KENNEL PERMIT FOR BETTY YERINGTON DBA YERBRIER KENNELS.PDF

Maricopa County
Animal Care and Control
2500 South 27th Avenue
Phoenix, AZ 85009
(602) 506-7387 Tele.
(602) 506-2739 Fax
KENNEL PERMIT K2\- OOCOOS
APPLICATION
CL) New maf Renewal
LET. [Breage Yerk Dek.
Name: Kennel Name:
“ r a
Mailing Address: BYY7 3, EL MUGG EA Kennel Address: Sa2Kne.
CH.
city, Sip achle State: AZ Zip: SHAZ7 city Powel _ rp. SSS ZZ
County Supervisorial District: ¢
Phone: ots LEO BSIZ7 Kennel Phone: CL3 GIG (BGO
Please complete and sign this application and return it to the above address with payment in the amount of three
hundred fifty dollar:
NOTE: Failure to renew the kennel permit by the expiration date of the previous year kennel permit will result in
penalty fees for each dog being assessed at $6 per month for unaltered dog and $3 per month for altered dog in
addition to the permit fee. It is suggested the renewal application be submitted 4 — 6 weeks in advance of the
expiration date to allow timely processing.
Pursuant to Arizona statute and county ordinance, a person must obtain a kennel permit issued by the Board
of Supervisors if the person operates a kennel in which there are five or more dogs which are not individually
licensed. A.R.S. §11-1009(A). A kennel is defined as “an enclosed, controlled area, inaccessible to other
animals, in which a person keeps, harbors or maintains five or more dogs under controlled conditions.” A.R.S.
§ 11-1001(8).
An appointment will be scheduled for inspection of the kennel premises by an Animal Control Officer upon
receipt of this kennel permit application and fee. This kennel application properly executed and a copy of the
inspection report will then be forwarded to, and must be approved by, the Maricopa County Board of
Supervisors. The kennel permit form will be sent to you after approval and will be valid for one year from the
date of the Board’s approval.
NOTE: Failure to show for a scheduled inspection and/or failure of inspection will warrant a Subsequent
Inspection Return fee of $49 for each additional visit at time of inspection. Failure of inspection may result in
denial of the kennel permit and require individual licensing of each dog under the provisions of A.R.S. §11-
1008.
PLEASE ANSWER THE FOLLOWING QUESTIONS AND INITIAL EACH RESPONSE
1.0 /We assume complete responsibility for the kennel at the premises for which I/we are making
cation for a permit and understand that “kennel” means an enclosed, controlled area, inaccessible to

other animals, in which a person keeps, harbors or maintains five or more dogs under controlled
(ARS 11-1001).
a
| ie)
e certify that I/We have dogs and that the kennel meets the definition in statute.
=>
We certify that I/We have not been convicted of a violation of A.R.S. §§ 13-2910 (cruelty to animals)
or 18-¥910.01 (dog fighting), or similar violations of any other state, county or municipal animal welfare law.
(Violations of license and leash laws DO NOT apply).
4. We certify that all dogs over the age of three (3) months that are kept, harbored or maintained on the
premise€s of the above named kennel have been properly vaccinated against rabies by a veterinarian licensed to
practice in the state of Arizona and that a current vaccination certificate signed by a licensed veterinarian is
maintained on the premises for each dog.
5. We certify that MWe are submitting a valid copy of the rabies vaccination certificate for each
th this application.
a
Sp 5 We understand that a dog remaining within the kennel is not required to be licensed individually under
§ 11-1008. I/we also understand that a dog leaving the controlled kennel conditions shall be licensed
a :
R.S. § 11-1008 except if the dog is only being transported to another kennel which has a permit issued
under this section.
7. e understand that a person who fails to obtain a kennel permit under A.R.S.§11-1009 is subject to a
nafty/¢f twenty-five dollars in addition to the annual fee.
8. LA bo understand that a person who knowingly fails to obtain a kennel permit within thirty days after
writer notification from the county enforcement agent is guilty of a class 2 misdemeanor..
Phe %
9 undersigned understand that that the kennel permit does not authorize the operation of any type
of b¢siness and is solely used for the purpose of licensing multiple dogs.
We certify that all of the information I/We have provided is true and accurate under penalty of law.
Me he 7 -_ if fis A /
Applicant Signature Date: 4 LZ
Applicant Signature Date:
For Official Use Only:
Copies of Valid Rabies Vaccination Certificates for each dog attached
Copy of Person’s Valid Identification Attached
Type of Identification submitted
BOS Approval Date Term of Permit
October 2015

