KENNEL PERMIT FOR MARILYN DOMHOFF DBA SHANTE AFGHANS KENNELS.PDF

Maricopa County
Animal Care & Control
2500 South 27" Avenue
Phoenix, AZ 85009
Phone: (602) 506-7387
pets.maricopa, gov
KENNEL PERMIT K21-000023
PREMISE INSPECTION
Number of Dogs: 8
Name: Marilyn Domhoff Kennel Name: Shante Afghans Kennels
Mailing Address: 6824 W. Karen Lee Ln. Kennel Address: Same
City: Peoria State: AZ Zip: 85382
County Supervisorial District: 4
Phone: 623-412-9739 Kennel Phone: 623-412-9739
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 EIGHT dogs on the property that are all currently
vaccinated for rabies and contained to the property.
Deputy Enforcement Agent & Badge #: ROMERO 4 _—SCs— Date: 2/16/21
October 2015

Maricopa County Animal Care and Control
2500 S. 27th Avenue
Phoenix, AZ 85009-6797
(602) 506-7387
htto://oets. maricopa.gov
Receipt Number: R21-416954 Receipt Date: 01/27/2021
Person ID: P1224832
Phone: 623 4129739
SHANTE AFGHANS KENNELS 1/27/2021 9:50:18AM BO:
6824 W KAREN LEE LN
PEORIA, AZ 85382
Item: Animal JD: Reference No: Price: Each: Amount:
KEN PERMIT AT77(7777 K21-000023 $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	18	1	9	12	1782	1665	122	26	85.564568	Chance:
5	1	18	1	9	13	2156	1662	99	36	96.209259	$0.00
4	1	18	1	10	0	220	1671	1988	60	-1	
5	1	18	1	10	1	220	1696	100	31	96.160622	Want
5	1	18	1	10	2	330	1695	44	32	95.922981	To
5	1	18	1	10	3	387	1695	66	32	96.614342	and
5	1	18	1	10	4	469	1695	140	30	93.296120	Contact
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5	1	18	1	10	6	798	1693	33	31	96.673096	to
5	1	18	1	10	7	844	1692	97	32	96.538834	email
5	1	18	1	10	8	955	1699	79	32	96.457031	your
5	1	18	1	10	9	1045	1691	191	31	96.457031	comments
5	1	18	1	10	10	1249	1689	49	32	96.794090	for
5	1	18	1	10	11	1311	1696	59	25	96.990326	our
5	1	18	1	10	12	1862	1671	15	26	39.134007	9
5	1	18	1	10	13	1899	1685	5	40	73.767624	:
5	1	18	1	10	14	2204	1689	4	5	1.732588	,
4	1	18	1	11	0	790	1711	1466	38	-1	
5	1	18	1	11	1	790	1740	5	5	17.706022	;
5	1	18	1	11	2	1708	1715	118	25	96.397644	Balance
5	1	18	1	11	3	1839	1714	65	26	96.700920	Due:
5	1	18	1	11	4	2156	1711	100	38	96.366158	$0.00
4	1	18	1	12	0	733	1747	124	25	-1	
5	1	18	1	12	1	733	1747	124	25	96.350624	review.
4	1	18	1	13	0	126	1869	2219	53	-1	
5	1	18	1	13	1	126	1890	141	32	96.673798	Animal
5	1	18	1	13	2	279	1890	240	32	94.986328	Information:
5	1	18	1	13	3	2007	1869	338	48	8.453770	MINCE
5	1	18	1	13	4	2231	1865	13	67	33.078251	A
2	1	19	0	0	0	124	1910	2004	38	-1	
3	1	19	1	0	0	124	1910	2004	38	-1	
4	1	19	1	1	0	124	1910	2004	38	-1	
5	1	19	1	1	1	124	1910	2004	38	95.000000	 
