ALPINE KENNELS PERMIT RENEWAL (K20-000039).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 k2O 00003 c\
-ZdOn ek S0144-
El New IZI/ Renewal
Name: ,4f101tteeoleteb Kennel Name:
Mailing Address: 2 c1'4/6/tit 6 OW Kennel Address: 2 ?4/6 AM ('41/
Cityi.arprli'mA- - State: AZ Zip: P4-3 6-'7 cit 1"1 .02,- IQ- Zip: trad,
County Supervisorial District: dri
phone‘oz; 440 4 Kennel Phone: Ca Z 33Z. 4404
‘oz, 3' °° 0
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.
§ 11-1001(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
TA° I/We assume complete responsibility for the kennel at the premises for which I/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).
IANe certify that I/We have 2 4-7 dogs and that the kennel meets the definition in statute.
3. I/VVe 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).
IANe certify that all dogs over the age of three (3) months that are kept, harbored or maintained on the
prerats-ers 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 IM/e are submitting a valid copy of the rabies vaccination certificate for each
dog with this application.
6. I/We 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 /We understand that a person who fails to obtain a kennel permit under A.R.S.§11-1009 is subject to a
penalt f twenty-five dollars in addition to the annual fee.
8. /We understand that a person who knowingly fails to obtain a kennel permit within thirty days after
written ification from the county enforcement agent is guilty of a class 2 misdemeanor..
he 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.
IM/e certify that all of the information .1/We have provided is true and accurate under penalty of law.
Applicant Signat 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

Maricopa County Animal Care and Control
2500 S. 27th Avenue
Phoenix, AZ 85009-6797
(602) 506-7387
http://pets.maricopa.gov
Receipt Number; R19-766022 Receipt Date: 04/16/2019
Person ID: P1890454
Phone: 623 3885000
ALPINE KENNELS
29416 N 161ST AVE 4/16/2019 3:57:49PM
SURPRISE, AZ 85387
Item: Animal ID: Reference No: Price: Each: Amount:
KEN PERMIT A7777777 K20-000039 $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.
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
aguayot WBUSOFF

Maricopa County
Animal Care & Control
2500 South 27th Avenue
Phoenix, AZ 85009
Phone: (602) 506-7387
pets.maricopa.gov
KENNEL PERMIT K20-000039
PREMISE INSPECTION
Number of Dogs: 20
Name: ZDENEK BLABLA Kennel Name: ALPINE KENNELS
Mailing Address: 29416 N 161ST AVENUE Kennel Address: SAME AS MAIL
City: SURPRISE State: AZ Zip: 85387
County Supervisorial District: 4
Phone: 602-332-4404 Kennel Phone: 602-388-5000
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.)
There are 20 dogs on the kennel premises; all dogs have current rabies vaccinations and all
are confined to the kennel property under controlled conditions.
Deputy Enforcement Agent & Badge #: Lt. Romero #4 Date: 4/24/19
October 2015

15411 N 31st St. Phoenix, AZ 85032. Phone (602) 971-9651
Certificate of Rabies Vaccination
Date of Rabies Vaccination: 01-07-18 Certificate No: 0
OWNER OF ANIMAL
First Name: Zdenek Last Name: Blabla
Address: 29416 N 161 Ave
City: Surprise State: AZ Zip: 85387
County:
This is to certify...
THAT I HAVE VACCINATED THE ANIMAL DESCRIBED BELOW AGAINST THE
RABIES VIRUS.
Patient Information:
Patient: Zuma Sex: Female
Species: Canine Age: 7Y
Weight: 55.00 Color and Markings: Sable
Microchip:
Breed: Shepherd, German
Signed: /2/1"-`,
'Kel6fiehil, DVM License: 4188
Vaccinations Performed:
Vxn Rabies Vaccination, 3 Year
Next Rabies Vaccination Due: 01-06-21
Rabies Vaccination Information:
Manufacturer: BOB Serial Number: 4150440A
Lot Expiration: Feb.2019 Administered: Sq

15411 N 31st St. Phoenix, AZ 85032. Phone (602) 971-9651
Certificate of Rabies Vaccination
Date of Rabies Vaccination: 01-07-18 Certificate No: 0
OWNER OF ANIMAL
First Name: Zdenek Last Name: Blabla
Address: 29416 N 161 Ave
City: Surprise State: AZ Zip: 85387
County:
This is to certify...
THAT I HAVE VACCINATED THE ANIMAL DESCRIBED BELOW AGAINST THE
RABIES VIRUS.
Patient Information:
Patient: Zigge Sex: Female
Species: Canine Age: 4Y
Weight: 60.00 Color and Markings: Sable
Microchip:
Breed: Shepherd, German
Signed:
Kelly H hn, DVM License: 4188
Vaccinations Performed:
Vxn Rabies Vaccination, 3 Year
Next Rabies Vaccination Due: 01-06-21
Rabies Vaccination Information:
Manufacturer: BOE Serial Number: 4150440A
Lot Expiration: Feb.2019 Administered: Sq

