STERLING SHELTIES KENNEL PERMIT (K19-000071).PDF

Maricopa County
Animal Care And Control
2500 South 27th Avenue
Phoenix, AZ 85009
(602) 506-7387 Tele.
(602) 506-2739 Fax
KENNEL PERMIT APPLICATION
New 0 Renewal Permit #
Name: Kennel Name:
Mailing Address:.1
City ft7 ZIP County Supervisorial District
Home Phone: V/1.' 'I / Kennel Phone:
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.
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. 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. §11-100B
PLEASE ANSWER THE FOLLOWING QUESTIONS AND INITIAL EACH RESPONSE
1. I/VVe assume complete responsibility for the kennel at the premises for which l/we are making
application 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 conditions (ARS 11-
1001). ,
2.T7 t ,i/VVe certify that I/We have dogs and that the kennel meets the definition in statute.
3:- INVe certify that I/We have not been convicted of a violation of A.R.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),
7-77— I/We 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. 1 /We certify that I/VVe are submitting a valid copy of the rabies vaccination certificate for each
dog with this application.
6/1 73-1 I/VVe understand that a 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 section.
7. . , INVe understand that a person who fails to obtain a kennel permit under A.R.S.§11-1009 is subject to a
pen" of twenty-five dollars in addition to the annual fee.
I/VVe 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..
6:- 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.
VVVe certify that all of the ipfprmation 1/We have provided is true and accurate under penalty of law.
Applicant Signature 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
2 of

Maricopa County
Animal Care & Control
2500 South 27th Avenue
Phoenix, AZ 85009
Phone: (602) 506-7387
pets.maricopa.gov
KENNEL PERMIT K19-000071
PREMISE INSPECTION
Number of Dogs: 20
Name: PEGGY STEPHENS Kennel Name: STERLING SHELTIES
Mailing Address: 3942 W TIERRA BUENA LN Kennel Address: Same
City: PHOENIX State: AZ Zip: 85053 City: PHOENIX Zip: 85053
County Supervisorial District: 3
Phone: 602-978-6833 Kennel Phone: 602-690-7151 (CELL)
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.)
Kennel was inspected on June 11, 2019; there are 20 dogs on the property which are
properly vaccinated and confined to an enclosed area.
Deputy Enforcement Agent & Badge #: TRUE #14 Date: 6/12/19
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: R19-822186 Receipt Date: 06/03/2019
Person ID: P2812076
Phone: 602 9786833
STERLING SHELTIES KENNELS
3942 W TIERRA BUENA LN 6/17/2019 10:38:08AM
PHOENIX, AZ 85053
Item: Animal ID: Reference No: Price: Each: Amount:
KEN PERMIT $350.00 1 $350.00
Total Fees Due: $350.00
Payments: Cash:
Check:
Credit Card: $350.00
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.
gillette WBUSOFF

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TLC:
VACCINATION CERTIFICATE
render Loving Care
Veterinary Services & Supplies LLC Corporate Office Hours:
Mon - Fri 9:00 am - 5:00 pm
, _ , , . -I -I — — — — — — — I . s-, VV., I -1-1 V..., /VIGJO3 r-V-. 1...,"- I IJ
T . : OWNER: Fill out sections4 .. -3_-.:' _ -. OFFICIAL RECORD - PLEASE PRINT CLEARLY www.TLCVetServices.corn
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Last Name: --J :"--" r (...> First Name:
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Address: _
City: State: Zip: I
Email:
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Home: 1,:°) 1- ,-_,--. - /- .), 6 - L- -.---? Cell: I___. - . - / ' , Work.
! acknowledge having read and I understand the back of this document Being aware of - r_ t.
these facts, !give my permission to TENDER LOVING CARE VETERINARY SERVICES & ,i- '-°--, ic 1 / -';: 2- ':---1':',/-`=---'- ------ DATE r.), / ° / 1 I
SUPPLIES LLC and/or the Doctorto treat and/or administerthe vaccinations Fated below. There isa $1 2$3`iivaste disposal fee per animal. Prescription ONLY fee $10. '
New Client Yet 0 No a How did you hear about this clinic? 0 Flyer from Store 0 Mailer 0 Referral 0 Website 0 Other
ed6lagEEME IllEiMINAINISIME1621 5
- )i...Dog -p .Male 0,4-elitered , --, (male) 0 On Medication N ,j 0.pog 0 Male 0-Neutered -(male) 0 On-Medication
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0 Cat 0 Female - 0 SpaykfernaleraPregnant 0 Cat ',El Female CI Sdaya-d- female) 0-Pregnant
Name: ---r- . , '4 . r — , / - '--- r----- ..,-- , c!:' '-, , . Age (/check one): Name: --_--, / _.) /---'1 !-;'-'7 4:,-; /-,-__ Age Vcheck one):
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Breed: '-n--k--_ J-, 1 '--°;_ ', -':---=13 - , ° ,.... 0 Mos Breed: ----- ':-° e A '1 1. C' . -2: 0 Mos
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2abies Type: KILLED VIRUS__ Mfg. 1:1-'_:, ;,;-: ,. PRICE NEXT BOOilgRt::::. Rabies Type: KILLED VIRUS Mfg. 47,-; 7 7 - PRICE idOetikiiiiiiia!