Maricopa County Animal Care and Control
2500 S. 27th Avenue
Phoenix, AZ 85009-6797
(602) 506-7387
http://pets.maricopa.gov
Receipt Number: R21-434778 Receipt Date: 02/16/2021
Person ID: P0999105
Phone: 623 5337269
YERBRIER KENNELS
2/16/2021 10:55:00AM
5447 S EL MIRAGE RD ee
~
TOLLESON, AZ 85353
Item: Animal ID: Reference No: Price: Each: Amount:
KEN PERMIT A7777777 K21-000005 $350.00 1 $350.00
Total Fees Due: $350.00
Payments: Cash:
Check: $350.00
Credit Card:
Total Payments Received: $350.00
Would you like to share your experience with our service to you? Thank You!
Please visit our website at http://pets.maricopa.gov and click on I
5	1	17	1	11	11	1773	1663	122	26	84.917831	Chanae:
5	1	17	1	11	12	2147	1662	100	36	96.342003	$0.00
4	1	17	1	12	0	209	1670	1990	57	-1	
5	1	17	1	12	1	209	1688	96	31	96.494743	Want
5	1	17	1	12	2	316	1688	44	31	96.774872	To
5	1	17	1	12	3	373	1688	66	31	95.810989	and
5	1	17	1	12	4	455	1688	141	31	93.037872	Contact
5	1	17	1	12	5	610	1687	161	31	89.475563	MCACC
. ;
to email your comments for our :
: Balance Due: $0.00
review.
Animal Information: NINN DU
A7777777 KENNEL PERM - BORN 9/14/1999, SPAYED, UNKNOWN/MIX, TRICOLOR DOG
License Information:
Tag Number: License Expires: Animal# Vacc Date: Vacc Expires:
Pet Licensed/Registered To: Yerbrier Kennels
Please retain this receipt with your pet's records
luffmanm WBUSOFF

Maricopa County
Animal Care & Control
2500 South 27" Avenue
Phoenix, AZ 85009
Phone: (602) 506-7387
pets.maricopa.gov
KENNEL PERMIT K21-000005
PREMISE INSPECTION
Number of Dogs: 10
Name: BETTY YERINGTON Kennel Name: YERBRIER KENNELS
Mailing Address: 5447 SEL MIRAGE RD Kennel Address: Same
City: AVONDALE State: AZ Zip: 85353
County Supervisorial District: 5
Phone: 623-680-5597 Kennel Phone: 623-925-1350
1. Are all dogs over the age of three months properly vaccinated for rabies and in
possession of a valid rabies vaccination certificate?
YES
2. Is the kennel an enclosed, controlled area, inaccessible to other animals, in which a
person keeps, harbors or maintains five or more dogs under controlled conditions?
YES
NOTE: Copies of each rabies vaccination certificate must be attached to the Kennel Permit
Premise Inspection form.
CORRECTIVE ACTION NEEDED FOR COMPLIANCE AND N/A DAYS GIVEN
BEFORE REINSPECTION. (Note: There will be $49 re-inspect fee payable to the
Inspector by check upon each return visit.)
NONE
This is a RENEWAL application; there are 10 dogs that reside on the property, all of which
are properly vaccinated for rabies, in which certificates have been provided, and all of which
are contained to the property in a sufficient manner. °
Deputy Enforcement Agent & Badge #: ROMERO #4 Date: 2/24/21
October 2015

