BOBBIES BULLIES KENNEL PERMIT (K19-000070).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
111 New Renewal Permit 51 0 000 -7 0
v
Name: Kennel Name: bo )k27AAA,
Kennel Location: 'J-I-
City \\-1 County Supervisorial District
Horne Phone: Kennel Phone: 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.
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. §11-1008.
PLEASE ANSWER THE FOLLOWING QUESTIONS AND INITIAL EACH RESPONSE
i.,,,CY-1/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).
I/We certify that IANe have dogs and that the kennel meets the definition in statute.
3. ' —l/We certify that IANe have not been convicted of a violation of A.R.S. §§ 13-2910 (cruelty to animals)
or 3-2910.01 (dog fighting), or similar violations of any other state, county or municipal animal welfare law.
(Violations of license and leash laws DO NOT apply).
I/VVe certify that all dogs over the age of three (3) months that are kept, harbored or maintained on the
preThises 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. ----4-m-e-certify that I/We are submitting a valid copy of the rabies vaccination certificate for each
dog with this application.
TA/Ve—iiiiderstand 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
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.
IZT %,...XVILe-understand that a person who fails to obtain a kennel permit under A.R.S.§11-1009 is subject to a
pen ty 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
wriffen notification from the county enforcement agent is guilty of a class 2 misdemeanor..
,--rhe 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/VVe certify that all of the informati n I/We have vided 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 2

Maricopa County Animal Care and Control
2500 S. 27th Avenue
Phoenix, AZ 85009-6797
(602) 506-7387
http://pets.maricopa.dov
Receipt Number: R19 -776940 Receipt Date: 04/29/2019
Person ID: P0645617
Phone: 480 9860806
BOBBIE'S BULLIE KENNELS 4/29/2019 3:32:15PM
3223 S BRICE
MESA, AZ 85212
Item: Animal ID: Reference No: Price: Each: Amount:
KEN PERMIT A9999999 U19-259923 $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:
A9999999 GENERIC BITE - BORN 8/23/2014, MALE, STAFFORDSHIRE, BROWN DOG
License Information:
Tag Number: License Expires: Animal# Vacc Date: Vacc Expires:
Please retain this receipt with your pet's records
luffmanm EBUSOFF

Maricopa County
Animal Care & Control
2500 South 27th Avenue
Phoenix, AZ 85009
Phone: (602) 506-7387
pets.maricopa.gov
KENNEL PERMIT K19-000070
PREMISE INSPECTION
Number of Dogs: 14
Name: BOBBIE NICHOLS Kennel Name: BOBBIE'S BULLIES KENNEL
Mailing Address: 3223 S BRICE Kennel Address: 3223 S BRICE
City: MESA State: AZ Zip: 85212 City: MESA Zip: 85212
County Supervisorial District: 2
Phone: 480-231-0110 Kennel Phone: 480-231-0110
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 property was inspected; there are 14 dogs on the premises. All dogs on the property
are currently vaccinated for rabies and are maintained under controlled conditions.
Deputy Enforcement Agent & Badge #: Romero #4 Date: 5/2/19
October 2015

P-#21:11: „ T
. 4 800.427.7973 ir
petvet.v1ppetcare.corn
CLINIC LOCATION
Tractor Supply Company
10545 E. Main St.
Apache Junction, Al 85120
CLIENT INFORMATION
TRACTOR sUPPLY COUPON, CASHIER PLEASE SCAN
Bobbie Nichols
3223 S Brice
Mesa, AZ 85212
(480) 231-0110
bbulldo970@yahoo.com
VISIT INFORMATION
Date: 04/28/19 Time: 10:08 AM
Blue Spring /
1 year - female - dog
14.2 lbs - br indle/blue - bostan terrier
Pet is healthy enough to vaccinate.
Pet's Visit ID:
PX0611 - 190422 - 9112(I6C
Rabies - Defensor $19
Manufactured by ThetiS
Lot Number 327233 '
1_YeeP4weter
ue on 04/27/2020 —
Rabies Tag $0
Barcode Number A531685
Medical Waste Disposal $3 rrVr
licrochipping ' Operated' lay VIP Petcare
Xai ,eworrning t TRACTOR SOW/ cOOPON, CAUHIE PLC $E SCAN
6 months - male - dog
9.5 Ilas - blue/el-1i to - booboo tei r ier iagnostic Tests lilliit 191111 0,1 2181 , 111 1 11
Pet is healthy enough to vaccinate.
Pet's Visit ID:
PX0611- 190428- 940586
$19 rs available
Rabies - Defensor 3
Manufactured by Zoetis isary
Lot Number 327233
7 days a week
(Due pn
$0 inic times,
Rabies Tag Tag
Barcode Number AS31682 .e.com
Medical Waste Disposal $3
ozi WI
10 months - female - dog Fe4 4, r%i ,/
21.2 lbs - black and chile - boston
ten ier
Pet is he.al thy enough to vaccinate. v I
Pet's Visit ID:
PX0611- 190428- 94334E
Rabies - DefeNsor 3 $19
Manufactured by Zeetis
Lot Number 327233
1 Ye:ex.-Bowater.
C-I)_u_e_on 04/27/2020
Rabies Tag $0