2	1	20	0	0	0	126	1938	1545	38	-1	
3	1	20	1	0	0	126	1938	1545	38	-1	
4	1	20	1	1	0	126	1938	1545	38	-1	
5	1	20	1	1	1	126	1947	171	29	91.703857	A7777777
5	1	20	1	1	2	312	1946	148	28	94.064827	KENNEL
5	1	20	1	1	3	471	1946	102	28	93.185547	PERM
5	1	20	1	1	4	597	1961	11	4	91.586182	-
5	1	20	1	1	5	621	1944	102	29	96.271240	BORN
5	1	20	1	1	6	738	1943	176	33	93.297218	9/14/1999,
5	1	20	1	1	7	927	1941	152	33	90.796577	SPAYED,
5	1	20	1	1	8	1093	1940	281	33	90.834091	UNKNOWN/MIX,
5	1	20	1	1	9	1386	1938	192	30	75.707886	TRIGOLOR
5	1	20	1	1	10	1591	1938	80	27	96.796135	DOG
2	1	21	0	0	0	129	2072	1959	90	-1	
3	1	21	1	0	0	129	2072	1959	90	-1	
4	1	21	1	1	0	129	2072	407	33	-1	
5	1	21	1	1	1	129	2075	153	30	96.496193	License
5	1	21	1	1	2	295	2072	241	33	86.459816	Information:
4	1	21	1	2	0	565	2112	1523	50	-1	
5	1	21	1	2	1	565	2123	68	39	96.347282	Tag
5	1	21	1	2	2	649	2121	166	32	96.723526	Number:
5	1	21	1	2	3	901	2120	149	31	96.329590	License
5	1	21	1	2	4	1066	2118	157	39	91.129471	Expires:
5	1	21	1	2	5	1284	2117	159	31	86.153625	Animal#
5	1	21	1	2	6	1534	2115	92	32	92.366386	Vacc
5	1	21	1	2	7	1642	2115	97	30	96.162201	Date:
5	1	21	1	2	8	1824	2114	92	31	92.868004	Vacc
5	1	21	1	2	9	1931	2112	157	41	96.701416	Expires:
2	1	22	0	0	0	715	2183	1051	43	-1	
3	1	22	1	0	0	715	2183	1051	43	-1	
4	1	22	1	1	0	715	2183	1051	43	-1	
5	1	22	1	1	1	715	2189	65	31	93.293800	Pet
5	1	22	1	1	2	791	2186	406	40	91.119827	Licensed/Registered
5	1	22	1	1	3	1210	2186	58	31	93.295441	To:
5	1	22	1	1	4	1282	2186	136	30	92.186836	Shante
5	1	22	1	1	5	1428	2184	165	39	96.525711	Afghans
5	1	22	1	1	6	1607	2183	159	31	96.396004	Kennels
2	1	23	0	0	0	126	2083	2162	40	-1	
3	1	23	1	0	0	126	2083	2162	40	-1	
4	1	23	1	1	0	126	2083	2162	40	-1	
5	1	23	1	1	1	126	2083	2162	40	95.000000	 
2	1	24	0	0	0	125	2145	2163	40	-1	
3	1	24	1	0	0	125	2145	2163	40	-1	
4	1	24	1	1	0	125	2145	2163	40	-1	
5	1	24	1	1	1	125	2145	2163	40	95.000000	 
2	1	25	0	0	0	817	2771	910	45	-1	
3	1	25	1	0	0	817	2771	910	45	-1	
4	1	25	1	1	0	817	2771	910	45	-1	
5	1	25	1	1	1	817	2777	125	31	96.458839	Please
5	1	25	1	1	2	954	2775	110	33	96.652008	retain
5	1	25	1	1	3	1078	2774	68	33	96.971443	this
5	1	25	1	1	4	1158	2774	129	42	96.872345	receipt
5	1	25	1	1	5	1301	2772	76	35	96.378754	with
5	1	25	1	1	6	1386	2783	92	31	96.841370	your
5	1	25	1	1	7	1484	2771	91	43	96.926353	pet's
5	1	25	1	1	8	1588	2771	139	33	96.880646	records
2	1	26	0	0	0	124	3186	365	32	-1	
3	1	26	1	0	0	124	3186	365	32	-1	
4	1	26	1	1	0	124	3186	365	32	-1	
5	1	26	1	1	1	124	3188	154	30	85.470306	luffmanm
5	1	26	1	1	2	303	3186	186	29	90.048401	WBUSOFF