RABIES VACCINATION CERTIFICATE
OWNER'S INFORMATION:
KENNELS YERBRIER P0999105 (623) 5337269 CELL
=
LAST NAME FIRST NAME PERSON ID TELEPHONE NUMBER EXT:
5447 S ELMIRAGE RD TOLLESON 85353
AZ
STREET ADDRESS APT CITY STATE ZP CODE
ANIMAL INFORMATION
DOG FEMALE 6/16/2007 POODLE TOY
ANIMAL TYPE ANIMAL SEX ANIMAL DATE OF BIRTH SIZE PRIWARY BREED SECONDARY BREED
A3242782 BRIDGET WHITE
ARINALTS
ANIMAL NAME MICROCHIP NUMBER PRIMARY COLOR SECONDARY COLOR
VACCINATION INFORMATION
ZOETIS 36 Months 11/20/2018 11/20/2021 11/20/18
VACCINE PRODUCER VACC. LENGTH DATE VACCINATED VACCINATION EXPIRES PRINT DATE
KILLED .) x. Prapetd Dvm
Maricopa County
VACCINE TYPE Animal Care & Control
VETERINARIANS SIGNATURE
2500 S 27th Avenue, Phoenix, AZ 85009
(602) 506-7387
SN293135 AZ3538
VACC. SERIAL NO. VETERINARIANS LICENSE NUMBER

Affordable Veterinary Services
Phone: (480) 522-6857
paulcarneyDVM@gmail.com
RABIES CERTIFICATE
Patient and Owner Information
Patient: Bubbles Owner: Yerbrier Kennels
Breed: Poodle (canine) Address: 5447 South El Mirage Road
Sex Male (ntact Tolleson, AZ 85323
Color Phone: 6235337269
Aye: 7 Years 6 Months 1 Week Email: Anmoraepoo@gmail.com
Birthdate: Jul 26, 2013 (est.)
Weight: 8 lbs
Chip:
Rabies Information
Tag Number:
Product: Rabies 3yr
Date Given: Jan 27, 2021
Date Due: Jan 27, 2024
Lot: 420628; Nobivac; Expires Oct 05, 2021
Veterinarian Information
Signature:
O 0
Name: Paul Carney
License: 720
Date: Feb 02, 2021
|
:
;

RABIES VACCINATION CERTIFICATE
OWNER'S INFORMATION:
KENNELS YERBRIER P0999105 (623) 5337269 CELL
LAST NAME FIRST NAME PERSON ID TELEPHONE NUMBER
EXT,
5447 S ELMIRAGE RD TOLLESON
AZ 85353
STREET ADDRESS APT city
STATE ZIP CODE
ANIMAL INFORMATION
DOG MALE 6/16/2008
POODLE TOY
ANIMAL TYPE ANIMAL SEX ANIMAL DATE OF BIRTH SIZE PRIMARY BREED SECONDARY
BREED
A3862098 CASH WHITE
RACH
ANIMAL NAME MICROCHIP NUMBER PRIMARY. COLOR ens
VACCINATION INFORMATION
ZOETIS 36 Months 12/17/2019 12/17/2022 12/17/19
VACCINE PRODUCER VACG. LENGTH DATE VACCINATED VACCINATION EXPIRES
PRINT DATE
K.
KILLED C) ution Rexhetd Dvn
Maricopa County
VACCINE TYPE Animal Care &
VETERINARIANS SIGNATURE Control
2500 S 27th Avenue, Phoenix, AZ 85009
(602) 506-7387
366861 AZ3538
VACC. SERIAL NO. VETERINARIAN'S LICENSE NUMBER
eeemeeneenaeeeaneneen se