abies Lot Winufat Rabies Pc4Fis 19,0 Medical Barcode Rabies Lot Rabies Pot MfAical
Tag . PXOCifl- 1 Tag Numbw ManufactutE:d - 1 8.1 lbs 6
NumbeCPT2';13 Pet's hoaliky yEar Waste Number Pet's heAthy months Waste
W _De4erisoit 1901128 Violet 27-i33 hy Detensor 19(0611-190428-941301: onouyh blno - Petunia Dis
bet .2 Visit 01'wtiqh -toia10- Disposal 3 Visit feclle -
i ID: t. b06n 631684 ID: to boston - osaI
:adrilltiti vnc tenl o4 vacci tou dog
I,
$3 $0 $19

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A TULAJDONOS ADATAI AZ ALLAT LEIRASA
• DETAILS OF THE OWNERSHIP • DESCRIPTION OF ANIMAL
1. Keresztnev / Name:
Vezet4knev / Surname:
Cim / Address:
AZ ALLAT FtNYKEPE
IranyitOszam / Post-Code: (nem kotelez6)
PICTURE OF THE ANIMAL
TelepOtes / City: (optional)
Orszag / Country:
Tetefanszrn /
Telephone number
(nem k)telezo / optional)
Atairas / Signature:
1. NI6v* / Name*:
2. Keresztnev / Name:
2. Faj / Species:
Vezetekney / Surname:
3. Fajta* / Breed*:
Gm / Address:
4. Ivar / Sex:
Iranyftdszam / Post-Code: 5, SzOletesi Ido* /
Date of birth*:
Telepules / City: 6. Szin / Colour:
Orszag / Country: • a tulajdonos altaL megadott adatok atapjAn / as stated by owner
7, Egyeb megkOVinbOzteta vagy azonositasra atkalmas jegyek es jettemzOk
Tele.fonszm / Any notable or discernable features or charaaeristics.
Telephone number
(cam kateleth / optional)
AlVras / Signature:
(Mal / Page 4/28 H U 18 4 4 9

I I I AZ ALLAT AZONOSiTO JELZESEI AZ CITLEVEL KIBOCSATOJA
• MARKING OF ANIMAL • ISSUING OF THE PASSPORT
1. A mikrochip atfanumerikus kddja / Transponder alphanumeric code Jogosult altatorvos / Authorised veterinarian
1:2 i1n1f1°,1V8e5rVo 1x2.;1 VIT,dard Née! Name: &-e..4. sc
Cm / Address: Ja/ 4
2. A mikrochip betittetesenek vagy beolvasasanak* datuma /
Date of application or reading* of the transponder
Iranyitoszarn /
Post-Code: ), 4 it.".g
/0.7(/2'-'
Tetep'Utes / City. r r 1\0_, ,
3, A mikrochip ethelyezkedese / Location of the transponder
(1 3 k—rc, LL
Orszag / Country:
4. A tetovalas alkanumedkus kodja / Tattoo alphanumeric code
Tetefonszam /
Telephone number
E-mail dm /
5. A tetovaLas tetrehozasanak vagy leolvasasanak* datuma / E-mail address:
Date of application/date of reading* of the tattoo
A kibocsatas datuma / Date of issuing:
6. A tetovalas elhelyezkedese / Location of the tattoo
' a nem klvant resz tortendO / delete as necessary
As azonosito jelzeseket as uttevelbe torteno minden (ki bejegyzes WM ellen-
eirizni kelt
The marking must be verified before any new entry is made on this passport. Belyegzo / Stamp
adat/ Page 6/28 HU 18 HU 18 ,I .? 5