Maricopa County
Animal Care and Control
2500 South 27th Avenue
Phoenix, AZ 85009
(602) 506-7387 Tele.
(602) 506-2739 Fax
KENNEL PERMIT K(2\- GOCO023
APPLICATION
of Renewal
(1 New
V0 Ny L2 whol? Kennel Name: S he rte AN kon S
Name:
Mailing Address: 2 9.24 Wa rer Lev Li Kennel Address: Sore
City: (Langs ze. State: AZ Zip:_7@sx7FZ City: Zip:
County Supervisorial District: 4
Phone: C03 ~V72- 923 9 Kennel Phone: 24.3 -“/2- 7 IF9
Please complete and sign this application and return it to the above address with payment in the amount of three
hundred fifty dollars ($350.00) within ten (10) days of receipt.
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.
§ 11-1004 (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. Wn IAWe assume complete responsibility for the kennel at the premises for which I/we are making
application for a permit and understand that kennel’
5	1	28	1	2	9	1324	3021	121	24	96.843102	means
5	1	28	1	2	10	1461	3021	42	23	94.740036	an
5	1	28	1	2	11	1521	3012	173	38	96.554291	enclosed,
5	1	28	1	2	12	1712	3011	177	34	96.412682	controlled
5	1	28	1	2	13	1907	3021	87	30	96.248306	area,
5	1	28	1	2	14	2015	3012	223	32	96.657555	inaccessible
5	1	28	1	2	15	2256	3014	32	30	96.446899	to

other animals, in which a person keeps, harbors or maintains five or more dogs under controlled
conditions (ARS 11-1004).
2, ji. \We certify that We have x dogs and that the kennel meets the definition in statute.
3. yd. \/We certify that I/We have not been convicted of a violation of AR.S. §§ 13-2910 (cruelty to animals)
or 13-2910.01 (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, Ml iWe certify that all dogs over the age of three (3) months that are kept, harbored or maintained on the
premises 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. mM? | We certify that [AWVe are submitting a valid copy of the rabies vaccination certificate for each
dog with this application.
6. hhh) iMWe understand that a dog remaining within the kennel is not required to be licensed individually under
A.R.S. § 11-1008. IAwe also understand that a dog leaving the controlled kennel conditions shall be licensed
under 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. mil \AWe understand that a person who fails to obtain a kennel permit under A.R.S.§11-1009 is subject to a
penalty of twenty-five dollars in addition to the annual fee.
8. my) We understand that a person who knowingly fails to obtain a kennel permit within thirty days after
written notification from the county enforcement agent is guilty of a class 2 misdemeanor..
9. nl The undersigned understand that that the kennel permit does not authorize the operation of any type
of business and is solely used for the purpose of licensing multiple dogs.
I/We certify that all of the information I/We have provided is true and accurate under penalty of law.
7 ly i AG 9 Y vw Al
Applicant Signature / Warudjs 2222. Vids a Date__
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

Date of Rabies Vaccination: 11-16-20 Certificate No: 0
Next Rabies Vaccination On:)11-46- Previous Rabies Vaccination:
VETERINARY CLINIC OWNER OF ANIMAL
Sunburst Animal Hospital Marilyn Domhoff
13807 North 51st Avenue, Suite A 6824 W. Karen Lee Ln.
Glendale, AZ 85306 Peoria, AZ 85382
602-938-1860 County:
This is to certify...
THAT | HAVE VACCINATED AGAINST RABIES THE ANIMAL DESCRIBED BELOW.
Patient information...
BREED: Afghan Hound
PATIENT}:
SPECIES: Canine WEIGHT: 67.80
SEX: M AGE: 5 years
Color and markings... Cream MICROCHIP: 911002001380470
Rabies Vaccine Information...
MFG BY: MER SER.NO: 18482 LOT EXP: 06/11/22 ADM: SQ
aver
Signed
Jessica A. Reynolds, DVM License: AZ4051