15411 N 31st St. Phoenix, AZ 85032. Phone (602) 971-9651
Certificate of Rabies Vaccination
Date of Rabies Vaccination: 01-07-18 Certificate No: 0
OWNER OF ANIMAL
First Name: Zdenek Last Name: Blabla
Address: 29416 N 161 Ave
City: Surprise State: AZ Zip: 85387
County:
This is to certify...
THAT I HAVE VACCINATED THE ANIMAL DESCRIBED BELOW AGAINST THE
RABIES VIRUS.
Patient Information:
Patient: Tiger Sex: Female
Species: Canine Age: 6Y
Weight: 60.00 Color and Markings: Sable
Microchip:
Breed: Shepherd, German
Signed:
License: 4188
Vaccinations Performed:
Vxn Rabies Vaccination, 3 Year
Next Rabies Vaccination Due: 01-06-21
Rabies Vaccination Information:
Manufacturer: BOE Serial Number: 4150440A
Lot Expiration: Feb.2019 Administered: Sq

're i5
qt Care and kin
15411 N 31st St. Phoenix, AZ 85032. Phone (602) 971-9651
Certificate of Rabies Vaccination
Date of Rabies Vaccination: 01-07-18 Certificate No: 0
OWNER OF ANIMAL
First Name: Zdenek Last Name: Blabla
Address: 29416 N 161 Ave
City: Surprise State: AZ Zip: 85387
County:
This is to certify...
THAT I HAVE VACCINATED THE ANIMAL DESCRIBED BELOW AGAINST THE
RABIES VIRUS.
Patient Information:
Patient: Tank Sex: Male
Species: Canine Age: 7Y
Weight: 65.00 Color and Markings: Sable
Microchip:
Breed: Shepherd, German
Signed:
fiehn, I5VM License: 4188
Vaccinations Performed:
Vxn Rabies Vaccination, 3 Year
Next Rabies Vaccination Due: 01-06-21
Rabies Vaccination Information:
Manufacturer: BOB Serial Number: 4150440A
Lot Expiration: Feb.2019 Administered: Sq

15411 N 31st St. Phoenix, AZ 85032. Phone (602) 971-9651
Certificate of Rabies Vaccination
Date of Rabies Vaccination: 01-07-18 Certificate No: 0
OWNER OF ANIMAL
First Name: Zdenek Last Name: Blabla
Address: 29416 N 161 Ave
City: Surprise State: AZ Zip: 85387
County:
This is to certify...
THAT I HAVE VACCINATED THE ANIMAL DESCRIBED BELOW AGAINST THE
RABIES VIRUS.
Patient Information:
Patient: Sarko Sex: Male
Species: Canine Age: 12M
Weight: 60.00 Color and Markings: Sable
Microchip:
Breed: Shepherd, German
Signed: e
Kelly Oin, DVM License: 4188
Vaccinations Performed:
Vxn Rabies Vaccination, 3 Year
Next Rabies Vaccination Due: 01-06-21
Rabies Vaccination Information:
Manufacturer: BOB Serial Number: 4150440A
Lot Expiration: Feb.2019 Administered: Sq

15411 N 31st St. Phoenix, AZ 85032. Phone (602) 971-9651
Certificate of Rabies Vaccination
Date of Rabies Vaccination: 01-07-18 Certificate No: 0
OWNER OF ANIMAL
First Name: Zdenek Last Name: Blabla
Address: 29416 N 161 Ave
City: Surprise State: AZ Zip: 85387
County:
This is to certify...
THAT I HAVE VACCINATED THE ANIMAL DESCRIBED BELOW AGAINST THE
RABIES VIRUS.
Patient Information:
Patient: LuvLuv Sex: Female
Species: Canine Age: 3Y
Weight: 60.00 Color and Markings: Sable
Microchip:
Breed: Shepherd, German
Signed: \
'KelIy ilehn, DVM License: 4188
Vaccinations Performed:
Vxn Rabies Vaccination, 3 Year
Next Rabies Vaccination Due: 01-06-21
Rabies Vaccination Information:
Manufacturer: BOB Serial Number: 4150440A
Lot Expiration: Feb.2019 Administered: Sq

