KIRSHNERS FOSTERS KENNEL PERMIT (K19-000069).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
tiew D Renewal Permit #IcrL:O000(
Name: Kennel Name: (C.511—r_S
Mailing Address: C.15 .619c. —645 Kennel Location: 1 .3 r\t Ig3rd Dr 731.c,
City G orrEi r ZIP g5337 County Supervisorial District• 1 W53
Home Phone: 10(93-1451 -g3L2 Kennel Phone: W3-16 1-11 31.R I
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
1. (-lINVe 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 CARS 11-
1001),
2. 111Ne certify that IANe have id, dogs and that the kennel meets the definition in statute.
3. l/We certify that INVe 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).
4art---' Me 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. -7V(--"I /We certify that I/We are submitting a valid copy of the rabies vaccination certificate for each
dog with this application.
6. -->r<,11/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. DR.IINVe understand that a person who fails to obtain a kennel permit under A.R.S.§11-1009 is subject to a
penalty of twenty-five dollars in addition to the annual fee.
h )
8. ).LC-IIIINe understand that a person who knowingly fails to obtain a kennel permit within thirty days after
written notification from the county enforcement agent is guilty of a class 2 misdemeanor..
9. t ..?1_ . Of he undersigned understand that that the kennel permit does not authorize the operation of any type
o usiness and is solely used for the purpose of licensing multiple dogs.
I/We certify that all of the information I/VVe have provided is true and accurate under penalty of law.
Applicant Signature Date: 1 15
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.00v
Receipt Number: R19-751847 Receipt Date: 04/02/2019
Person ID: P2787128
Phone: 623 4514361
KIRSHNER FOSTER KENNEL 4/2/2019 12:41:35PM
153 N 193RD DR
BUCKEYE, AZ 85326
Item: Animal ID; Reference No: Price: Each: Amount:
KEN PERMIT A7777777 K19-000069 $350.00 1 $350.00
Total Fees Due: $350.00
Payments: Cash:
Chock: $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
andrewsa WBUSOFF

Maricop a County
Animal Care & Control
2500 South 27 1h Avenue
Phoenix, AZ 85009
Phone: (602) 506-7387
pets.rnarieopa,gov
KENNEL PERMIT K19-000069
PREMISE INSPECTION
Number of Dogs: 12
Name: STACY KIRSHNER Kennel Name: KIRSHNER'S FOSTERS KENNEL
Mailing Address: PO BOX 7545 Kennel Address: 153 NORTH 193RD DRIVE
City: GOODYEAR State: AZ Zip: 85338 City: Buckeye Zip: 85326
County Supervisorial District: 4
Phone: 623-451-4361 Kennel Phone: 623-451-4361
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 12 dogs residing at the kennel address; all dogs are currently vaccinated for
rabies and are enclosed in a controlled area.
Deputy Enforcement Agent & Badge #: Lt AMBER ROMERO #4 Date: 4/16119
October 2015

1/21/2019 I Clinic HQ
Dr. Kelly's Mobile Unit - West
602-909-5383
Animal Summary/ Rabies Certificate
This is not an invoice.
Owner
Stacy Kirshner
153 North 193rd Drive, Buckeye, AZ 85326
623-451-4361
Animal Details Animal's Name: Scout
Sex: Male
Species: Dog
Age:10 Years, 0.0 Months
Color: Black / Tan
Breed: German Shepherd Dog mixed
Weight: 6120 lbs
Spayed/Neutered: Yes
Visit Date:1/21/2019
Animal Type: Owned
Animal Number:19-214
Microchip Number:
Already Altered: Yes
Rabies Vaccine Producer: Nobivac
Type: Three Year
Vaccine Lot Number: 274706 (expires 7/23/2019)
Date Vaccinated:1/21/2019
Expires:1/21/2022
Veterinarian: Amy Jakobe License # 4603
Signature:
Dr. Kelly's Mobile Unit - West
Clinic Info: 6405 E Thomas Rd, Scottsdale, AZ 85251
602-909-5383
All Products/Services Date Description
1/21/2019 Rabies 3 year vaccine
This is not an invoice.
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2/26/2018 Clinic HQ
Dr. Kelly's Mobile Unit - West
602-909-5383
Animal Summary Rabies Certificate
This is not an invoice.
Owner
Stacy Kirshner
153 North 193rd Drive, Buckeye, AZ 85326
623-451-4361
Animal Details Animal's Name: Vixen
Sex: Female
Species: Dog
Age:4 Years, 0.0 Months
Color: Tr-color
Breed: undo
Weight: 43.60 lbs
Visit Date: 2/26/2018
Animal Type: Owned
Animal Number:18-778
Microchip Number:
Already Altered: Yes
Rabies Vaccine Producer:Nobivac
Type: Three Year
Vaccine Lot Number: 236502A (expires 12/18/2018)
Date Vaccinated: 2/26/2018
Expires: 2/26/2021
Veterinarian: Kelly Patriquin License # 3463
Signature: Wil:44e
Dr. Kelly's Mobile Unit - West
Clinic Info: 4008 North 87th St, Scottsdale, AZ 85251
602-909-5383
All Products/Services Date Description
2/26/2018 Rabies 3 year vaccine
This is not an invoice.
aboubblank 1/1