_Ot # --'—) 1 \ i. /----- 4f-:.; ',-__L.-- ,--_,71 . NI,' - Tag . , # (Does not include 3-4 6 12 36 Lot # 1-j-) 1. =,70(-C)---,, (-2, . rag # ' - (Dees not include 3_4 6 — . •, .12 -, ., — 36 ..,,
,---;___ price of boosters.) weote month, month, mow, ._ . _ ' . 6..,,,.."..,i,......) price of boosters.) Weeks Months Months Months
2abies Date Vaccinated: '-/_,. / '' / \ -' I 1 .-•, ' Rabies Date Vaccinated: L-•-' / I / i . ---1 -
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2abies Vaccination Due: r-,-) / \ / ."::-.1-.:-=-;` , $1---.2„.—'iTh . i Rabies Vaccination DUE (.77, / i . 1 :::4-..1:-.2 $ IC) „7-7----, . , -
DP1- DA2PPv,/ Bordetella Nasal I Deworm cc $ DPI - DA2PPv I Bordetella Nasal IDeworm- - cc $
CP1 - 4-in-1 (FVRCP) I Leukemia ,' Deworm a $ CP1 - 4-in-1 (FVRCP)1Leukemia I Deworm cc -$
DA2PPv / DA2PPv 414 / Corona $ DA2PPy / - DA2PPy+L4 [Corona $
Bordetella - Nasal / Injectable 1 Oral $ Bordetella - Nasal / Injectable / Oral $
Rattle Snake / H3N8 / H3N2./ Lyme! Lepto. 4 _ $ Rattle Snake 1 H3N8 i H3N2 / Lyme / Lepto. 4 $
. - -
Deworming (Protal 50 mg/ml) cc _ $- _ Deworming (Prota) 50 mg/MI) cc $ .
.Cat 4-in-1 (FVRCP) / Leukemia $ Cat 4-in-1 (FVRCP) 1 Leukemia
Test Heartworm / FELV/ Parvo/ - 0 Pos 0 Neg $ Test Heartworm 1 FELV/ Parvo/ 0 Pos 0 Nag $
Heartworm Mfg: 0 Tr -Heart Plus 0 0 Heartworrn Mfg: 0 Tri-Heart -Plus-0 O.
Pet's Wei e ht: 0 0-25# 0 26-50#0 51 -100# $ ' .-:---, Pet's Weietit. 0 0-25# 0 26-50# 0 51 - 100#: - $
Micro Chip # . $ Mt. . Micro Chip # $ Mfg.
Other: $ Qty: Other: Qty: @ $
Other: • $ Qty: @ $ Other $ ' Qty: @ $ •
Other: . $ Qty: @ $ Other: $ Qty: @ $
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Exam Fee: $5, $20 Health Certificate: $ $--7,--:_c-r: , - - Exam Fee: $5120 Health Certificate: $ $CY.,::
Waste Dispo-sal Fee: ',..$-1-1 $2 $3 $1- 01.- — ---- ----------. Waste Disp6S-al Fee: ( $1 '-., $2 $3 - .
Resp: L-)C.' Pet #1 Total (rf, otal C traiCsaction doeg-not include ee.) q) 6, 1 • ,-,. - I - -, HR: i — l' 9 . i -, .. Resp: )1--/ J. Pet #2 Total obi - al doe - s.nOt include e, ,
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PHYSICAL EXAM: PHYSICAL EXAM:
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3eneral Appearance 0 0 Next Booster(s) Estimated Price $ ) --),•)>'.I .1 General Appearance b o Next Booster(s) Estimated Price $ ,;
Skin / Coat 0 0 NOTES / DOSAGE: - -__ -- - . Skin / Coat 0 0 • NOTES / DOSAGE: __-
Eyes 0 0 Eyes P 0
Ears P 0. Ears 0 0 .
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oose effectiveness. Returning after loose effectiveness. Returning after
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it an additional cost to You. .. - ' , at an additional cost to you. - Sub Total:
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ieterinarian: - Al • . iN, Location: •°,, ) v •,..:I '-' ! . i Tech: Int ,1:'-'4- ; CC Fee: $
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;tate Lie*/ 1442 Dat :r.,, Bal $ Cash-0 I CC 0 $ Cashier Int TOTAL: $.-
White: TLC VE1 ERINARY SERVICES & SUPPLIES LLC Yellow: CLIENT / COUNTY

T. LC.
VACCINATION CERTIFICATE
Tender Loving Care
L
Veterinary Services & Supplies LLC Corporate Office Hours:
Mon - Fri 9:00 am - 5:00 pm
480-699-9950
P.O. Box 14483 • Mesa, AZ 85216
OFFICIAL RECORD - PLEASE PRINT CLEARLY wwW.TLCVetServices.com
Last Name: /-- f-' - /..-- -- ,.... ..:-
---- First Name — ,
Address: UI.
—
City: State: Zip:
Email: , -
, _ „ _ _ _
Home : ''-' oz. - - Cell: - I Work: -
I acknowledge having read and I understand the back of this document. Being awa e of _.-- 7--„i--,-.'--,-_-
these facts, I give my permission to TENDER LOVING CARE VETERINARY SERVICES & \ A "-----' "i.:, . ._.. = ---" DATE .2 / / /
SUPPLIES LLC and/or the Doctorto treat and/or administerthe vaccinations listed below. `,_, There is a $1$3:-at e disposal fee per animal. Prescription ONLY fee $10.
New Client Yes 0 No 0 How did you hear about this clinic? 0 Flyer from Store 0 Mailer 0 Referral 0 Website 0 Other
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,t i.,Dog .f0TMale IfNeutered (male) 0 On Medication '-..)C) Dog p Male 0,Neutered (male) 0 On-Medication
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Colors. I Ym Colors: A — -' `0 Ys
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Rabies Typei KILLED VIRUS Mfg. 1:_) PRICE NEXT BOOSTERS Rabies Type KILLED VIRUS Mfg. PRICE NEXT BOOSTERS
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Rabies Date Vaccinated: ',,--i2 / i - 1, Rabies Date Vaccinated: (-2: / I / - 1
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abies Vaccination Due: ',. i -' I / 1-77; _ 7 5 Rabies Vaccination Due: (170 / 1 / :4,: ::) $l —:,
DP1- DA2PPvlBordetella Nasal /Deworm cc opt- DA2PPv I Bordetella Nasal /Deworm cc $
CPI- 4-in-t (FVRCP) I Leukemia /Deworrn CC CPI- 4-in-1 (FVRCP) I Leukemia / Deworm cc $
DA2PPv / DA2PP\H-L4 I Corona $ DA2PPy / DA2PPv-i-L4 / Corona $
Bordetella - Nasal / Injectable / Oral Bordetella - Nasal / Injectable / Oral
Rattle Snake! H3N8 / H3N2 /Lyme / Lepto. 4 $ Rattle Snake / H3N8 / H3N2 / Lyme / Lepto. 4 $
Deworming (Protal 50 mg/ml) cc $ Deworming (Protal 50 mg/ml) CC $
Cat 4-in-1 (FVRCP) / Leukemia $ Cat 4-in-1 (FVRCP) / Leukemia $
Test Hearbmorm / FELV/ Panto/ 13 Pos 0 Nag $ Test Heartworm / FELV/ Parvo/ 0 Pos 0 Neg $
Heartworm Mfg: 0 Tr-Heart Plus 0 0 Heartworm Mfg: 0 Tr-Heart Plus 0 0
Pet's Weight 0 0-25# 0 26-504 0 51-100# 1.I I Pets Weight: 0 0-25# 0 26-50#D 51-100#- $
Micro Chip #f $ Mfg, Micro Chip # $ Mfg .
