BUCKEYE AZ BULLDOGGES KENNEL PERMIT RENEWAL (K20-000060).PDF

maricopa County
Animal Care And Control
200 South 27th Avenue
Phoenix, AZ 85009
(602) 506-7387 Tele.
(602) 506-2739 Fax
KENNEL PERMIT APPLICATION
Li New /Renewal Permit # K20 0000(00
Nameanua Kennel Name:
Mailing Address: )3 zill—S,saiOg.:_t_Die Kennel Location:
zip q6-3(giv CountySJp .e.-4-,ris c.--,rial Distict
Home Phone: 5-C22:22-a6 Kennel Phone:
Please complete and sign this . -Ipplication and return it to the above address with payment in the amount of
three hundred fifty dollars ($35,00) within ten (10) days of receipt.
Pursuant to Arizona . statute an county ordinance, a person must obtain a kennel permit issued by the Board of
Supervisors if the person ope: dtes 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 ke?2s, harborS or maintains five or more dogs under controlled conditions." A.R.S.
§ 11-1001(8).
An appointment Will be sChee led for inspection of the kennel premises by an Anima! Control Officer u_pori
receipt of this kennel permit ai plication and fee: This kennel application pnTerly executed and a copy of the
inspection report will then bz,! forwarded to, and must be approved byLthe Maricopa County Board of
Supervisors. The kennel perry it 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 i.eduled inspection and/or failure of inspection will warrant a Subsequent
Inspection Return fee of $49 fc - each additional visit. Failure of inspection may result in denial of the kennel
permit and require individual IL nsing of each dog under the provisions of A.R.S. §11-1008.
PLEASE ANSWE), THE FOLLOWING QUESTIONS AND INITIAL EACH RESPONSE
-
1. 0/71/We assume comrete responsibility' for the kennel at the premises for which l/we are making
application for a permit and ur.erstand.that "kennel" means an enclosed, controlled area, inaccessible to other
animals, in which a person kee:.-.)s, harbors or maintains five or more dogs under controlled conditions (ARS 11-
.100)A.
e certify that I/We dogs and that the kennel meets the definition in statute.
: I/We Certify that INVc ,:have not been convicted of a violation of A.R.S. §§ 13-2910 (cruelty to animals)
or 13-2 .9-10.01 (dog fighting), '..)r similar violations of any other state, county or municipal animal welfare law.
(Violations of license and leas':. laws DO NOT apply).
4.W/, livve certify that all dc OS over the age of three (3) months that are kept, harbored or maintained on the
premises of the above named ennel have been properly vaccinated against rabies by a veterinarian licensed to

practice in the state of Arizori;, and that a current vaccination certificate signed by a licensed veterinarian is
maintained/øh the premises for each dog.
I AR/e certify that IN' e are submitting a valid copy of the rabies vaccination certificate for each
with tfiris application.
I/We understand they dog remaining within the kennel is not required to be licensed individually under
A.R.S. § 11-1008. I/we 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 s‘ction.
77/7 I/VVe understand that person who fails to obtain a kennel permit under A.R.S.§11-1009 is subject to a
penalty of tw 'nty-five dollars in ::.ddition to the annual fee.
8. I/We understand tha a person who knowingly fails to obtain a kennel permit within thirty days after
written notification from the cou ,ty enforcement agent is guilty of a class 2 misdemeanor..
9. ,"The undersigned uncle' rstand that that the kennel permit does not authorize the operation of any type
of business and is solely used Dr the purpose of licensing multiple dogs.
1/1Ne certify that all of the inf; rmation INVe have provided is true and accurate under penalty of law.
Applicant Signa Date:
Applicant Signature Date:
For Official Use Only:
Copies of Valid Rabies Vaccinatior. Certificates for each dog attached
Copy of Person's Valid ldentificati i Attached
Type of Identification submitted
BOS Approval Date Term of Permit
2 of 2

Maricopa County Animal Care and Control
2500 S. 27th Avenue
Phoenix, AZ 85009-6797
(602) 506-7387
httb://bets.maricopa.dov
Receipt Number: R19-889505 Receipt Date: 09/03/2019
Person ID: P2381323
Phone: 602 5270366
BUCKEYE BULLDOGGES KENNELS 9/3/2019 1:03:06PM
13411 S 208TH DR
BUCKEYE, AZ 85326
Item: Animal ID: Reference No: Price: Each: Amount:
KEN PERMIT A7777777 K20-000060 $350.00 1 $350.00
Total Fees Due: $350.00
Payments: Cash:
Check: $350.00
Credit Card:
Total Payments Received: $350.00
Thank You!
Would you like to share your experience with our service to you? Change: $0.00
Please visit our website at http://pets.maricopa.gov and click on Balance Due: $0.00
"Contact Us" to email your comments for our review.
Animal Information:
A7777777 KENNEL PERM - BORN 9/14/1999, SPAYED, UNKNOWN/MIX, TRICOLOR DOG
License Information:
Tag Number: License Expires: Animal# Vacc Date: Vacc Expires:
Please retain this receipt with your pet's records
johnsonk WBUSOFF