RABIES VACCINATION CERTIFICATE
OWNER'S INFORMATION:
KENNELS YERBRIER
P0999105 (623) 5337269 CELL
LAST NAME FIRST NAME PERSON ID TELEPHONE NUMBER
EXT:
5447 S ELMIRAGE RD TOLLESON
AZ 85353
STREET ADORESS APT CITY
STATE ZIP CODE
ANIMAL INFORMATION
DOG MALE 4/11/2017
POODLE STND
ANIMAL TYPE ANIMAL SEX
ANIMAL DATE OF BIRTH SIZE PRIWARY BREED SECONDARY BREED
A4177664 CHASE
WHITE
ANINALTO
ANIMAL NAME MICROCHIP NUMBER PRIMARY COLOR SECONDARY COLOR
VACCINATION INFORMATION
ZOETIS 36 Months 12/17/2019 12/17/2022
12/17/19
VACCINE PROOUCER VACC. LENGTH DATE VACCINATED
VACCINATION EXPIRES PRINT DATE
ee
KILLED i. Pra fete DVM
» Maricopa County
VACCINE TYPE VETERINARIANS SIGNATURE Animal Care & Control
2500 S 27th Avenue, Phoenix, AZ 85009
(602) 506-7387
366861 AZ3538
VACC, SERIAL NO. VETERINARIAN'S LICENSE NUMBER