Signature Sianature Signature Signature Signature Signature Signature
/ & a & & &
ailatorvos veterinarian tamp Stamp Stamp& Stamp Stamp& Stamp Stamp
/ / / /
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jogosult Authorised es es / as es as es
kelt.
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szerepelnie
VEDOOLTAS RABIES date, from) until) signature
Vaccination Valid Valid K5 alarrasnak and
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Vakcinazas rg tyanyesse Ervanyessag a's/(,,e f 3 2 3 1 2 3 telefonszarnnak telephone 2 3 1 2 3 2 3 2 3
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VESZETTSEG VACCINATION / cfrnnek,
Number name,
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I A TULAJDONOS ADATAI AZ ALLAT LEIRASA
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• DETAILS OF THE OWNERSHIP • DESCRIPTION OF ANIMAL
1. Keresztnev / Name:
Vezeteknev / Surname:
Cim / Address: 3,22 3 -r e
AZ ALLAT FeNtirtpE
Iranyttdszarn / Post-Code.. (3.2 3- ) 2 s (cam keytelezo)
PICTURE OF THE ANIMAL
Telepules / City: (optional)
Orszag / Country:
Telefonszam /
Telephone number:
(nem Otelez6 / optional)
Alafras / Signature:
1. Nev. I Name*: '16
2. Keresztnev / Name: 2. Faj / Species:
•Pc.,3
Vezeteknev / Surname: 1 Fajta* / Breed*: 1/Zol
Cirn / Address: 4. Ivar / Sex:
s.
Iranyitoszam / Post-Code. 5. SzOletesi ido* / IVO
Date of birth*:
TetepOtes / City: 6, Sin / Colour:
a tulajdonos Offal magadott adatok alapjan / as stated by owner
Orszag / Country.
7. Egyeb meg Li tOnbOzteto vagy azonosItasra alkalmas jegyek es jellemzok /
Telefonszam / Arty notable or discernable features or characteristics:
Telephone number:
(nem kiitetezd / optional)
Alairas / Signature:
Oldal I Page 4/28 H U 19 HU 19 OtclaU Page 5/28

I I I AZ ALLAT AZONOSiTo JELZESEI Ili AZ OTLEVEL K1BOCSAToJA
I • MARKING OF ANIMAL I V ISSUING OF THE PASSPORT
1. A triiktorhip atianumerikus kodja / Transponder alphanumeric code Jogosutt altatorvos / Authorised veterinarian
IM 1:1111111111111111111111111111111111111111111111 Nev / Name: iC)C4t 'X
953010003433423
Clm / Address!
2. A mikroch0 beatetesenek vagy beolvasasanak* datuma /
Date of application Or reading of the transponder
Iranyitoszarn /
Post-Code:
-V(17
TelepUtes / City:
3. A mikrochip ethelyezkerlese / Location of the transponder
/
Orszeg / Country:
4. A tetovatas alfanumerikus kodja / Tattoo alphanumeric code
Tetefonszam /
Telephone number:
E-mail rim /
5, A tetovales letrehozasanak vagy teolvasasanak . datuma / E-mail address:
Date of application/date of reading"' of the tattoo
A kiborsatas datum / Date of issuing:
6. A tetovates elhetyezkedese / Location of the tattoo
f/i'3/2;-1)
a nem Idvant resz tarlendo / delete as necessary
Az azonositO jelzeseket az uttevolbetarteno minden ij bejegyzes Witt ellen-
orizni kelt.
The marking must be verified before any new entry is made on this passport Atafras / Signature Betyegze / Stamp
Otdal/ Page 6/23 HU 19 Wall Page 7128

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1 • DETAILS OF THE OWNERSHIP • DESCRIPTION OF ANIMAL
1. Keresztnev / Name:
Vezeteknev / Surname: 7/
Cim / Address: '1 I
AZ At LAT FENYKEPE
Iranyitoszam I Post-Code: A 5 ' ;2 (eem kotetez6)
PICTURE OF THE ANIMAL
(optional)
Tetejkles / City: .(4 ,
/
Orszag / Country'
Telefonszam /
Telephone number'
(nem kotelezO / optional)
Alairas / Signature:
1. Nev* / Name*:
/4-
, 2.Keresztnev / Name: 2. Faj / Species:
Vezetekoev / Surname: 3. Fajta* / Breed':
Cim I Address: 4. Ivar / Sex:
Iranyitoszam / Post-Code' 5. SzCitetesi id6* / :30/0
Date of birth".
TetepOles / City: 6. Szin / Colour: ,17
* a tulajdonos SiSal megadott adatok alap* / as staled by owner
Orszag / Country:
7. Egyeb megkulanbazteta vagy azonositasra alkalmos jegyek es je1temz6k /
Tel.eforlsz6m / Any notable or discernable features or characteristics:
Telephone number'
(nem kotelezd / optional)
Ala iras / Signature:
°Idol/Page 4/26 H U 1 9 U 19 Oldat/RRge5/28

