Application For Special Event License - Arizona Department Of Liquor Licenses And Control

Download a blank fillable Application For Special Event License - Arizona Department Of Liquor Licenses And Control in PDF format just by clicking the "DOWNLOAD PDF" button.

Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.

Complete Application For Special Event License - Arizona Department Of Liquor Licenses And Control with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.

Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.

ADVERTISEMENT

FOR 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:
(602) 542-5141
License:
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 12).
SECTION 1
Name of Organization: ________________________________________________________________________________________
Name of Licensed Contractor only (if any): ________________________________________________________________
SECTION 2
Non-Profit/IRS Tax Exempt Number: _____________________________________________________________________________
SECTION 3 Event Location: ___________________________________________________________________________________________
Event Address: ____________________________________________________________________________________________
SECTION 4
Applicant must be a member of the qualifying organization and authorized by an Officer, Director, or Chairperson
of the Organization.
___________________________________________________________________ ________________________
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: ___________________________________________________________________________________________
I,
________________________________________________
declare that I am the APPLICANT filing this application
(Print Full Name)
as listed above. I have read the application and the contents and all statements are true, correct and complete.
X ___________________________________ ___________________________________ _______________ ___________________
Signature
Title/ Position
Date
Phone Number
The foregoing instrument was acknowledged before me this
_______________ ____________________________ _______________
Day
Month
Year
State __________________County of ________________________
___________________
__________________________________________________________
My Commission Expires on:
Date
Signature of Notary Public
9/12/2017
Page 1 of 5
Individuals requiring ADA accommodations call (602)542-2999

ADVERTISEMENT

00 votes

Related Articles

Related forms

Related Categories

Parent category: Legal
Go
Page of 5