RABIES VACCINATION CERTIFICATE
OWNER'S INFORMATION:
KENNELS YERBRIER P0999105 (623) 5337269 CELL
LAST NAME FIRST NAME PERSON ID TELEPHONE NUMBER EXT:
5447 S ELMIRAGE RD TOLLESON
AZ 85353
STREET ADDRESS APT CITY STATE Zip
CODE
-ANIMAL INFORMATION
DOG MALE 2/14/2010 CHIHUAHUA SH
ANIMAL TYPE ANIMAL SEX ANIMAL
5	1	42	1	7	6	942	1107	48	15	96.815628	DATE
5	1	42	1	7	7	996	1107	26	15	96.815628	OF
5	1	42	1	7	8	1030	1108	54	15	96.928658	BIRTH
5	1	42	1	7	9	1288	1105	41	16	86.533081	SIZE
5	1	42	1	7	10	1564	1107	85	15	95.372429	PRIMARY
5	1	42	1	7	11	1655	1107	64	17	94.602852	BREED
5	1	42	1	7	12	2017	1113	118	15	96.253693	SECONDARY
5	1	42	1	7	13	2142	1113	64	16	96.842628	BREED
4	1	42	1	8	0	267	1154	1913	58	-1	
5	1	42	1	8	1	267	1154	186	33	92.157135	A4017987
5	1	42	1	8	2	657	1157	162	33	90.585129	DENZEL
5	1	42	1	8	3	1593	1164	135	33	96.823318	BLACK
5	1	42	1	8	4	2046	1165	134	47	96.158607	WHITE
4	1	42	1	9	0	308	1204	1887	47	-1	
5	1	42	1	9	1	308	1204	99	46	0.000000	ARIWALTO
5	1	42	1	9	2	675	1229	72	16	94.718597	ANIMAL
5	1	42	1	9	3	752	1230	54	15	96.062477	NAME
5	1	42	1	9	4	1104	1233	106	17	96.124672	MICROCHIP
5	1	42	1	9	5	1216	1235	81	16	38.219795	NUMBER
5	1	42	1	9	6	1581	1227	85	16	95.587944	PRIMARY
5	1	42	1	9	7	1671	1229	68	15	95.587944	COLOR
5	1	42	1	9	8	2003	1226	115	21	52.178593	SECONDARY
5	1	42	1	9	9	2129	1227	66	20	91.646660	COLOR
4	1	42	1	10	0	1090	1273	369	25	-1	
5	1	42	1	10	1	1090	1273	177	23	95.888962	VACCINATION
5	1	42	1	10	2	1277	1275	182	23	96.276344	INFORMATION
4	1	42	1	11	0	398	1330	1812	47	-1	
5	1	42	1	11	1	398	1330	148	32	90.109612	ZOETIS
5	1	42	1	11	2	875	1335	43	31	96.388168	36
5	1	42	1	11	3	945	1335	132	33	96.388168	Months
5	1	42	1	11	4	1244	1341	181	32	96.442787	11/20/2018
5	1	42	1	11	5	1651	1344	196	33	96.102440	11/20/2021
5	1	42	1	11	6	2058	1344	152	33	96.308167	11/20/18
4	1	42	1	12	0	363	1401	1831	34	-1	
5	1	42	1	12	1	363	1401	81	15	95.540833	VACCINE
5	1	42	1	12	2	451	1401	106	17	95.836090	PRODUCER
5	1	42	1	12	3	893	1406	55	15	80.928925	VACC,
5	1	42	1	12	4	956	1407	76	15	95.934731	LENGTH
5	1	42	1	12	5	1289	1411	48	15	95.739716	DATE
5	1	42	1	12	6	1343	1411	117	16	96.098793	VACCINATED
5	1	42	1	12	7	1635	1415	126	15	95.441017	VACCINATION
5	1	42	1	12	8	1768	1416	82	15	95.034470	EXPIRES
5	1	42	1	12	9	2084	1419	57	15	96.304520	PRINT
5	1	42	1	12	10	2146	1420	48	15	95.813461	DATE
4	1	42	1	13	0	396	1460	1664	93	-1	
5	1	42	1	13	1	396	1496	138	33	96.773224	KILLED
5	1	42	1	13	2	855	1460	54	86	23.727980	Oy
5	1	42	1	13	3	915	1460	94	86	25.266914	ution
5	1	42	1	13	4	1035	1471	39	37	0.000000	K.
5	1	42	1	13	5	1091	1470	187	80	19.090281	Rrnpetd
5	1	42	1	13	6	1311	1494	100	45	47.461056	Dvn
5	1	42	1	13	7	1821	1519	130	34	96.776062	Maricopa
5	1	42	1	13	8	1961	1521	99	32	96.787651	County
4	1	42	1	14	0	397	1555	1702	56	-1	
5	1	42	1	14	1	397	1569	80	15	96.488686	VACCINE
5	1	42	1	14	2	483	1570	48	16	95.508873	TYPE
5	1	42	1	14	3	1005	1578	155	17	51.393707	VETERINARIANS
5	1	42	1	14	4	1166	1581	108	15	96.304276	SIGNATURE
5	1	42	1	14	5	1775	1555	106	54	96.513573	Animal
5	1	42	1	14	6	1891	1556	62	54	95.634361	Care
5	1	42	1	14	7	1963	1561	24	25	93.116447	&
5	1	42	1	14	8	1997	1557	102	54	96.681564	Control
4	1	42	1	15	0	1658	1597	559	34	-1	
5	1	42	1	15	1	1658	1597	69	25	93.180649	2500
5	1	42	1	15	2	1737	1598	16	25	92.897263	S
5	1	42	1	15	3	1763	1598	62	25	96.907906	27th
5	1	42	1	15	4	1832	1599	109	30	96.562248	Avenue,
5	1	42	1	15	5	1951	1600	118	31	96.712021	Phoenix,
5	1	42	1	15	6	2080	1601	44	25	94.242493	AZ
5	1	42	1	15	7	2134	1601	83	26	96.063026	85009
4	1	42	1	16	0	1832	1638	213	32	-1	
5	1	42	1	16	1	1832	1638	73	32	96.963539	(602)
5	1	42	1	16	2	1916	1639	129	27	91.799721	506-7387
4	1	42	1	17	0	370	1652	812	34	-1	
5	1	42	1	17	1	370	1652	193	34	90.758942	SN293135
5	1	42	1	17	2	1071	1660	111	26	92.307312	AZ3538
4	1	42	1	18	0	378	1733	924	25	-1	
5	1	42	1	18	1	378	1733	54	15	75.242325	VACC,
5	1	42	1	18	2	440	1734	67	15	95.333786	SERIAL
5	1	42	1	18	3	513	1734	31	15	95.397560	NO.
5	1	42	1	18	4	976	1739	154	16	45.471363	VETERINARIAN'S
5	1	42	1	18	5	1137	1741	78	16	96.144455	LICENSE
5	1	42	1	18	6	1222	1742	80	16	91.659042	NUMBER
2	1	43	0	0	0	736	1308	9	469	-1	
3	1	43	1	0	0	736	1308	9	469	-1	
4	1	43	1	1	0	736	1308	9	469	-1	
5	1	43	1	1	1	736	1308	9	469	95.000000	 
2	1	44	0	0	0	2336	619	18	1176	-1	
3	1	44	1	0	0	2336	619	18	1176	-1	
4	1	44	1	1	0	2336	619	18	1176	-1	
5	1	44	1	1	1	2336	619	18	1176	95.000000	 
2	1	45	0	0	0	1536	1317	9	474	-1	
3	1	45	1	0	0	1536	1317	9	474	-1	
4	1	45	1	1	0	1536	1317	9	474	-1	
5	1	45	1	1	1	1536	1317	9	474	95.000000	 
2	1	46	0	0	0	195	1763	2146	31	-1	
3	1	46	1	0	0	195	1763	2146	31	-1	
4	1	46	1	1	0	195	1763	2146	31	-1	
5	1	46	1	1	1	195	1763	2146	31	95.000000	 
2	1	47	0	0	0	1491	3263	1018	12	-1	
3	1	47	1	0	0	1491	3263	1018	12	-1	
4	1	47	1	1	0	1491	3263	1018	12	-1	
5	1	47	1	1	1	1491	3263	1018	12	95.000000