I Ur AZ OTLEVEL KIBOCSAToJA
AZ ALLAT AZONOSiTo JELZESEI
I I I V • ISSUING OF THE PASSPORT
• MARKING OF ANIMAL
1.A mikrochip alfanumerikus kad / Transponder alphanumeric code Jogosult allatorvos / Authorised veterinarian
Nev / Name: -
11111111111113111111011111111111111111111111111
953010003430543
Clm / Address:
2. A mikrochip beCatetesenek vagy beolvasAsanak* cl6tuma /
Date of application or reading" of the transponder
Iranykoszam /
Post-Code:
TetepOles / City:
3. A rnikrochip eLhelyezked6se / Location of the transponder
01( Orszag / Country.
4. A tetovala s alfanumenkus kodja / Tattoo alphanumeric code
Telefonszam /
Telephone number:
E-mail cim /
5. A tetovaLas tetrehozasanak vagy leolvasasanak* daturna / E-mail address:
Date of application/date of reading* of the tattoo
A kibocs.Ras d6tuma / Date of issuing:
6. A tetovalas ethelyezkedese / Location of the tattoo
a nem klvant resz tortendo / delete as necessary
As azonosito jelzeseket az utlevetbe tiktend minden Cij bejegyzes elott etten-
órIzni kelt.
The marking must be verified before any new entry is made on this passport
Oldal /Page 6/28 HU 19 Oldal / Page 7/28

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/ / / / /
osult alairas alairas atairas Mhires aigres alaires
Jog Authorised - .77 es es / es es es es
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-Tr Belyegz6 Belyegzo Belyegzo Betyegze Belyegzo Belyegz6
B szerepeirre
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VEDoOLTAS untit3
Vaccination Vaiid Valid 41 atairesnak and
/ / kezdeteZ / vege3 /„26 1 /,2- '1' i az number
AGAINST es
detumai 1
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a address,
VACCINATION / cimnek,
VESZETTSEG Number name,
Tetetszem a least
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IA TULAJDONOS ADATAI AZ ALLAT LEIRASA
I I
• DETAILS OF THE OWNERSHIP a DESCRIPTION OF ANIMAL
1. Keresztriev / Name: Z? /
Vezeteknev / Surname:
Urn / Address: C
AZ ALLAT FENYKEPE
(earn k5telezal
Iranylt.oszam / Post-Code:
;:C
PICTURE OF THE ANIMAL
(optional)
Tel.epules / City.
Orszag / Country:
TelefonszAm /
Telephone number
(nem kate1e7.6 / optional)
Alairas / Signature:
1. WV* / Name:
T 1'4 sl— x..)6
2, Keresztnev / Name: 2. Faj / Species:
Vezetekney / Surname: 3. Fajta*/ Breed':
Clm / Address 4. Ivar / Sex:
IranyitOszam / Post-Code: 5. Sztaetesi 1(15* /
Date of birth":
Telepales / City: 6. SzIn / Colour
" a tutajdonos Altai megadott aKiatok, atapjan / as stated by owner
Orszag / Country:
7. Egyeb megkadnbazteto vagy azonositasra atialmas jegyek es jel.temzok /
Teefonszam / Any notable or discernable features or characteristics:
Telephone number:
(nem kotelezo / optionat)
Alaires / Signature:
Oldal/Page 4/28 H U 18 OldaL/Page 5/28

I I I AZ ALLAT AZONOSiTo JELZtSEI I AZ OTLEVEL KIBOCSATojA
Me MARKING OF ANIMAL V ISSUING OF THE PASSPORT
I., A Mikrochip alfammerikus kodja / Transponder alphanumeric code jogosult allatorvos / Authorised veterinarian
1.9119111 111110° 15113j111211 1111111!1,11.1111.1111,11,E,11111,11) Nay / Name: z
Cim / Address:
2. A mikrochip beOltetesenek vagy beolvasasanak* datuma /
Date of application or reading' of the transponder
Irany[tdszam /
Post-Code: )(.
At'S- (2.:,")
TelepOtes / City:
3. A mikrochip elhelyezkedese / Location of the transponder
$7.46f• - Orszag / Country:
4. A tetovalas atfanumerikus kodja / Tattoo alphanumeric code
Telefonszam /
Telephone number: .1' 6
cim /
5. A tetovalas letrehozasarrak vagy leolvasasanak*datuma / E-mail address:
Date of application/date of reading of the tattoo
A kibocsatas datuma / Date of issuing:
6. A tetovalas elhelyezkedese / Location of the tattoo
„
a rem klvant resz tOrlendo / delete as necessary
Az azonosito jetzeseket az Catevelbetorteno minden Uj belegyzes elan ellen-
Onzni kelt.
The marking must be verified before any new entry is made on this passport.
Oidat / Page 6/28 H U 1 8 Oldal/ Page 7/28