Other: $ Qty: @ $ Other: $ Qty: @ $
Other: - $ Qty: @ $ Other: $ Qty: @ $
Other: $ Qty: @ $ Other: $ Qty: @ $
Treatment)Fee: $ Script Fee: $10 $ ____ Treatmen_tEee: $ Script Fee: $10 $ -
Exam Feb: $5 $20 Health Certificate: $ $777 Exam Feb: $5 $20 Health Certificate: $ $'-r.,- fj_,_ —
Waste Disposal Fee:f $1 $2 $3 _. Waste Digprisal Fee: c $11-::, $2 $3 s i -1:-.•.( )
iR: ! 5:"- -0 Resp:7r 'S. '-----) Pet #1 Total (Totg does fiat include , HR: IN-10 Resp: ‘-/"" 1 Pet V ei ,,,, z iota ,- „ (Total does dot include „.,
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em F I k_y Weight., ...2-,) i _ ,,--, -, Temp: P li 1 Weight a • i_i
PHYSICAL EXAM: Next Booster(s) /Due On: (--.) i I ' PHYSICAL , EXAM: , Next Booster(s) Due ,On: I I
Normal AbnounN 1 Normal Abnormal
;eneral Appearance to 0 Next Booster(s) Estimated Price $ .fl General Appearance 0 D Next Booster(S) Estimated Price $
3kin / Coat ICI 0 NOTES! DOSA'GE: Skin/ Coat D 0 NOTES / DOSAGE: '
:yes to 0 Eyes 0 0
are i0 0 Ears 0 0
Aouth / Dental 0 0 Mouth/Dental b 0
tespiratory k:l 0 \ 1 Respiratory t0 t 0 , \ P,
fEALTH WITHIN NORN1AL LIMITS ) 1,„__,./ HEALTH WITHIN.NOPMAL ' LIMITS \,.,:‘,./
ye,i-cri No 0 Yes-0 1, No 0
laccinations not delivered on schedule Vaccinations not dehered on schedule
xose effectiveness. Returning after loose effectiveness. Returning after
ie booster's due date may equire the booster's due data may require
idditional vaccines for proper otecf n additional vaccines for proper protection
t an additional cost to you. i _ at an additional , -- cost — to you. ,- _, _ Sub Total: $ i
i A 1), -
'eterinarian: Location: l' ---; r Tech. [nit: CC Fee: Sr ,
1442
tate Lic # Date: Bat $ CastiaS CC 0 $ Cashier Init: L 1 -, TOTAL: $
VVhite: TLC VE ERINARY SERVICES SUPPLIES LLC Yellow: CLIENT/ COUNTY

TAX, VACCINATION CERTIFICATE
render Loving Carp
VeteririarY Services & SuPPfies LLC Corporate Office Hours:
- Mon - Fri 9:00 am -5:00 pm
P.O. Box 14483 • Mesa, AZ 85216
El OWNER:::_Fill piit itrM www.TLCVetServices.com
mr
I Last Name: First Name:
Address: fff. La' aq.aa.q. s_,r1 -I If -
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1. City: State: I r -1 Zip: fLff. ,.
Email: it: I
Home: ff. ,f2 Cell: Work:
..trilowiedge having read and I understand the back of this document Being aware of V /) i -
ll.. facts, I give my permission to TENDER LOVING CARE VETERINARY SERVICES DATE / / /
LIES LLC andlorthe Doctorto treat and/or administer the vaccinations listed below. There is a $1:-$31,Waste--dispdSal fee per animal. Prescription ONLY fee $10.
0 New Client Yes‘,0 No 0 How did you hear about this clinic:El Flyer from Store 0 Mailer 0 Referral 0 VVebsite 0 Other
Dog Male rNeutered (male) 0 On Medication e Dog Li, Male O rautered (male) 0 On Medication
Cat 0 Female Of, S\jjayedife-mate) aPregnant 0 Cat 0 Female d Spanyecilerinale)-0-RFegnant
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,--. eaaelapeoele.. once of boosters.) ..... Weeks Months Months Months - ----" -,..,„ ,, 1,1, lac t2; . rualeal aakai preset of boosters.) Weeks Months Months Months ,
Rabies Date Vaccinated: f _ff.. / 1 / .I - 1 . , f. e . Rabies Date Vaccinated: f 0 / . / I 1 . _ -... ....f - _ :,.. : :
Rabies Vaccination Due: rfr-- - / i / r,--.1,Q _ $:;:., ''''':- j . . ' ' - - Rabies Vaccination Due: r . _ - I ..1 / -.---_:. - -.... $ 1..., ,
Dpi- DA2PPv I Bordetella Nasal / Deworrn cc $ Dpi- DA2PPv/Bordetella Nasal I Deworm cc $
CP1- 4-in-1 (FVRCP) [Leukemia! Deworm cc $ CP1 ,- 4-in-1 fFVRCP)/Leukemia / Deworm cc $
DA2PPv / DA2PPv-i-L4 / Corona $ DA2PPv / DA2PRH-L4 / Corona * $
Bordetella - Nasal / Injectable I Oral $ Bordetella - Nasal / Injectable! Oral $
Rattle Snake! H31\18 / H3N2 / Lyme / Lepto. 4 $ Rattle Snake 1 H3N8 / H3N2 i Lyme / Lepto 4 $
Deworming (Protal 50 mg/m1) CC $ Deworming (Protal 50 mg/ml) CC $
Cat 4-in-1 (FVRCP) / Leukemia $ Cat 4-in-1 (FVRCP) I Leukemia
Test Heartworm I FELV/ Paivo/ 0 Pos 0 Keg $ Test: Heartworm i FELVI Parvoi 0 Pos 0 'leg 1 $
Heartworm Mfg: 0 Tr-Heart Plus 0 0 Heartworm Mfg: 0 Tr -Heart-Plus 0 0
Pets Weight: 0 0-25# 0 26-50# 0 51-100# $ PM Mg Pet's Weight: 0 0-25# 0 26-50# 0 51-100#- $
Micro Chip # $ Mfg. Micro Chip # Mfg.