15411 N 31st St Phoenix, AZ 85032. Phone (602) 971-9651
Certificate of Rabies Vaccination
Date of Rabies Vaccination: 01-07-18 Certificate No: 0
OWNER OF ANIMAL
First Name: Zdenek Last Name: Blabla
Address: 29416 N 161 Ave
City: Surprise State: AZ Zip: 85387
County:
This is to certify...
THAT I HAVE VACCINATED THE ANIMAL DESCRIBED BELOW AGAINST THE
RABIES VIRUS.
Patient Information:
Patient: Largo Sex: Male
Species: Canine Age: 8Y
Weight: 65.00 Color and Markings: Sable
Microchip:
Breed: Shepherd, German
Signed:
IRWIghi;;, DVM License: 4188
Vaccinations Performed:
Vxn Rabies Vaccination, 3 Year
Next Rabies Vaccination Due: 01-06-21
Rabies Vaccination Information:
Manufacturer: BOB Serial Number: 4150440A
Lot Expiration: Feb.2019 Administered: Sq

15411 N 31st St. Phoenix, AZ 85032. Phone (602) 971-9651
Certificate of Rabies Vaccination
Date of Rabies Vaccination: 01-07-18 Certificate No: 0
OWNER OF ANIMAL
First Name: Zdenek Last Name: Blabla
Address: 29416 N 161 Ave
City: Surprise State: AZ Zip: 85387
County:
This is to certify...
THAT I HAVE VACCINATED THE ANIMAL DESCRIBED BELOW AGAINST THE
RABIES VIRUS.
Patient Information:
Patient: Jet Sex: Male
Species: Canine Age: 9Y
Weight: 60.00 Color and Markings: Sable
Microchip:
Breed: Shepherd, German
Signed:
Kelly Rehn, DVM License: 4188
Vaccinations Performed:
Vxn Rabies Vaccination, 3 Year
Next Rabies Vaccination Due: 01-06-21
Rabies Vaccination Information:
Manufacturer: BOE Serial Number: 4150440A
Lot Expiration: Feb.2019 Administered: Sq

15411 N 31st St. Phoenix, AZ 85032. Phone (602) 971-9651
Certificate of Rabies Vaccination
Date of Rabies Vaccination: 01-07-18 Certificate No: 0
OWNER OF ANIMAL
First Name: Zdenek Last Name: Blabla
Address: 29416 N 161 Ave
City: Surprise State: AZ Zip: 85387
County:
This is to certify...
THAT I HAVE VACCINATED THE ANIMAL DESCRIBED BELOW AGAINST THE
RABIES VIRUS.
Patient Information:
Patient: Haka Sex: Female
Species: Canine Age: 12M
Weight: 60.00 Color and Markings: Sable
Microchip:
Breed: Shepherd, German
Signed: //2"\
Kelly Hefin, DVM License: 4188
Vaccinations Performed:
Vxn Rabies Vaccination, 3 Year
Next Rabies Vaccination Due: 01-06-21
Rabies Vaccination Information:
Manufacturer: BOE Serial Number: 4150440A
Lot Expiration: Feb.2019 Administered: Sq

15411 N 31st St. Phoenix, AZ 85032. Phone (602) 971-9651
Certificate of Rabies Vaccination
Date of Rabies Vaccination: 01-0748 Certificate No: 0
OWNER OF ANIMAL
First Name: Zdenek Last Name: Blabla
Address: 29416 N 161 Ave
City: Surprise State: AZ Zip: 85387
County:
This is to certify...
THAT I HAVE VACCINATED THE ANIMAL DESCRIBED BELOW AGAINST THE
RABIES VIRUS.
Patient Information:
Patient: Gus Sex: Male
Species: Canine Age: 12M
Weight: 65.00 Color and Markings: Sable
Microchip:
Breed: Shepherd, German
Signed:
Kerly Rehn, DVM License: 4188
Vaccinations Performed:
Vxn Rabies Vaccination, 3 Year
Next Rabies Vaccination Due: 01-06-21
Rabies Vaccination Information:
Manufacturer: BOB Serial Number: 4150440A
Lot Expiration: Feb.2019 Administered: Sq

15411 N 31st St. Phoenix, AZ 85032. Phone (602) 971-9651
Certificate of Rabies Vaccination
Date of Rabies Vaccination: 01-07-18 Certificate No: 0
OWNER OF ANIMAL
First Name: Zdenek Last Name: Blabla
Address: 29416 N 161 Ave
City: Surprise State: AZ Zip: 85387
County:
This is to certify...
THAT I HAVE VACCINATED THE ANIMAL DESCRIBED BELOW AGAINST THE
RABIES VIRUS.
Patient Information:
Patient: Fury Sex: Female
Species: Canine Age: 3Y
Weight: 60.00 Color and Markings: Sable
Microchip:
Breed: Shepherd, German
Signed:
Vaccinations Performed:
Vxn Rabies Vaccination, 3 Year
Next Rabies Vaccination Due: 01-06-21
Rabies Vaccination Information:
Manufacturer: BOB Serial Number: 4150440A
Lot Expiration: Feb.2019 Administered: Sq