Signature Signature Signature Signature Signature Signature Signature
/ & & & a &
allatorvos veterinarian Stamp Stamp& Stamp& Stamp Stamp Stamp Stamp
/ / / / / /
suit atalres alairas atairAs atair-as atairs ataitas
---gq thor.INd es do / es es do es
-, 6, BelyegzO Belyegze kelt. Betvegzo Belyegze Belyegze Belyegzet
,,---
szerepetnie
VEDoOLTAS RABIES dated from= u'iltii3.7. signature.
Vaccination Valid Valid alakasnak and
/ I / yege3 , /.", az number
AGAINST daturnal kezdete2 6- es
ELLEN' /0
Vak.cinezes ErOnyesseg Erverlyesseg ,'-9c-, 2 telefonszamnak telephone 2 3 2 3 1 2 3 2
a address,
VESZETTSEG VACCINATION / cIrrinek,
Number a name,
TeteLszarn nevnek, least
Batch At
a
V V / vaccine Legatabb
nave of
vaktina Name
a &
es
gyarte Manufacturer
A
1eP10 at5Fdi 8V9 1eP10 BV6=paedi

I A TULAJDONOS ADATAI AZ ALLAT LEIRASA
I I
• DETAILS OF THE OWNERSHIP • DESCRIPTION OF ANIMAL
1. Keresztnev / Name. r
Vezeteknev / Surname:
Cim / Address:
AZ ALLAT FENYIVE
Iranyitoszm / Post-Code: el.._ (ram koteleza)
PICTURE OF THE ANIMAL
TelepUes / City: (optional)
Orszag / Country:
Telefonsza' m /
Telephone number:
(nem Otelezd opt/oral)
Aláirás / Signature:
1. Nay* / Name*:
2. Keresztnev / Name: 2. Faj / Species:
Vezeteknev / Surname: 3. Fajta. / Breed*:
Om / Address: 4. Ivar / Sex:
IranyitOszarn / Post-Code: 5, SzOletesi Ic16* /
Date of birth*:
TeleWes / City: 6. Szin / Colour:
tutaidonos Aol niegadott edatok alapjan / as stated by owner
Orszag / Country:
7. Egyeb megkatonboztetO vagy azonositasra alkeimas jegyek es JeLlemzok /
Telefonsz6m / Any notable or discernable features or characteristics:
Telephone number
(nem Otelezo / optional)
/ Signature;
Oldal/Page 4/29 HU 18 HU 18

I H AZ ALLAT AZONOSiTo JELZESEI I la AZ CJITLEVEL KIBOCSATOJA
I • MARKING OF ANIMAL V • ISSUING OF THE PASSPORT
1. A mikrochip alfanumerikus k6dja / Transponder alphanumeric code jogosult allatorvos / Authorised veterinarian
ISO Transponder:2.1212mm
ISO 11784/11785 bXB Standard Nev / Name: 7.0 K-
Elm / Address: r' LA 4
2,A mikrochip bebitetesenek vagy beolvasasanak" datuma /
Date of application or reading* of the transponder
Iranyftoszam /
Post-Code:
/20-to,
3. A mikrochip elhelyezkedese / Location of the transponder TeLepules / City:
e L
Orszag / Country:
4, A tetovalas alfanumerikus kodja / Tattoo alphanumeric code
Telefonszern /
Telephone number'
E-mail rim /
5, A tetovalas letrehozasanak vagy leolvasasanak*datuma / E-mail address:
Date of application/date of reading of the tattoo
A kibocsatas daturna / Date of issuing:
6 A tetovalas elhelyezkedese / Location of the tattoo
• a rem 4:ivant rasa tortende / delete as necessary
As azonositO jelzeseket az iftlevalbe tdrtend minden Cij befegyzas elott ettere-
órizni kelt,
The marking must be verified before any new entry is made on this passport. Belyegz6 / Stamp
Olda/Page 6/28 HU 18 HU 18 Oldal/ Page 7/28