SIDE VETERINARY HOSPITAL
CSREES . CO URT
ROCKY MOUNT. NO ev. -
ee (252) 442-2824
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en
Patient !D:
Client [D: 9862
Tuuent Nam
i Client Name: Marvland Domhoff
opecies: CANINE
Address: 6824 W. Karen Lee Lane
Breed: HOUND, AFGHAN
Sex: Femate
Peoria, AZ 85382
Color: BLK
PROT: {(823)442-8735 Markings:
Birthday: 07/14/2015
Weight: 61.30 pounds on 3/24/2020
Tag Number G-38668? Vaecinatian Date:
Lot Number: 372929A Expiration Date:
Rabies Vacce Defensor 3
Produces: Zoetis
tur AAI VIC Ff I D- OEN. Kiltoan PATS N! Vitrsic ¥ Tf Nd
Stafi Name Or Chandra Meachem Tucker, DVM
firaoren arenas a faaa
L_.

CERTIFICATE OF VACCINATION.
sone SE eee eaneenneeaeee ara
Date of Rabies Vaccination: 08 Certificate No: 0
Next Rabies Vaccination Onl0 Previous Rabies Vaccination:
VETERINARY CLINIC OWNER OF ANIMAL
Sunburst Animal Hospital Marilyn Domhoff
5032 W. Thunderbird Road 6824 W. Karen Lee Ln.
Glendale, AZ 85306 ~ Peoria, AZ 85382
602-938-1860 County:
This is to certify...
THAT | HAVE VACCINATED AGAINST RABIES THE ANIMAL DESCRIBED BELOW.
Patient information...
PATIENT:(Bo ” TAG NO:
SPECIES: Canine WEIGHT: 63.90
SEX: M AGE: 5.years
Color and markings... Fawn/Black Face MICROCHIP: 941000016207260
Rabies Vaccine Information...
MFG BY: MERI SER.NO: 18424 LOT EXP: 03/06/21 ADM: SQ
Pyllted,
Signed
Jessica A. Reed, Dy : License: AZ4051

Rabies Vaccination: 08-08-70 Gari: ”
Date af _
=hies Vaccination Ont Previous Rabies Vaccination:
VETERINARY CLINIC OWNER OF ANIMAL
Sunburst Animal Hospitat Variiyrs Gossiiait
43807 North 51st Avenue, Suite A 6824 W. Karen Lee un.
Glendale, AZ 85306 Peoria, AZ Guuue
02-98-4860 Counk, SEM
This is to certify...
THAT | HAVE VACCINATED AGAINST RABIES THE ANIMAL DESCRIBED BELOW,
Patient information...
PATIENT: Mira’ BREED: Afghan Hound
SPECIES: Canine WEIGHT: 56.60
SEX: F AGE: 19 months
Color and markings... Brindle MICROCHIP:
Rabies Vaccine tnformation...
MFG BY: MERI SER.NO: 18465 LOT EXP: 02/12/22 ADM: SQ
SEL
ws
A ere, SMG L
Signed
Michelle L’ Porter, DVM License: AZ3196