112112019 Clinic HQ
Dr. Kelly's Mobile Unit - West
602-909-5383
Animal Summary Rabies Certificate
This is not an invoice.
Owner
Stacy Kirshner
153 North 193rd Drive, Buckeye, AZ 85326
623-451-4361
Animal Details Animal's Name: Dallas
Sex: Male
Species: Dog
Age: 2 Years, 0.0 Months
Color: White / Tan
Breed: Pitbull mixed
Weight: 6570 lbs
Spayed/Neutered: Yes
Visit Date:1/21/2019
Animal Type: Owned
Animal Number:19-213
Microchip Number: 985112010721039
Already Altered: Yes
Rabies Vaccine Producer: Nobivac
Type: One Year
Vaccine Lot Number: 274706 (expires 7/23/2019)
Date Vaccinated:1/21/2019
Expires:1/21/2020
Veterinarian: Amy Jakobe License # 4603
Signature:['
Dr. Kelly's Mobile Unit - West
Clinic Info: 6405 E Thomas Rd, Scottsdale, AZ 85251
602-909-5383
All Products/Services Date Description
1/21/2019 Rabies 1 year vaccine
This is not an invoice,
abouttlank 1/1

Vaccine Clinic Animal Care Record
Patient Information
Name Tri Species D Sex t-st Age
Breed Color and Markings -Takgrk il2fAltered
Microchip Weight 11 ibs (estimated)
Owner Information
Name c,t-°)CM-4- 114_.A.r-SY\ aer Phone Loa7:-.23— L4S k -24.1LA
Address P... C.)i¼"15741 c-
ab/ Cic>r)6N4r col State AZ Zip Code 8G-3S8
Services- To be filled out by veterinary _ staffl _
Rabies Vaccine
If selected, this record hereby notifies that the animal identified here has been vaccinated against rabies
n Midwestern University Rabies vaccine, 1 year Date of Next Vaccine:
Product Name: Rabvac 3 Manufacturer: Boehringer Ingelheirn Serial: 4150464A
zEnclIDPetCare Rabies vaccine, / year Date of Next Vaccine: 2 I ti 2ec)
Product Name: Nobivac 3 Manufacturer: Zoetis Serial: 321086
Other Services:
j2r6ore vaccine (FVRCP for cats, DHPP for dogs) Date of Next Vaccine Z1r7 (2:0
icrochip - Maintain registration at www.found.org (Place sticker here)
Comments:
Attending Veterinarian:
n Midwestern University 1 5715W. Utopia Road I Glendale, AZ 85308
MDPetCare I 30 N. 40 th PI I Phoenix, AZ 85034

MARICOPA COUNTY ANIMAL CARE \GL CONTROL
Date: Uno Por Uno [ X ] Other [ ] OFFICIAL USE ONLY
Authorized Services _
Owner (Duefio) Information Rabies Vaccination C$ 0.00)
DA2PPv (Dog 4-in-1) $ 23.00
Name (Nombre): L I FVRCP (Cat 3-in-1) $ 27.00
Address (Direccion): Apt #: Bordatella (IN) $ 14.00
City (Cuidad): Microchip $ 10.00
Altered S/N
ZIP (Codigo postal): (Esterilizado) License $ 17.00
Phone (Telefono): ( Unaltered License $ 42.00
Alt. Phone (Tele. Alterno): ( Senior Citizen (65+)
Email Address (Correo Electretkico): Altered (Esterilizado)
, itkicense $ 6.00
Donation
Animal (Mascota) Information
TOTAL
Animal Name ombre): OFFICIAL USE ONLY
Age (Edad): Dog (Ferro) [LJ Cat (Gato) [ Payment
Color(s): Credit Card [ I
. Expiration Date:
Male (Macho) [ ] Neutered [ ] Female (Hembra) F] Spayed [I ] • Check [ ]
Breed (Raza): 1 Check #:
DL #:
Senior License: [ ] I swear or affirm that I am 65 years of age or older Expiration:
and that the dog referenced in this document is sterilized and that I am State:
the owner of the referenced dog. Cash [ ]
Altered License: [i1 or affirm that the dog referenced in this
document is sterilized and that I am the owner of the referenced dog. Payment Taken By: Cv4— ,
• OFFICIAL USE ONLY RABIES CERTIFICATE
Clinic Name: Maricopa County Animal Care & Control -- Neuter Scooter Mobile Unit
Date Vaccine Given: (if( Date Rabies Vaccine Expires:
Vaccine Producer: PFIZER License Tag #:
Vaccine Serial (Lot) No: SN 120629 License Tag Expires:
Veterinarian's Signature: KA ( 1.11101YMM. ,
OFFICIAL USE ONLY Form Update 06/29/2016
Weight: # Temp: °F Pulse: Resp: Body condition: 1 2 3 4 5
Owner Signature: ; Date: •-•