Maricopa County
Animal Care & Control
2500 South 27th Avenue
Phoenix, AZ 85009
Phone: (602) 506-7387
pets.maricopa.gov
KENNEL PERMIT K20-000060
PREMISE INSPECTION
Number of Dogs: 6
Name: DONNA WILLIAMS Kennel Name: BUCKEYE BULLDOGGES KENNELS
Mailing Address: 13411 S 208TH DR Kennel Address: SAME AS MAIL
City: BUCKEYE State: AZ Zip: 85326 County Supervisorial District: 5
Phone: 602-527-0366 Kennel Phone: 602-527-0366
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 erflosed, controlled area, inaccessible to other animals, in which a
person keeps, hart ors 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 :)ach return visit.)
There are 6 dogs on the property, all currently vaccinated and confined to suitable
enclosures.
This is a RENEWAL and here is no reported history at this address.
Deputy Enforcement Agent & Badge #: Lt. Romero #4 Date: 9/9/19
October 2015

ADAPTED NASPHV FORM 51 lai; _
PRINT - use ball point pen or type Cert. Serial #1:
_. LYME DISEASE
TELENE CANINE DISTEMPER
Ltr .ode•
CANINE PARAINF:LUENZA
EET STATE ZIP
fi CANINE ADENOVIRUS 2
I SEX: AGE: SIZE: Pf'. ! Ettc INANT BREED: COLORS: CANINE PARVOVIRUS
I Male 3 Mo. to 12 Mo. Under 20 lbs. Li i '! A :C. .1 CANINE CORONAVIRUS
Female 12 Mo. or older 20 - 50 lbs •1 CANINE BORDETELLA
Altered I Over 50 lbs. LEPTOSPIROSIS
FELINE LEUKEMIA VIRUS
PRODUCER: J FELINE PANLEUKOPENIA
\ Veterinarian's ki
License No. FELINE RHINOTRACHEITIS
Day Year (First 3 Letters) FELINE CALICIVIRUS
_ FELINE CHLAMYDIA
I 1 yr. Lic.Nacc. \ Signature
VACqINATON EXPIRES- . FELINE IMMUNODEFICIENC`
I 3 yr. Lic./Vace' VIRUS
jr==7.7,7774N:
rr-n i Boehringer
40V Ingelheim
BUCKEYE VETERINARY SERVICES Client No. 15562
WILLIAMS, DONNA & ROGER
24090 W. IIIGHWAY 85 13411 S. 208TH DR.
Buckeye, AZ 85326 Buckeye, AZ 85326
Phone: (623) 386-2532 Phone: (602) 527-0366
Fax: (623) 386-0870
Spay/Neuter Certificate 08101119 4:19 PM
NAME MAGIC MIKE
SPECIES: CANINE WEIGHT: lbs Rabies Tag IV
BREED: BULL DOG ID #1:
GENDER, MN ID #2:
COLOR: SABLE Last Visit: 08/01119
BIRTHDAY: 02128/17
AGE: 2 yrs, 5 months
I hereby certify that the above animal has been neutered
OR. HELEN RYAN License: 3793

Rabies Tag $
Bar cod Number A44442C
Weste r)isr;csal $
i it
: nnths - fenali - do;
- Qid
he.:11+J,
ei's Vis:t
PX01 - 190421 54011t:o:
Rabies - Defensor 3
Mante....tured by 7oet"..i,
Number 329 ,2S7:_,
'.ear Booster
Rabies Tag $C
BeruiDde Number A444479'
Medloel .Waste 51sposi=11
SubtoIai: $44
Saies Tax: $C
t VA
-aymants:
$44
:44:44444 U 5j
Future Booster Fees Not Included
t!'; t
tho iuut
:Lit;:rtam
OFFICIAL PROOF
OF VACCINATION
Rabies Certiicaie
Veterinarlan Signature
atherth..e Chicotka
_:cense:
A7-7178-Exoires:12/30/2020
Pear