Other: - $ Qty: @ $ Other: $ Qty: @ $
Other: $ Qty: @ $ Other: $ . Qty: @ $
Other: $ Qty: @ $ Other: $ Qty: @ $
Treatment Fee: $ Script Fee: $10 $ Treatment Fee: $ Script Fee: $10 $
Exam Fee( $6)$20 Health Certificate: $ $, b(---;:, — --- ''..1: Exam Fee: $5, $20 Health Certificate: $ $'=-_i elY'ess-L_--- ' — —
Waste Disposal Fee: ($t $2 $3 $t a) --..-p Waste Disi56sal Fee: ( $1'; $2 $3 $ 1 07. .", - -.
HR: t 1:4 D Resp: fff'ff., f....3 Pet #1 Total (Tdtal C/C transaction does not include fee.) 6, 4) , )11‘1:-"=', i i HEti MC) Reap ,I.-5 ) Pet #2 Total (Totel C/C transaction does not include .4) „Is
Temp: , W , 0 Weight' . :-- r '.------. - \ . '-‘4- 1 I .-„_ Temp. . . \,-) H 1 ' :, 1 Weight' . -. .. 1 , I
PHYSICAL EXAM: '--. Next Booster(s)/DI ue On: CT_ I ' ' ' ---- - PHYSICAL EXAM: Next Next Booster(s) Due On: C-.0 I (. I
Normal o Abnermal o Next B6oster(S) I Estimated Price - 6, ,,---, r , - >\2'-'; — '-, General Appearance Normal 0 Abnormal 0 Next Booster(s) Estimated \ Price $ ii r--) './ ":";
General Appearance ": :
Skin !Coat P '3 NOTES! DOSAGE: , Skin 1)Co 'at 3 0 NOTES] DOSAGE: ------ - -- -- ---
Eyes o o 1 Eyes 0 0
Ears ti 0 , Ears! 0 0
Mouth! Dental 0 0 Mouth / Dental0 . , , 0 ,z I
Respiratory 0 o ' '-..' _li 1 .., i li dapiratery .0l 0
HEALTH WITHIN NORMAL LIMITS ----.. ?, -, ; -, j,,,..,,- --- WITHINAQRMAIL LIMITS
Yes 0? No 0 , - --. ) Yes El._ No 0
Vaccinations not delivered on schedule Vaccinations not delivered on schedule
loose effectiveness. Returning after loose effectiveness. Returning after
the boosters due date may require the boosters due date may. require
additional vaccines for proper -oted n , .„ . additional vaccines for proper protection
at an additional cost to you. , at an additional cost to you. Sub Total: $ f . .. !--
, - -
Veterinarian: '..:i- _ . *‘. Location: \ . -% -,-.- .... , ,. :, _ , ,. . , . ..„. Tech T . hit: .. ; i CC Fee: $ .
State Lic # 1442 Dat_LA ei 1 Bai $ Cash..1.] $ 0 $ Cashier Init. , -. _ TOTAL: $
VVIlite: TLC VETERINARY SERVICES 8. SUPPLIES LLC Yellow: CLIENT! COUNTY

TLC: VACCINATION CERTIFICATE
Tender Loving Care
Veterinary Services & Supplies LLC Corporate Office Hours:
Mon - Fri 9:00 am - 5:00 pm
480-699-9950 P.O. Box 14483 • Mesa, AZ 85216
_owNER:
OFFICIAL RECORD - PLEASE PRINT CLEARLY www.TLCVetServices.com
— ,--- , ... , :,.,,,,.
Last Nam ___I First Name: ,
, I ,1-1 i 1 i
Address: - ---, , (---•.-', (-(1,-.1ft f:-.1-12-) 11---) 1--- '' l'Ad ___, 4---- Wi II -1 1 al 1
,,_,
City: . II Li . 1,-1-- II • I State: /..4 ,r r. —7 ' Zip: . r-:Hr- ti_l
• 1 1 I ----1 i ' n
Email: I— 1 1 I J
1, 21 LJP[1i . I 1 ' _1
Home: 1 Cell ,____J - 1 - [ ___i I . 1 -' '' i___... ----1_ ___I WorIc. . , I- I •1- .