15411 N 31st St. Phoenix, AZ 85032. Phone (602) 971-9651
Certificate of Rabies Vaccination
Date of Rabies Vaccination: 01-07-18 Certificate No: 0
OWNER OF ANIMAL
First Name: Zdenek Last Name: Blabla
Address: 29416 N 161 Ave
City: Surprise State: AZ Zip: 85387
County:
This is to certify...
THAT I HAVE VACCINATED THE ANIMAL DESCRIBED BELOW AGAINST THE
RABIES VIRUS.
Patient Information:
Patient: Cibule Sex: Female
Species: Canine Age: 8Y
Weight: 60.00 Color and Markings: Sable
Microchip:
Breed: Shepherd, German
Signed: 71\
License: 4188
Vaccinations Performed:
Vxn Rabies Vaccination, 3 Year
Next Rabies Vaccination Due: 01-06-21
Rabies Vaccination Information:
Manufacturer: BOE Serial Number: 4150440A
Lot Expiration: Feb.2019 Administered: Sq

Certificate of Rabies Vaccination
Date of Rabies Vaccination: 01-07-18 Certificate No: 0
OWNER OF ANIMAL
First Name: Zdenek Last Name: Blabla
Address: 29416 N 161 Ave
City: Surprise State: AZ Zip: 85387
County:
This is to certify...
THAT I HAVE VACCINATED THE ANIMAL DESCRIBED BELOW AGAINST THE
RABIES VIRUS.
Patient Information:
Patient: Chubo Sex: Male
Species: Canine Age: 8Y
Weight: 60.00 Color and Markings: Sable
Microchip:
Breed: Shepherd, German
Signed:
Kelly lIehn, DVM License: 4188
Vaccinations Performed:
Vxn Rabies Vaccination, 3 Year
Next Rabies Vaccination Due: 01-06-21
Rabies Vaccination Information:
Manufacturer: BOE Serial Number: 4150440A
Lot Expiration: Feb.2019 Administered: Sq

15411 N 31st St. Phoenix, AZ 85032. Phone (602) 971-9651
Certificate of Rabies Vaccination
Date of Rabies Vaccination: 01-07-18 Certificate No: 0
OWNER OF ANIMAL
First Name: Zdenek Last Name: Blabla
Address: 29416 N 161 Ave
City: Surprise State: AZ Zip: 85387
County:
This is to certify...
THAT I HAVE VACCINATED THE ANIMAL DESCRIBED BELOW AGAINST THE
RABIES VIRUS.
Patient Information:
Patient: Chula Sex: Female
Species: Canine Age: 6Y
Weight: 55.00 Color and Markings: Sable
Microchip:
Breed: Shepherd, German
Signed:
Kelcy" ehn, DVM License: 4188
Vaccinations Performed:
Vxn Rabies Vaccination, 3 Year
Next Rabies Vaccination Due: 01-06-21
Rabies Vaccination Information:
Manufacturer: BOB Serial Number: 4150440A
Lot Expiration: Feb.2019 Administered: Sq

Certificate of Rabies Vaccination
Date of Rabies Vaccination: 01-07-18 Certificate No: 0
OWNER OF ANIMAL
First Name: Zdenek Last Name: Blabla
Address: 29416 N 161 Ave
City: Surprise State: AZ Zip: 85387
County:
This is to certify...
THAT I HAVE VACCINATED THE ANIMAL DESCRIBED BELOW AGAINST THE
RABIES VIRUS.
Patient Information:
Patient: Chubra Sex: Female
Species: Canine Age: 12M
Weight: 55.00 Color and Markings: Black and Tan
Microchip:
Breed: Shepherd, German
Signed:
KellyYlehn, DVM License: 4188
Vaccinations Performed:
Vxn Rabies Vaccination, 3 Year
Next Rabies Vaccination Due: 01-06-21
Rabies Vaccination Information:
Manufacturer: BOE Serial Number: 4150440A
Lot Expiration: Feb.2019 Administered: Sq