u_ Signttire Signature Signature Signature Signature Signature Signature
veterinarian IOZSEF apf6ny 277 & & &
altatorvos ID? Stamp Stamp Stamp& /Stamp Stamp& Stamp& Stamps,
*_11 / / I / /
alairas alairas atairas aLeiras alairas alaitas
Jogosutt __Authorised es e_s / es es &s és
kelt_
Ele[yegzo Betyegzd Be(yegzo Betyegza Betyegzo Belyegzo
szerepelnie
VEDoOLTAS RABIES date' from2 untiP signature,
Vaccination Valid Valid slairesnak
/ / numberand
AGAINST kezdete2 yege3 az es
ELLEN!
Vakcinazascl&tumal/ Ervenyesseg Ervenyesseg telefonsz6mnak telephone
1 2 3 1 2 3 2 3 1 2 3 2 3 2 3
a address,
VESZETTSEG VACCINATION / Number dmnek, name,
Teteiszarn a least
Batch nevnek, At
• , a
ItAr V I vaccine Legatibb
neve of
vakcina Name 253624A 04.06.2019
a
es
gyarto Manufacturers lAt
A
2P10 t.),==c1/1 8Z/9 6-5ed/leP10 BZ.16

I A TULAJDONOS ADATAI AZ ALLAT LE1RASA
I I
a DETAILS OF THE OWNERSHIP • DESCRIPTION OF ANIMAL
1. Keresztnev / Name;
Vezeteknev / Surname:
Cfm / Address .
AZ ALLAT FENYKPE
(tern kertelezei)
IranyitOszam / Post-Code: A 0 ; 5- if
PICTURE OF THE ANIMAL
(optional)
TetepOtes / City: C)c- A71/ cr
Orszbg / Country:
. C. 4_
Telefonszam /
Telephone number:
(nem kOteLezO / optional)
Alairas / Signature:
1. Nev* / Name*: r
/i iI-•1 A..) 0.4).
2. Keresztnav / Name: 2. Fa; / Species:
P.(.)
Vezeteknev / Surname; 3, Fajta*/ Breed':
Cfm / Address: 4. lvar / Sex: /-4
lranyftdszam / Post-Code: .2 5, Szaetesi Ida* / (:t:2 /.4:),re
Date of birth*:
TelepAes / City . 6. Szin / Colour: /1.(.4Tri
*a tutejdonos Sisal megadott adatot alapjan / as stated by owner
Orszag / Country: 7. Egyeb megUtonbtiztetei vagy azonositasra alkalrflas jegyek es jeltemzok /
Tetefonszam / Any notable or discernable features or characteristics:
Telephone number:
(nem kotelez6 / optional)
Atafras / Signature:
Oldal / Page 5/28
Oldal/Page 4/28 H U 1 8

I I I AZ ALLAT AZONOSiTO JELZESEI • AL, AZ OTLEVEL KIBOCSATto
II • MARKING OF ANIMAL W • ISSUING OF THE PASSPORT
1. A mikrochip alfanumenkus kddja / Transponder alphanumeric code Jogosutt allatorvos / Authorised Veterinarian
Nev I Name: .4 5-.1'4(
Cim / Address:
2. A mikrochip beuttetesenek vagy beotvasasanak daturna /
Date of application or reading' of the transponder
Iranyitoszam
Post-Code:
a
2 ,c; oir 213
TetepOles / City:
3. A mikrochip ethelyezkedese / Location of the transponder
Orszag / Country:
4. A tetovatas atfanumer kus kddja / Tattoo alphanumeric code
Tetefonszam /
Telephone number
cim /
5, A tetovatas tetrehozasanak vagy leolvasasanak" datuma / E-mail address:
Date of application/date of reading* of the tattoo
A kibocsatas cfatuma / Date of issuing:
6. A tetovalas ethelyezkedese / Location of the tattoo
,f
* a nem klvant resz torterldo / delete as necessary
As azonosito jetzeseket az iftlevelbe torteno minden üJ bejegyzes elott ellen-
onset keLL
The marking must be verified before any new entry is made on this passport. BeLyegzo / Stamp
Oldal/Page 6/28 H U 1 8 Otdat/ Page 7/28