I acknowledge having read and I understand the back of this document. Bein g aware of X-- ,
these facts, I give my permission to TENDER LOVING CARE VETERINARY SERVICES & iT . DATE - ,
SUPPLIES LLC and/or the Doctorto treat and/or administerthe vaccinations listed below. There is.:611f$L3'waste disposal fee per animal, Prescription ONLY fee $10,
New Client Yes m No 0 How did you hear about this clinic? 171.Flyer from Store 0 Mailer 0 Referral 0 Website 0 Other
11,--Dog 0 Male 0 Neutered (male) 0 On Medication ADog 0 Male 01Pleutered (male) 0 On-Medication
0 Cat ::Ofemale '1723:Spayed (female) 0 Pregnant 0 Cat tl,Female II Sptilem—aTe)----9.-gregn-ant
Name: I A Age Vcheck one): Name: °) HI /1, 4-1 Age Vcbeck one):
0 Wks - 3 t .0 Wks.
Breed: 0 Mos Breed: — . Men
Colors: "y-s0 Yrs Colors: f- - Yrs
Rabies Type: KILLED VIRUS Mfg, . IKD ,,...- ii ---7 PRICE NEXT, _ .. .- BOOSTERS ..., _. . ,:. Rabies:Type: KILLED VIRUS Mfg. 1 PRICE -NEXT _ - BOOSTEltilj . _ , . .;,
_ot # 2-,:\ C.r: Cr, -7 'TP Tag #A,,,,,„„,,,..,,,,,, (Does no include 3_4 6 12 36 Lot# -'L1 CC- ) `TC-- --) (-I Tag # — (Does not include 3_4 12 36
,,,, price of boosters) Weeks Months Months Month i ,..b=4.4•74...-0 price of boosters.) Weeks Months Months Month
Rabies Date Vaccinated: ,...c- / \ / 1 ---1. o ,-- Rabies Date Vaccinated: (-..,r-7 I 1 /
abies Vaccination Due f7 I I ;--:?;-; $ 1) • ) Rabies Vaccination Due: Cf.) / i I ,:-.---4-;-:'
DP1- DA2PPv / Bordetella Nasal I Deworrn - cc $ , DPI- DA2PPv1Bordatella Nasal /Deworm. CC
CPI- 4-in-1 (FVRCP) /Leukemia/ Deworrn cc $ CP1- 4-in-1 (FVRCP) I Leukemia! Deworm cc $. - -
DA2PPv / DA2PPv+L4 i Corona $ DA2PPv / DA2PPv±L4 / Corona $
Bordetella - Nasal / Injectable / Oral $ Bordetella - Nasal / Injectable / Oral $
Rattle Snake IH3N81H3N2 / Lyme / Le o. 4 $ Rattle Snake! H3N8 I HIN.L.Lyme / Leplo. 4 $ •
Deworming ( Protal 50 mg/m1) CC $ Deworming (Prole' 50 mg/m1 ) cc $
Cat 4-in-1 (FVRCP) / Leukemia $ Cat 4-in-1 (FVRCP) / Leukemia $
Test Heartworm / FELV/ Parvo/ 0 Fos 0 keg $ Test Heartworm / FELV/ Parvo/ 0 Pos 0 keg $
Heartworm Mfg: 0 Tri-Heart Plus 0 Haartworm Mfg : Tri-Heart-Pius 0
Pets We.. ht: 0 0-25# 0 26-50 0 51-100# $ Pets We' ht. 0 0-25 0 26-50# 0 51 100# $
Micro Chi. t/ $ Mt.. Micro Chi # Wu
Other: $ Qty: @ $- Other $ Qty: @ $
Other: $ Qty: @ $ Other $ Qty: @ $ .
Other. $ Qty: g $ - Other. Qty: @ $
Treatment Fee: $ Script Fee: $10 $ Treatment Fee: $ Script Fee. $10 ''
Exam Fee, $5$20 Health Certificate: $ $.<7 ,),_, ------_, ----2,_ Exam Fee, $$20 Health Certificate: $_ $., Cisi
Waste DispriS-al Fee: $1,, $2 $3 $ i ni 0 ----- --t- - -Waste Disposal Fee: $ 1 $2 $3 $ 7.-- '
..- _...„ (Total does not-iriclude . (Total doesAt include ml i .--..
-IR: __,--ResP: . rn /-4" (----) 9 Pet #1 Total C/C transac,I16'n fee.) ' sL HP,. c---)- Resp: 1110 Pet #2 Total C/C transaction ee.) at
/--r-I t \
Imp; 1 Cr =, Weight: i-sL - - , Temp: , t Weignt;---/,-.). I ) . I • I if
PHYSICAL EXAM: Next Booster(S) Due On: [ C---; I ,:„ - ,..4IYSICAL EXAM: Next Booster(s) Due On: r,, 1(1/7 i l l l , 1
Noeng Abnormal . I ,-, Ne Abnomd
.;enet al Appearance b 0 Next -Booster(s) Estimated Pfice i . ' ' 1 r ,enera ' I Appearance A nce - E71 0- Next Booster(s) Estimated Price--- _
skin! Coat cl CI NOTES I DOSAGE: SlUn I Coat El ' 0 NOTES /DOSAGE: .
Eyes CI ..171 ------____--- - Eyes b 0
Ears 0 . 0 Ears P 0
Muth i Dental . . 0 0 Mouth / Dental - 0 0 ' -4-. A \ L -
Respiratory 0 0 Respiratory 0 0 \ ,}, --I --......,
ii -',,
-IEALTH WITHIN NORMAL OMITS - HEALTH WITHIN NORMAL LIMITS —
Yes-01 No 0 Yes-9-f No 0
laccinations not delivered on schedule Vaccinations not delivered on schedule
nose effectiveness. Returning after loose effectiveness Returning after
he boosters due date may require the boosters due date may. require
idditional vaccines for proper ()tea n additional vaccines for propei protection
it an additional cost to you at an additional cost to foci. - Sub Total: $- I
ieterinarian: A Location: i L- -- ------ ' 1 ' i - Tech. (nit -_.-, CC Fee: $(
;tate Lic # 1442 Bal $ C as hila- .S\ 0 $ Cashier Init: TOTAL: $' -
White* TLC VETERNARY SERVICES & SUPPLIES LLC Yellow: CLIENT / COUNTY

TLC. VACCINATION CERTIFICATE
Tender Loving Care ffici 101 f of, -V" cc En,atio
Veterinary Services & Supplies LIC uplicate - requests-ernailetl Keepiliii.recordiii -withip•Z4hotirs'Atrowlier a tafe'Plat-ef'7' -On Corporate Office Hours:
Mon - Fri 9:00 am - 5:00 pm
480-699-9950
P.O. Box 14483 • Mesa, AZ 85216
ET OWNER: t-Octidris114-3 OFFICIAL RECORD - PLEASE PRINT CLEARLY www.TLCVetServices.com
Last Name: -: : , \-- t ,..,..t ' --- First Name:
Ad dress:
City:, State: Zip:
Email: L
_ ----7, .,.. _ =,--; -:,7 - _ _ _
7,;• Work:
I acknowledge having read and I understand the back of this document Being aware of - v, .
these facts, I give my permission to TENDER LOVING CARE VETERINARY SERVICES & "' -•-• ' _._, • - - DATE b / / / / ' I
SUPPLIES LLC and/or the Doctorto treat and/or administerthe vaccinations listed below. There is,-at$1434aste disposal fee per animal. Prescription ONLY -fee $10.