RABIES VACCINATION CERTIFICATE RABIES TAG NUMBER
NASPHV FORM 51 012674
Owner's Name . MICROCHIP NUMBER
LAST FIRST . M.I. TELEPHONE
Cutbirth Tommy & April (417) 699-2003
ADDRESS CITY STATE ZIP
518 Fox Squirrel Rd. Galena MO 65656
SPECIES SEX AGE SIZE PREDOMINANT BREED PREDOMINANT
v Dog 51Male • Under 20 lbs COLORS/MARKINGS
• Cat OFemale 3 51 Months I3120 -50 lbs
Other • Altered N/A • Years Over 50 lbs :---- rcortch S a 1 Itiej 61,0CLA ' t
(Specify)
Animal Control License 1 Yr 3 Yr [2 Other NAME
Kennel 2019
DATE VACCINATED PRODUCT NAME Veterinarian: Sarah Phillips, D.V.M.
8/19/2019 License No: M02002025658
--MA il- AZ :1--
NEXT VACCINATION MANUFACTURER MIS IR
DUE BY: (First 3 Letters)
8/18/2020
In 1 yr USDA Licensed Vaccine
03 yr USDA Licensed Vaccine Veterinarians '
Signature:
04 yr USDA Licensed Vaccine
.0 Initial dose ['Booster Dose Address: All About Pets Veterinary Clinic
11131 8044 Farm Road 2062
Vacc. Serial (Lot) No. Purdy, MO 65734
Meafi oaf

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auetorized Veterinarian Signature animals 1 44654 OH Troyer
to in OWNER Types: Moon acclimated ARKSIADDMONAL animals -NUMBER SHIPMENT
Issuing listed this I I 44654
inspect this OFFICIAL on IDs: Age: to IN
animals certificate USE this shipment AGENT temperatures 110( phone 59fir5 Ohio
and Is ONLY certificate. are 02101/19 CERTIFICATION 614-723-631 We East Deportneerd
Issue accredited those STATEMENT I up Sale V4-725-6229
certificates. Date certified Killed Type Color to 85 PURPOSE(S) 40068 Sirost of
and has to Blue I F and PIN/LID: Phone. 6702 Junior AratcuIflo•
been and Gender down STATEMENTS OF / Millersburg, TR L. SHIPMENT CONSIGNOR,
are This Medal to 44654 OH 113 Troyer
Ole,Slate indicated 1101 VETERINARIAN is a Manufacturer Male I -20 F. MOVEMENT 44654 PRESENT INSPECTION FOR
requireMeN5. on fit,oking 44004 legally VETERINARIAN'S Breed:
the SOS 2919-05-08 FOREIGN
No certificate. of CERTIFICATION binding French OWNER DATE Contact
further To Infectious, 111c SIGNATURE: Automobile CARRIER OF State
weirderty the - I Bulldog SHIPMENTS of
Is beat of contagiouL certify. •-if I TYPE ISSUE CERTIFICATE
made My as on a Head PINIUD: Phone, Buckeye, 13411 Donna (Outside Destination
or knowledge, arrdior accsedeed handwntten 18344 Lot Count: 1 85326 AZ S 208th DESTINATION DATE for
implied. the communicable 2019-05-08 Mariana Number 1 Williams 2019-05-08 United OF
85326 Dr. OF Movement
arwmid s Vetennanan, McCarty signature, J States
Sited &Jesse, Lot HERD SHIPMENT or VETERINARY
on mio 11:20:04 Leaving Requirements
mos texcept floovw DVM Expiration STATUS ENTRY
comeore whir* arwyis -05.00 United and
I•••,e• tVtezdi how NUMBER PERMIT States) INSPECTION
pp re beam 2019-05-08 Administered PIN110 Primus Buckeye, 13411 Donna SHIPMENT NUMBER USE Certificate
Amos •1•107011X6 I S CONSIGNEE,
evrocap 85325 AZ 2O8tnDc. Williams FEDERAL Validity
eeeianox,,,r4 e 85326 NEW
mem ce sfic 2020-05-08 Expiration HERD FORM
we,* wee :sat FREE OWNER
Elkits FOR OF BRAM
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pttIO 6702 Junior INSPECTION CERTIFICATE
istaerSOUtil TR L CARRIER.
1.4654 014 113 Troyer NUMBER
4fil554 TRANSPORTER & 19-0H-14650041 NUMBER
ISSUE
DATE

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Durant Animal Hospital
86 W Mulberry St.
Durant. OK 74701
(580) 924-1640
Fax: 580-924-1684
Email: duranta _r_ limalhoan
Rabies Certificate
Name: Chris Fancy Pet's name Dixie
Address: 307 Private Rd 15 Species: Canine
Breed: Bulldog, French
City: Whitewright Sex: Female
State: TX Color: Cream
Postal Code: 75491 Birth Date: 3/30/2019
Rabies Vaccination Information
Tag Number 54158 6/25/2019
Lot Number D12153C 6/25/2020
Producer BOEHR1NGER INGELHE1M
K 1MVL Rabvac 3 (killed virus)
Microchip ID Number:
Vaccination Reminders:
Rabies 1 Year 6/25/2020
Veterinarian:
License Number: 01(2756, TX12808 Boyd Mills, DVM