2'37.
u.
OZSEF 2773 tare
NapfElly 3 Signature Signature Signature Signature Signature Signature Store
/ & & a a
atatorvos veterinarian Stamp Stamp& Stamp Stamp& Stamp Stamp Stamp&
I / / / / its / /
tat atafras atairas ataires all atairas alairas
jogosult es Is / Is Is Is Is
..„,--npthocised ketl.
Belyegz6 Belye2z8 BIlyegz6 Betyegzo BelyegzO Belyegz6
szerepetnie
RABIES datel from2 untif3 signature.
Vaccination Valid VaLtd atairasnak and
/ / 47/IL'Ar? az
AGAINST / kezdete2 vege, ' es number
VEDoOLTAS ELLEN9 VESZETTSEG d4Wrnai
Ervenyess=:,..g trvenyesseg 2/ teLefonszamnak telephone
Vakcin.zAs 3 1 2 3 2 3 2 3 3 1 2 3 1 2 3
a address,
VACCINATION / cfmnek,
Number name,
Teteiszam a /east
Batch nevriek, 'At
V • a
V / vaccine "LegaLabb
neve of
vakcina Name 36024A, 03.10.2019
a &
es
gyarto Manufacturer
A
12V0 abed/ 8V8 CO eP10 l abec/ ElZ/6

I A TULAJDONOS ADATAI AZ ALLAT LEIRASA
I
DETAILS OF THE OWNERSHIP I • DESCRIPTION OF ANIMAL
1. Keresztnev / Name:
4
Vezeteknev / Surname: -V, jz
Cim / Address:
ALLAT FENYKEPE
IranyltOszam / Post-Code: - (tern kotetez6)
C .2 C
PICTURE OF THE ANIMAL
(optional)
Tetepi,les / City: (,± P(f
Orszag / Country:
Telefonszkn /
Telephone number:
(nem kOtetezci / optional)
Alafras I Signature:
L Nev*/ Name*:
2.Kereszfney / Name: - 2. fraj / Species:
13Q,14,
Vezeteknev / Surname: L../ , c 0 4 3, Fajta*/ Breed*:
•77.e.
Cim / Address: 4. ivar / Sex:
3 Z '•
IranyitOszam I Post-Code: 5. Szatetesi Ida* /
,2 - Date of birth*: / 2,1)/ e
TelepOtes / City: 6. Szin / Colour: hr t zL.-T- 1)
a tulajdonos altat megadott adatok alapjAn / as stated by owner
Orszag / Country:
7, Egyab megkOLOnboztetti vagy azonosiOsra atkalmas jegyek es jellemzok /
Telefonszam / Any notable or discernable features or characteristics:
Telephone number:
(nem (6telez6 / optional)
Atafras / Signature:
°dal/ Page 4/28 H U 1 8 H U 18

I I I AZ ALLAT AZONOSITo JELZESEI Ur AZ CITLEVEL KIBOCSATOJA
MARKING OF ANIMAL g V • ISSUING OF THE PASSPORT
FtArochip a tranumerikus kodja / Transponder alphanumeric code JogosuLt allatorvos / Authorised veterinarian
11111119,11A1)1111 Nes/ / Name' ITs2j'r/1 rT3 4f
19
11,,!!!!!!!11311113111, 11
Cim / Address:
YC).1
2: A mikrochip beOltetesenek vagy beolvasasanak' datuma /
Date of application or reading* of the transponder
IranyttOszam /
Post-Code:
9,; /0,171,2f) re
3.A mikrochip e.theLye7kedese / Location of the transponder TelepOles / Crty: • 'A i.1.4
Orszag / Country:
,1-41 k••_-_
4. A tetovatas atfanumerikus kOdja / Tattoo alphanumeric code
Tetefonszarn /
Telephone number: if 0
E-mail cim /
5. A tetovalas Letrehozasanak vagy Leolvasasanak* datuma / E-mail address;
Date of application/date of reading of the tattoo
• A kibocsatas clatuma / Date of issuing:
6. A tetovatas eLhelyezkedese / Location of the tattoo
a earn kivant resz torlend6 / delete as necessary
Az azonositcSjetzesaket az iitievelbe tortem5 minden 11j bejegyzes elott ellen-
Orizni kelt
The marking must be verified before any new entry is made on this passport.
Oldal / Page 6/28 H U 18 H U 18