New Client Ye S d' No 0 How did you hear about this clinic? 0 Flyer from Store 0 Mailer 0 Referral 0 Website 0 Other
•
-b. Dog 0 Male 0,iNetitered (male) ' 0 On Medication 20_,Dog 0 Male 0,Neutered (male) 0 On-Medication
0 Cat -0-female dSpayki4terna1er ---CI Pregnant 0 Cat \-7,.,Female 6 Sp\ayed (female)-73-gregnant
Name: I ."-=\ Is--( ( Age Vcheck one): Name: i'i I ----, 1,---- , r ...) - A ----. i Age (/check one):
i --:. 7 r ,,. - 0 Wks j 2 __,-;.,:,---,,' _,._,-.7 0 Wks
Breed: -fir '.-' )_,..J;- t.t, ' ' " 0 Mos Breed: -:_.-± -1,_ - -- ..0 Mos
Colors: .. 1 Colors: [)LL(- ',El , Yrs
, ., „,
PcED0TTE WT EF c5 ROFEJCE - .,.- W -.=:-.-.1. A ' LNE
a bi es Type: KILLED VIRUS Mfg. 1 IF, PRICE NEXT BOOSTERS Rabies Type: KILLED VIRUS Mfg I'? 1 i.-1 . PRICE NEXT BOOSTERS
_Ot# --;. —." o— l',._C) ‘-_,i-' I -;-',---7 f (`-• \ LI' Tag # • Poes noi include, 3-4 12 36 Lot # ------I'' 1. :: -:=7 .-; -;-11 CT:r Tag # ' (Does not include ,3_4 6 . 12 , , - ._ , 36 ,...T
,...- _ 03.e.st aa 1 I pnce of boosters4 Weeks Months Months Weil.- , E..f..fmf,......, p ri te of boosters.) weeks Months Months Months
2abies Date Vaccinated: `-----r- / 1 / 1 Rabies Date Vaccinated: (.--;--: / I / i -- 1 _
,--- _
2 abies Vaccination Due: '-.S.--' 1 'i / c---=',.) $ .---: =. - Rabies Vaccina#on Du t. ,- I 1 1 ,-4.-- --4 $
DP1- DA2PPvlBordetella Nasal! Deworrn cc $ DPI- DA2PPv / Bordetella Nasal / Deworrn -- cc $
CPI-4-in-1 (FVRCP)1Leulcernia / Deworrn cc CP1- 4-in-1 (FVR.CP1/ Leukemia / Deworrn cc
DA2PPv i DA2PPv+L4 / Corona $ DA2PPv / DA2PPv-I-L4 / Corona $
Bordetella - Nasal I Injectable .! Oral $ Bordetella - Nasal / Injectable i Oral $
Rattle Snake / H3N8 / H3N2 / L me / Le a. 4 $ Rattle Snake/ H3N8 / H3N2 / L me / Leeto. 4 $
Deworming (Prota):50 rngiml) cc $ Deworming (Protal 50 mg/m1) cc
....$ ,
Cat 4-in-1 (FVRCP) I Leukemia . Cat 4-in-1 (FVRCP) i Leukemia
1
Test Heartworm /FEDI/ Pam/ 0 Pen 0 Neg $ Test Heartworm I FELVI Pam/ - 0 Pos ONeg $
Heartwonn Mfg: 0 Tn-Heart Plus 0 0 Heartworrn Mfg: 0 Tri-Heart.P1us0 " C3
Pets Weight: 0 0-25# 0 26-50# 0 51 -100# $ Pet's Weight, 0 0-25# 0 26-50# 0 51-100# $
Micro Chip # _ $ Mfg. Micro Chip # $ Mfg,
Other: $ Qty: @ $. Other Qty: @ $
Other: - $ Qty: @ $ Other $ Qty: @ $ -
Other: $ Qty: @ $ Other. $ Qty: @ $
Treatment,Fee: $ Script Fee: $10 $ Treatment Fee: $ Script Fee: $10
Exam Fee: $5 $20 Health Certificate: $ _ Exam Fee $5 $20 Health Certificate: $ -
•
Waste Disposal Fee:( $1i $2 $3 $ ) -- (3(1 - - Waste Disposal Fee:( $1 . , $2 $1 : $ 1 f- ,
H C) Raspy. !--/C-, Pet #1 Total C/pi'ansaction (Total dois not include fee.) LI I , ,— 'i- i-IF , , • , -1.% , <-- - R esP. ' t- 1.19,-': .._ Pet #2 Total cic (Total transaction does,nOt include ,
(,, 4)
.em :i \-, - ' Weight -.=-- - : -Temp: Ic% c 0 - 'I.) - , Weight- • ,42 - 1 (,, - - .