RABIES VACCINATION CERTIFICATE
OWNER'S INFORMATION:
KENNELS YERBRIER. P0999105 (623) 5337269 CELL
LAST NAME, FIRSTNAME PER | TELEPHONE NUMBER
EXT:
5447 S ELMIRAGE RD TOLLESOQN
AZ 85353
STREET ADDRESS APT CITY
“STATE ZIP CODE
ANIMAL INFORMATION
DOG MALE 3/24/2011
POODLE TOY MIX
TARTS TMA SEX aie ieee 73 —FRTARY BREED —
SECONDARY GREED
A4017990 FRANKY
WHITE
ARTALTO
ANIMAL NAME MICROCHIP NUMBER PRIMARY COLOR SECONDARY COLOR :
VACCINATION INFORMATION
ZOETIS 36 Months 11/20/2018 11/20/2021 11/20/18
VACCINE PRODUCER VACC. LENGTH ~ DATE VACCINATED VACCINATION EXPIRES
~~ PRINT DATE
KILLED ) K. Depots Dum
Maricopa County
— csi Animal Care & Control
2500 S 27th Avenue, Phoenix, AZ 85009
SN293135 AZ3538 (602) 506-7387
VACG. SERIAL NO, VETERINARIANS LICENSE NUMBER

Affordable Veterinary Services
Phone: (480) 522-6857
paulcarneyDVM@gmail.com
RABIES CERTIFICATE
Patient and Owner Information
Patient: Henry Owner: Yerbrier Kennels
Breed: Poodle (canine) Address: 5447 South El Mirage Road
Sex: Male (intact) Tolleson, AZ 85323
(
exien Phone: 6235337269
Age: 5 Vers Week Email: Anmoraepoo@gmail.com
Birthdate: Jan 25, 2016 (est.)
Weight: 8 Ibs
Chip:
Rabies Information
Tag Number:
Product: Rabies 3yr
Date Given: Jan 27, 2021
Date Due: Jan 27, 2024
Lot: 420628; Nobivac; Expires Oct 05, 2021
Veterinarian Information
Signature:
Name: Paul Carney
License: 720
Date: Feb 02, 2021
7 Page 1 oft