Certificate of Rabies Vaccination
Date of Rabies Vaccination: 01-07-18 Certificate No: 0
OWNER OF ANIMAL
First Name: Zdenek Last Name: Blabla
Address: 29416 N 161 Ave
City: Surprise State: AZ Zip: 85387
County:
This is to certify...
THAT I HAVE VACCINATED THE ANIMAL DESCRIBED BELOW AGAINST THE
RABIES VIRUS.
Patient Information:
Patient: Boxa Sex: Female
Species: Canine Age: 7Y
Weight: 55.00 Color and Markings: Sable
Microchip:
Breed: Shepherd, German
Signed: ,r-.1/1z•-
ell He 17, DVM License: 4188
Vaccinations Performed:
Vxn Rabies Vaccination, 3 Year
Next Rabies Vaccination Due: 01-06-21
Rabies Vaccination Information:
Manufacturer: BOE Serial Number: 4150440A
Lot Expiration: Feb.2019 Administered: Sq

15411 N 31st St. Phoenix, AZ 85032. Phone (602) 971-9651
Certificate of Rabies Vaccination
Date of Rabies Vaccination: 01-07-18 Certificate No: 0
OWNER OF ANIMAL
First Name: Zdenek Last Name: Blabla
Address: 29416 N 161 Ave
City: Surprise State: AZ Zip: 85387
County:
This is to certify...
THAT I HAVE VACCINATED THE ANIMAL DESCRIBED BELOW AGAINST THE
RABIES VIRUS.
Patient Information:
Patient: Borg Sex: Male
Species: Canine Age: 8Y
Weight: 60.00 Color and Markings: Sable
Microchip:
Breed: Shepherd, German
Signed:
License: 4188
Vaccinations Performed:
Vxn Rabies Vaccination, 3 Year
Next Rabies Vaccination Due: 01-06-21
Rabies Vaccination Information:
Manufacturer: BOE Serial Number: 4150440A
Lot Expiration: Feb.2019 Administered: Sq

Certificate of Rabies Vaccination
Date of Rabies Vaccination: 01-07-18 Certificate No: 0
OWNER OF ANIMAL
First Name: Zdenek Last Name: Blabla
Address: 29416N 161 Ave
City: Surprise State: AZ Zip: 85387
County:
This is to certify...
THAT I HAVE VACCINATED THE ANIMAL DESCRIBED BELOW AGAINST THE
RABIES VIRUS.
Patient Information:
Patient: Bimba Sex: Female
Species: Canine Age: 6Y
Weight: 55.00 Color and Markings: Sable
Microchip:
Breed: Shepherd, German
Signed:
License: 4188
Vaccinations Performed:
Vxn Rabies Vaccination, 3 Year
Next Rabies Vaccination Due: 01-06-21
Rabies Vaccination Information:
Manufacturer: BOE Serial Number: 4150440A
Lot Expiration: Feb.2019 Administered: Sq

Certificate of Rabies Vaccination
Date of Rabies Vaccination: 01-07-18 Certificate No: 0
OWNER OF ANIMAL
First Name: Zdenek Last Name: Blabla
Address: 29416 N 161 Ave
City: Surprise State: AZ Zip: 85387
County:
This is to certify...
THAT I HAVE VACCINATED THE ANIMAL DESCRIBED BELOW AGAINST THE
RABIES VIRUS.
Patient Information:
Patient: Bady Sex: Male
Species: Canine Age: 11Y
Weight: 55.00 Color and Markings: Sable
Microchip:
Breed: Shepherd, German
Signed:
KWHetin,DVM License: 4188
Vaccinations Performed:
Vxn Rabies Vaccination, 3 Year
Next Rabies Vaccination Due: 01-06-21
Rabies Vaccination Information:
Manufacturer: BOB Serial Number: 4150440A
Lot Expiration: Feb.2019 Administered: Sq

15411 N 31st St. Phoenix, AZ 85032. Phone (602) 971-9651
Certificate of Rabies Vaccination
Date of Rabies Vaccination: 01-07-18 Certificate No: 0
OWNER OF ANIMAL
First Name: Zdenek Last Name: Blabla
Address: 29416 N 161 Ave
City: Surprise State: AZ Zip: 85387
County:
This is to certify...
THAT I HAVE VACCINATED THE ANIMAL DESCRIBED BELOW AGAINST THE
RABIES VIRUS.
Patient Information:
Patient: Awesome Sex: Male
Species: Canine Age: 13M
Weight: 55.90 Color and Markings: Black
Microchip:
Breed: Shepherd, German
Signed:
Kelly He .n, DVM License: 4188
Vaccinations Performed:
Vxn Rabies Vaccination, 3 Year
Next Rabies Vaccination Due: 01-06-21
Rabies Vaccination Information:
Manufacturer: BOB Serial Number: 4150440A
Lot Expiration: Feb.2019 Administered: Sq