PHYSICAL EXAM: Next Booster(s) - Doe t On: I t---) PHYSICAL EXAM: Next Booster(s) Due pn: ,.7,, I
Nenrel b k_verrnel 0 Next Booster(s) Estimated_Price Nomal i Abnorrnel Next Booster(s) -Estimated - \ ' Price $ _
3eneral Appearance $ i ' - 1 J-T C-i:neral Appearance 0 0 ,
ikin/Coat ,- - '- Ti NOTES / DOSAGE: -•••• -r---- - --- - • - Skin/Coat 0 0 NOTES / DOSAGE:
Eyes 0 0 Eyes 0 0
Ears 0 0 i Ears 0 El
Aouth / Dental 0 0 f i Mouth! Dental 0 0
tespiratory p 0 Respiratory 0 0 I, 1 i
iEALTH WfTHIN,NORIvIAL LIMITS HEALTH WITHIN_NORMAL LIMITS ‘ I
Yes (7 No 0 Yes El-) i \ No 0
taccinations not `delivered on schedule Vacdnations not delivered on schedule
mse effectivendss. Returning after loose effectiveness. Returning after
le booster's due date may require thebooster's due date may require
idditional vaccines forproper rotect n A additional vaccines for properprotedion . , -:-\.--._.;
tan additional cost to you. itil '11 at an additional cost to you. ' Sub Total: $ t
iøI.
eterinarian: Location: Tech. lit: CC Fee: $
tate Lic # 1442 Bal $ Caa1-1614 1-t 0 $ Cashier InifL TOTAL:
White: TLC VE I tRINARY SERVICES & SUPPLIES LLC Yellow: CLIENT: COUNTY

Katz and Dogs Wellness Clinic Client No. 3442
8190 W Union Hills Dr, Ste 145 Stephens, Peggy
3942 W Tierra Buena Ln
KATZ&DOGS Glendale, AZ 85308 Phoenix, AZ 85053
Phone: (623) 825-7717 Phone: (602) 978-6833
WELLNESS CLINIC Fax: (623) 223-1780
www.katzdogswellness.com
Rabies Vaccination Certificate
NAME: FLIRT
SPECIES: Canine WEIGHT: 18.80 lbs Rabies Tag #: 013609
BREED: Sheltie ID #1: 985 112 010 278 620
GENDER: Fl ID #2:
COLOR: Blue Merle/White Last Visit: 3/20/2019
BIRTHDAY: 7/24/2018
AGE: 0 yrs, 7 months
Item Description Given Due Date Lot # Manufacturer Exp. Date
8001 Rabies Boost in 1 year 3/20/2019 3/19/2020 321288 Zoetis 5/12/2020
I hereby certify that this animal has been vaccinated in accordance with the manufacturer's recommendation for the vaccine used on above date.
Katz & Dogs Wellness Clinic
8190W Union Hills Dr. #145
Glendale, AZ 8530,
623-825-7717
Date Issued 3/20/2019
License: 1715

Katz and Dogs Wellness Clinic Client No. 3442
,it,.7er 8190W Union Hills Dr, Ste 145 Stephens, Peggy
Glendale, AZ 85308 3942 W Tierra Buena Ln
KATZ&DOGS Phoenix, AZ 85053
Phone: (623) 825-7717 Phone: (602) 978-6833
WELLNESS CLINIC Fax: (623) 223-1780
www.katzdogswellness.com
Rabies Vaccination Certificate
NAME: BEAR
SPECIES: Canine WEIGHT: 16.80 lbs Rabies Tag #: 013608
BREED: Sheltie ID #1. 985 112 010 282 070
GENDER: MI ID #2:
COLOR: Black/White Last Visit: 3/20/2019
BIRTHDAY: 7/24/2018
AGE: 0 yrs, 7 months
Item Description Given Due Date Lot # Manufacturer Exp. Date
8001 Rabies Boost in 1 year 3/20/2019 3/19/2020 321288 Zoetis 5/12/2020
I hereby certify that this animal has been vaccinated in accordance with the manufacturer's recommendation for the vaccine used on above date.
Katz & Dogs Wellness Clinic
8190W Union Hills Dr...#-145
Glendale, AZ 85
623-825-7717,
Date Issued 3/20/2019
Dr. David Rice License: 1715

Katz and Dogs Wellness Clinic Client No. 3442
8190W Union Hills Dr, Ste 145 Stephens, Peggy
Glendale, AZ 85308 3942 W Tierra Buena Ln
KATZ&DOGS Phoenix, AZ 85053
Phone: (623) 825-7717 Phone: (602) 978-6833
WELLNESS CLINIC Fax: (623) 223-1780
www.katzdogswellness.com
Rabies Vaccination Certificate
NAME: FREDDY
SPECIES: Canine WEIGHT: 17.60 lbs Rabies Tag #: 013610
BREED: Sheltie ID #1: 985 112 010 282 788
GENDER: MI ID #2:
COLOR: Black/White Last Visit: 3/20/2019
BIRTHDAY: 7/24/2018
AGE: 0 yrs, 7 months
Item Description Given Due Date Lot # Manufacturer Exp. Date
8001 Rabies Boost in 1 year 3/20/2019 3/19/2020 321288 Zoetis 5/12/2020
I hereby certify that this animal has been vaccinated in accordance with the manufacturer's recommendation for the vaccine used on above date.
Katz & Dogs Wellness Clinic
8190W Union Hills Dr._#145
Glendale, AZ 8
623-825-771
Date Issued 3/20/2019
Dr. David Rice License: 1715

Katz and Dogs Wellness Clinic Client No. 3442
8190 W Union Hills Dr, Ste 145 Stephens, Peggy
Glendale, AZ 85308 3942 W Tierra Buena Ln
KATZ&DOGS Phoenix, AZ 85053
Phone: (623) 825-7717 Phone: (602) 978-6833
WELLNESS CLINIC Fax: (623) 223-1780
www.katzdogswellness.com
Rabies Vaccination Certificate
NAME: WEEZY
SPECIES: Canine WEIGHT: 21.20 lbs Rabies Tag #: 012521
BREED: Sheltie ID #1: 4B7 162 4F1 8
GENDER: FS ID #2:
COLOR: Tr-Color Last Visit: 91512018
BIRTHDAY: 8/27/2011
AGE: 7 yrs, 0 months
Item Description Given Due Date Lot # Manufacturer gxp. Date
8002 Rabies Boost in 3 years 9/5/2018 9/4/2021 288171 Zoetis 8/27/2019
I hereby certify that this animal has been vaccinated in accordance with the manufacturer's recommendation for the vaccine used on above date.