RABIES VACCINATION CERTIFICATE
OWNER'S INFORMATION:
KENNELS YERBRIER P0999105 (623) 5337269 CELL
LAST NAME FIRST NAME PERSON ID TELEPHONE NUMBER EXT:
5447 S ELMIRAGE RD TOLLESON AZ 85353
STREET ADDRESS APT CITY STATE ZIP CODE
ANIMAL INFORMATION
bDoG-_| ‘NEUTERED 12/15/2007 CHIHUAHUA SH
ANIMAL TYPE ANIMAL SEX ANIMAL DATE OF BIRTH SIZE PRIMARY BREED SECONDARY BREED
A3863053 P DIDDY TAN WHITE
PARLTG ANIMAL NAME MICROCHIP NUMBER PRIMA COLOR ON me
VACCINATION INFORMATION
ZOETIS 36 Months 12/17/2019 12/17/2022 12/17/19
VACCINE PRODUCER VAC. LENGTH DATE VACCINATED VACCINATION EXPIRES PRINT DATE
C) ruhotd DVM
KILLED » Maricopa County
anc Animal Care & Control
mar TYPE VETERINARIANS SIGNATURE
2500 S 27th Avenue, Phoenix, AZ 85009
(602) 506-7387
366861 AZ3538
VACG. SERIAL NO. VETERINARIANS LICENSE NUMBER

RABIES VACCINATION CERTIFICATE
OWNER'S INFORMATION:
KENNELS YERBRIER P0999105 (623) 5337269 CELL
[AST NAME FIRST NANE PERSON ID TELEPHONE NUMBER
EXT:
5447 S ELMIRAGE RD TOLLESON
AZ 85353
STREET ADDRESS APT City
STATE ZIP CODE
ANIMAL INFORMATION
DOG MALE 10/15/2010 FOX TERR SMOOTH
MIX
ANIMAL TYPE ANIMAL SEX ANIMAL DATE OF BIRTH SIZE PRIMARY BREED
SECONDARY BREED
A4017992 SUNNY TRICOLOR
ARIAL TO
ANIMAL NAME MICROCHIP NUMBER PRIMARY COLOR SECONDARY COLOR
VACCINATION INFORMATION
ZOETIS 36 Months 11/20/2018 11/20/2021 11/20/18
VACCINE PRODUCER VACG. LENGTH DATE VACCINATED VACCINATION EXPIRES
PRINT DATE
K.
KILLED Cutie Renpetd Dv
Maricopa County
VACCINE TYPE Animal Care & Control
VETERINARIANS SIGNATURE
2500 S 27th Avenue, Phoenix, AZ 85009
(602) 506-7387
SN293135 AZ3538
VACC, SERIAL NO. VETERINARIANS LICENSE NUMBER

RABIES VACCINATION CERTIFICATE
OWNER'S INFORMATION:
KENNELS YERBRIER P0999105 (623) 5337269 CELL
LAST NAME FIRST NAME PERSON ID TELEPHONE NUMBER ExT:
5447 S ELMIRAGE RD TOLLESON AZ 85353
STREET ADDRESS APT City STATE ZIP CODE
ANIMAL INFORMATION
DOG MALE 9/5/2010 POODLE TOY MIX
ANIMAL TYPE ANIMAL SEX ANIMAL DATE OF BIRTH SIZE PRIMARY BREED SECONDARY BREED
A4017994 WILLIE WHITE
ARIAL TO PRIMARY COLOR SECONDARY COLOR
ANIMAL NAME MICROCHIP NUMBER
VACCINATION INFORMATION
ZOETIS 36 Months 11/20/2018 11/20/2021 11/20/18
VACCINE PRODUCER VACG. LENGTH DATE VACCINATED VACCINATION EXPIRES PRINT DATE
a
KILLED c) Mrxpetd Dvn
Maricopa County
Animal Care & Control
YOCCIIE TEE VETERINARIANS SIGNATURE
2500 S 27th Avenue, Phoenix, AZ 85009
(602) 506-7387
SN293135 AZ3538
VACC. SERIAL NO. VETERINARIAN'S LICENSE NUMBER