE ONLY
Event Date(s):
Arizona Department of Liquor Licenses and Control
Event time start/end:
800 W Washington 5th Floor
Phoenix, AZ 85007-2934
CSR:
License:
(602) 542-5141
APPLICATION FOR SPECIAL EVENT LICENSE
Fee= $25.00 per day for 1-10 days (consecutive)
Cash Checks or Money Orders Only
A service fee of $25.00 will be charged for all dishonored checks (A.R.S. § 44-6852)
IMPORTANT INFORMATION: This document must be fully completed or it will be returned.
The Department of Liquor Licenses and Control must receive this application ten (10) business days prior to the event. 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 government before submission to the Department of
Liquor Licenses and Control (see Section 15).
SECTION 1
Name of Organization: ________________________________________________________________________________________
SECTION 2
Non-Profit/IRS Tax Exempt Number: _____________________________________________________________________________
SECTION 3
The organization is a: (check one box only)
Charitable
Fraternal (must have regular membership and have been in existence for over five (5) years)
Religious
Civic (Rotary, College Scholarship)
Political Party, Ballot Measure or Campaign Committee
SECTION 4
Will this event be held on a currently licensed premise and within the already approved premises?
Yes
No
Name of Business
License Number
Phone (include Area Code)
SECTION 5
How is this special event going to conduct all dispensing, serving, and selling of spirituous liquors? Please read R-19-
318 for explanation (look in special event planning guide) and check one of the following boxes.
Place license in non-use
Dispense and serve all spirituous liquors under retailer’s license
Dispense and serve all spirituous liquors under special event
Split premise between special event and retail location
(IF NOT USING RETAIL LICENSE, SUBMIT A LETTER OF AGREEMENT FROM THE AGENT/OWNER OF THE LICENSED PREMISE TO SUSPEND THE
SPECIAL
LICENSE DURING THE EVENT. IF THE
EVENT IS ONLY USING A PORTION OF PREMISE, AGENT/OWNER WILL NEED TO SUSPEND THAT
PORTION OF THE PREMISE.)
SECTION 6
What is the purpose of this event?
On-site consumption
Off-site (auction)
Both
_____________________________________________________________________________
SECTION 7
Location of the Event:
Address of Location: ____________________________________________________________________________________________
Street
City
COUNTY
State
Zip
SECTION 8
Will this be stacked with a wine festival/craft distiller festival?
Yes
No
SECTION 9
Applicant must be a member of the qualifying organization and authorized by an Officer, Director or Chairperson
of the Organization named in Section 1. (Authorizing signature is required in Section 13.)
___________________________________________________________________ ________________________
1. Applicant:
Last
First
Middle
Date of Birth
_____________________________________________________________________________
2. Applicant’s mailing address:
Street
City
State
Zip
3. Applicant's home/cell phone: (____) __________________________ Applicant’s business phone: (____) _____________________
4. Applicant's email address: ___________________________________________________________________________________________
3/1/2016
Page 1 of 4
Individuals requiring ADA accommodations call (602)542-9027.
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