Katz & Dogs Wellness Clinic
8190W Union Hills Dr. #145
Glendale, AZ 85308
623-825-7717
Date Issued 9/5/2018
Tanja L. Katz License:,1 4727

Katz and Dogs Wellness Clinic Client No. 6153
jetzt.. 8190 W Union Hills Dr, Ste 145 Shelley, Joann
17343 N. 77th Way
Glendale, AZ 85308 Scottsdale, AZ 85255
KATZ&DOGS Phone: (623) 825 -7717 Phone: (480) 861-2618
WELLNESS CLINIC Fax: (623) 223 -1780
www.katzdogswellness.com
Rabies Vaccination Certificate
NAME: TED
SPECIES: Canine WEIGHT: 28.00 lbs Rabies Tag #: 012412
BREED: Sheltie ID#1: 4C2 468 622 1
GENDER: MI ID #2:
COLOR: Blue Merle Last Visit: 8/16/2018
BIRTHDAY: 3/31/2012
AGE: 6 yrs, 4 months
Item Description Given Due Date Lot # Manufacturer Exp. Date
8002 Rabies Boost in 3 years 8/16/2018 8/15/2021 270782 Zoetis 6/12/2019
I hereby certify that this animal has been vaccinated in accordance with the manufacturer's recommendation for the vaccine used on above date.
Katz & Dogs Wellness Clinic
8190W Union Hills Dr. #145
Glendale, AZ 85308
623-825-7717
Date Issued 8/1612018
Tanja L. Katz License:
NASPIIIT RABIES FORM VACCINATION 51 (revised 2007) CERTIFICATE RABIES TAG #
Owner's Name & • dress Print Clearly MICROCHIP #
LAST - IRST M.I. TELEPHONE #
NO:3 9 Li _..., lki rt. „vary r „ ' E4 ZIP
h Ks; b 53
SPECIES il/e AGE i MONT SIZE PREDO 1 BREED PREDOMINANAT COLORS/
CAT DOG YEARS. Under 20 lbs. n ? ,.) MARKINGS
0 'i - 50 lbs. Ale
FERRET 0 SEX 4 , - lbs.
OTHER 0 MALE ANIMAL NAME
(specify) FEMALE 7. C h I c_—e,
NEUTERED 0
ANIMAL CONTROL LICENSE 0 1 YR 0 3 YR 0 OTHER TERINARIAN . ,..r
DATE VACCINATED PRODUCT NAME ..,
0'
LICENSE --
Z.-- / 5-5--Q
MONTH/DAY/YEAR MANUFAC In MI rA w
FIRST 3 LETTERS
I
_ USDA Licensed Vaccine VETERIN . .'S SIGNATURE
NEXT VACCINATION DUE BY 40111r• USDA Licensed Vaccine AFe7 .e5,C)C- /
. YR USDA Licensed Vaccine ADDRESS
0 Init1 Do se 0Hooster Dose errik-17:4?--- lS g 3-0-4/4/
/
MONTH/D AR VACCINE SERIAL (LOT) NUMBER

Katz and Dogs Wellness Clinic Client No. 3442
8190 W Union Hills Dr, Ste 145 Stephens, Peggy
Glendale, AZ 85308 3942 W Tierra Buena Ln
KATZ&DOGS Phoenix, AZ 85053
Phone: (623) 825-7717 Phone: (602) 978-6833
WELLNESS CLINIC Fax: (623) 223-1780
www.katzdogswellness.com
Rabies Vaccination Certificate
NAME: HALLE
SPECIES: Canine WEIGHT: 23.60 lbs Rabies Tag #: 012520
BREED: Shetland Sheepdog ID #1: 985 112 001 205 701
GENDER: FS ID #2:
COLOR: Black/White Last Visit: 91512018
BIRTHDAY: 5/4/2013
AGE: 5 yrs, 4 months
Item Description Given Due Date Lot # Manufacturer Exp. Date
8002 Rabies Boost in 3 years 9/5/2018 914/2021 288171 ZoetiS 8/27/2019
I hereby certify that this animal has been vaccinated in accordance with the manufacturer's recommendation for the vaccine used on above date.
Katz & Dogs Wellness Clinic
8190W Union Hills Dr. #145
Glendale, AZ 85308
623-825-7717
Date Issued 9/5/2018
Tania L. Katz License: ./4727
1(1135-L.Cib V.H.L.A...:11‘11.1:XJAJN uracw.L.r.t.L.axr:
NASPHV FORM 51 (revised 2007) RABIES TAG #
Owner's Name & Address Print Clearly MICROCHIP #
LAST kali, FIRSTAp c1 M.I. TELEpHONE #
J r...-4,
N52)61 14- IV CITY P h STATE it-t ZIP kcal S3
SPECIES „s45.,- AGE 1. MONTHS SIZE PREDOMINANT BREED pREDOMINANAT COLORS/
DOG YEARS Under 20 lbs. MARKINGS,
CAT 0 20 - 50 lbs.
FERRET 0 SEX Over 50 lbs. ANIMAL NAME -WI .
OTHER 0 MALE
(specify) FEMALE Ot (A (4-1L/kr )
ERED 0
ANIMAL CONTROL LICENSE O 1 YR 3 YR 0 OTHER VE0ERSCA5aS N
DATE VACCINATED Zr Milli' Of.) by ik,
t j77 il ti PRODUCT l'7 '' LICENSE NUMB Az J -3-
r
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FIRST 3 LETTERS
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1 YR USDA Licensed Vaccine ERI 'S SIGUAT
(4)YR USDA Licensed Vaccine
NEXT VAC RATIO DUE BY YR USDA Licensed Vaccine ADDRESS
7r-. 0 Initi 1 Dose El Booster Dose C ter) 4'2-
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MONTH/DAY/YEAR VACCIN SERI V 4/”UMBER