ES VA CERTIFICATE [RABIES TAG NUMBER
‘ACCINATION
a id 8} (Revised 2007) i
| MICROCHIP NUMBER
iQwner's Name & Address Print Uieariy
‘LAST FIRST Mad. {ELEPHONE
-vomnott Viarilyn (623)4 12-9739
‘NO STREET CITY STATE ‘air
'6824 W. Karen Lee Lane Peoria AZ 85382
‘PKEOOMINANT BREED |PREDOMINANT
SSPECIES iSEX {AGE jsize i
‘Dog |Male Ci | Months {| |Under 20 Ibs | |\Afghan Hound |COLORS/MARKINGS »
‘Cat flifemale 18 Years & l20 - 50 Ibs XI vane {Blue & Cream
iOther i} {Neuter {; | juver dU IDS
a
(Specify)
|Animal Control License |) 1Yr {13 Yr {J Other
‘DATE VACCINATED PRODUCT NAME [veterinarian Dr. Michele Johnson
08/06/2018 sos epg pet ve ng tenn eee License No: AZ 4189
4
iF a i | Wickets
(First 3 Letters) P Fabrsaan
Leah. Veterinarian's C0 py
‘NEXT VACCINATION
'DUF BY: i dvr ISDA Licensed Vaccine i Sianature
©08/05/2021 : ; i 3 yr USDA Licensed Vaccine iAddress Grand Paws Animal Clinic
|| 4 yr USDA Licensed Vaccine | 11310 W. Bell Rd Suite #103
{{ Initialdose |! Boosterdose | Surprise, AZ 85378
174704. ok
_Vace. Serial (Lot) No. N
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- it GER TIPICATE
IMICROCHIP NUMBER
T Mi. JELEPHONE
LAD FIRST
PuaeereTetst) Marilyn (623)4 12-9739
NO STREET CTY STATE pate
:6824 W. Karen Lee Lane Peoria AZ 185382
POPEUIES jSEX iAGE iSiZE {PREDOMINANT BREED {PREDOMINANT
‘Dog > |Male 1 Months |_| [Under 20 Ibs {Afghan Hound |COLORS/MARKINGS |
Sot OC Pssria MER Years 4 '20-50 Ibs Kin a ‘Blue & Cream
iUuIner 4 dNeuter | jUver DU IDS :
i ‘Animal Control License ($1 Yr {.:3 Yr i.) Other ;
‘DATE VACCINATED PRODUCT NAME ~ ‘Veterinarian: Dr. Michele Johnson
08/06/2018 ‘License No: AZ 4189 |
‘(First 3 Letters) PFA,
iNEXT VACCINATION bee toe do! \Veterinarian's jobusan OU
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“DIE RY: Ho dur USDA Linanced Vaccine ‘Clan ctics
08/05/2021 iX 3 yr USDA Licensed Vaccine [Address Grand Paws Animal.Clinic.
i 4 yr USDA Licensed Vaccine 11310 W. Bell Rd Suite #103
{ { Linitialdnse | | Bonsterdose Surorise. AZ 85378
j 1747046
i Vacc. Serial (Lot) No. |
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Mate of Rabies Vaccination, 17-20-49
iwwai Rabies Vaccination Qn Previous. Rabies Vaccination:
—
VETERINARY CLINIC OWNER OF ANIMAL
Sunburst Animal Hospital Marilyn Domhoff
tata,
5032 W. Thunderbird Road 6824 W. Karen Lee Ln.
james Glendale, AZ 85306 Peoria, AZ &0502
602-938-1860 Query,
This is to certify...
THAT 1 HAVE VACCINATED AGAINST RABIES THE ANIMAL DESCRIBED BELOW.
Patient information..,
PATIENT:'Saxon’ TAG NO:
SPECIES: Canine WEIGHT: 46.20
SEX: M AGE: 19 weeks
Color and markings... Cream MICROCHIP: 276098106892058
Rabies Vaccine information...
MFG BY: ZOE SER.NO: 343374B LOT EXP: 09/22/20 ADM: SQ
Signed
Mark A. Stevens, DVM License: AZ1246

*
VACCINATION RECORD ¢ °.
Tag fee $:
RABIES VACCINATION CERTIFICATE Name
-
ADAPTED NASPHV FORM 51 Tag #: O RABIES
PRINT NT'~ — use balfpoint i pen or type Serial ial #: #:
Owner's Name & Address Cert LYME DISEASE
LAST FIRST Mi TELEPHONE Q CANINE DISTEMPER
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Pn STREET CITY STATE ZIP O CANINE ADENOVIRUS 2
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SPECIES: SEX: AGE: SIZE: PREDOMINANT BREED: (CANINE CORONAVIRUS -
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Other O | Altered | YeS72-2°O | oversots, 0
O FELINE LEUKEMIA VIRUS
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PRODUCER: Veterinarian’s FORS
# FELINE
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- \O- Wan (First Letters) License No.
3 Q FELINE CHLAMYDOPHILA
Month Day Year | PRODUCT NAME: Veteri Name (please print)
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VACCINATION EXPIRES: 1 yr. Lic/Vacc.
3 yr. LicVacc.OX
Qe HiGOk
Month
Vacc. Serial (Lot) No.
USCAHNON02066