Signature Signature Signature Signature Signature Signature Signature
/ & & a & &
allatorvos veterinarian Stamps Stamp Stamp Stamp Stamp Stamp Stamp&
fres/ / / / 1 /
prised aiairas atairas atairas atalras aletras atAiras
jogosulk ds ds I es de es as
Isett.
BetyegzO Belyegz6 Belyegzo Belyegzo Bdtyegzo Belyegzo
szerepelnie
VEDoOLTAS RABIES datel from2 unV,.- signature.
Vaccination Valid Valid atafrasnak and
AGAINST kezdete2 / step& az es number
ELLEN!
Vakcinazasclatumal/ tivenyessee Enrenyesseg 2 3 1 2 3 tetefonszamnak telephone 2 3 2 3 1 2 3 2 3
a address,
VESZETTSEG VACCINATION / Number rtmnek, name,
Tetetszam a (east
Batch nevnek, At
• a
V / vaccine Legatabb
nave
of
vakcina Name 36602-4:4 03.10.2014
a es &
gyartd Manufacturer
A
lEPTO e5ed/ elie /len° a6ed 8Z/6

i. ODAJE 0 VLASTNiCTVE IL POPIS ZVIERKIA
I. DETAILS OF OWNERSHIP IL DESCRIPTION OF ANIMAL
1 . Meno:
Nome:
Priezvisko:
Su rrnarne:
Ad resa : SNIMKA ZVIERAtA
Address:
(volitel'nci)
PS: PICTURE OF THE ANIMAL
Post-Cocle:
Meslo/obec: (optional)
City:
Country:
Telefonne .
Telephone number*:
Pod pis:
1 Meno*: LL. vey
Name*:
2. Meno: 2. Druh: ttr.
Name:
Priezvisko: Species:
Surrnome: 3. Plemeno*:
Ad resa: Breed*:
Address: 4, Pohlavie:
Sex:
5. Datzerotetrodurri-ct: 4,1oh64.4,0114
csigalgOr:
Post-code: 6. Farba:
Mesto/obec: Colour:
City:
ttat: 7. Vietky podstatnealebo rozligitel'ne vlastnosti a lebo charakteristiky:
Country: Any notable or discernable features or characteristics:
Telefon ne 61slo*:
Telephone number*:
Podpis:
Signature:
nepovinneitoptional * Podro (tdajoy vlastnika/.0:::.taleci by owner
Strom] z 36 A S K 001176050 S K 001176050 Stan° z 36 5

OZNAdENIE NIERAtA IV. VYDANIE PASU
III. MARKING OF ANIMAL IV. ISSUING OF THE PASSPORT
1, Alfanumericky kod tronspondera: Meno povereneho
Transponder oink veterinarneho lekara: MVDr„Daniel Cifik
111111111111111111111111111111111111111111111111111111. Nome of the authorised
900164001491 .010' veterinarian:
Adresa: RULV a 1:0. .....
2. Datum aplikacie a lebo naditania* transpondera: Address:
Date of application or reading* of the transponder:
J%- Clttt
3. Umiestnenie transpondera: 135t -979•01
Location of the transponder: Past-Code:
ty1eito/obec:
City ....Rmayska.Sobota,
4, Alfanumericky kad tetovania:
Tattoo alphanumeric code: Couniry; Slavensk'd.Repltlika.
Telefanne dislo:
5, Datum aplikacie/datum naditonia tetovania: Telephone number: ....... • 00421.9.03.725.6.94 ......... •.„ . ...
Date of application/date of reading of the tattoo: E-mailova adresa:
E-mail address:
6. Umiestnenie tetovania: Datum vydania: L: •ZI'Lt._
Location of the tattoo: Dole of issuing:
Oznatenie so musi overif pri kaidom novaertizapise ,
do tohto pasu Peeiatka a podpfs
The marking must be verified before any new entry is made on this.possport Stamp & Signature
" Nehodiace sa knite./deiev as ec....ry
Strona 6
z 36 SK 001176050

S.
fekar
veterinarian 11/Si
veterinamy MyDrfikririitiy signature. signature.
Authorised 0'tdDfl/ici
Poverenk co1ot:46: b'er•-cMd and
N., • M,i-rn' number
BESNOTE RABIES vakcinacie tram until teie•pfiane- telephone
Def.,: od/valid do/Valid
AGAINST Datum Vaccination Platna Plaind addiess, address,
PROTI 1 2 3 name, name,
tarie le'ast least
vtrobnej Nuniber podpi—S./At podpis./At
VAKCINAC1A VACCINATION Bak', a a
Oslo i, i erisIo
V. V. Rabisia 02/12-2016 telefOnee.erslo tatefonne
yakciny Vaa.:5isi theRtat adresa; adresa,
of Nunie liCe."- thulaml, L435667 plena, meno,
nazov &
a najmeotom Prinairneniom
VSirobcci .m,-1-11.4ociurer
\-• *
ID t_rt ID 0..