MARICOPA COUNTY ANIMAL CARE & CONTROL
Date: (7 Uno Por Uno [XI Other [ OFFICIAL USE ONLY
Authorized Services ,
Owner (Mello) Information I
Rabies Vaccination $_„ 0.00
DA2PPv (Dog 4-in-1) $ 23.00
Name (Nombre): FVRCP (Cat 3-in-1) $ 27.00
Address (Direccion): Apt #: Bordatella (IN) $ 14.00
City (Cuidad): Microchip $ 10.00
Altered S/N
ZIP (C6digo postal): (Esterilizado) License $ 17.00
Phone (Telefono): (' Unaltered License $ 42.00
Alt. Phone (Tele. Alterno): ( Senior Citizen (65+)
Email Address (Correo Electronic°): Altered (Esterilizado)
, W,cense $ 6.00
bbnation $
Animal (Maseota) Information
TOTAL $ Sf(
Animal Name (Nombre): OFFICIAL USE ONLY
-
Age (Edad): Dog (Perro) LIT' Cat (Gato) 1 Payment
Color(s): Credit Card [ I
,. Expiration Date:
Male (Macho) [ 1 Neutered H Female (Hembra) [ Spayed H Check [ I
Breed (Raza): Check It:
DL #:
Senior License: [ I swear or affirm that I am 65 years of age or older Expiration:
and that the dog referenced in this document is sterilized and that I am State:
the owner of the referenced dog. Cash r l
Altered License: [1],I swear or affirm that the dog referenced in this
document is sterilized and that I am the owner of the referenced dog. Payment Taken By:c--__-_,
OFFICIAL USE ONLY RABIES CERTIFICATE
Clinic Name: Maricopa County Animal Care & Control - Neuter Scooter Mobile Unit
Date Vaccine Given: I Date Rabies Vaccine Expires:
Vaccine Producer: PFIZER License Tag #:
Vaccine Serial (Lot) No: SN 120629 ito* License Tag Expires:
Veterinarian's Signature: KA UrIGIN,
OFFICIAL USE ONLY Form Update 06/2912016
Weight: # Temp: °F Pulse: Resp: Body condition: 1 2 3 4 5
Owner Signature: Date:

2/2612018 Clinic HQ
Dr. Kelly's Mobile Unit - West
602-909-5383
Animal Summary / Rabies Certificate
This is not an invoice.
Owner
Stacy Kirshner
153 North 193rd Drive, Buckeye, AZ 85326
623-451-4361
Animal Details Animal's Name: Phoebe
Sex: Female
Species: Dog
Age:2 Years, 0.0 Months
Color: Tr-color
Breed: Jack Russell Terrier mixed
Weight:15.60 lbs
Visit Date: 2/26/2018
Animal Type: Owned
Animal Number:18-777
Microchip Number:
Already Altered: Yes
Rabies Vaccine Producer: Nobivac
Type: Three Year
Vaccine Lot Number: 236502A (expires 12/1812018)
Date Vaccinated: 2/2612018
Expires: 2/26/2021
Veterinarian: Kelly Patriquin License # 3463
Signature: 7/x;7-1.
Dr. Kelly's Mobile Unit - West
Clinic Info: 4008 North 87th St, Scottsdale, AZ 85251
602-909-5383
All Products/Services Date Description
2/26/2018 Rabies 3 year vaccine
This is not an invoice.
about:blank 1/1

Tag fee $:
RABIES VACCINATION CERTIFICATE
Tag #:
ADAPTED NASPHV FORM 51
MINT— use ballpoint pen or type Cert. Serial #:
TELEPHONE
&073-1-1Q-Ligil
NO.
2Q
SPECIES: SIZE:
Deg Under 20 lbs. LI
20-50 lbs. U this.61
Cat CI
Other U Over 50 lbs.
(Specify)
DATE VACCINATED: PRODUCER: Veterinarian's
License No.
(First 3 Letters)
Month Day Year PRODUCT NAME: Veterinarian's Name (please print)
VACCINATION EXPIRES: 1 yr. LicNacc.)( Signature 4t1i;
6'1 95 c?oi, 3 yr. LicNacc. Address —
Month Day Year
Vacc. Serial (Lot) No.
USCAHNON02066
PET Name ) —t.,S 9e,r Breed IktkAV4..L.f colorTatAP gk tA
Age U 3 to 12 mo mo Altered ZiiIYes U No
Weight _ 57 Temp Puse Resp
111111111)11jEllIAINIIIIIIMR1111111
Microchip Vlicrocnip Manufacturer
Da2PPcv1:1:113-diiiSglia---E1-FORCT I Date 9: .4,31A-7
15601W Bell Road, Ste 204, Surprise, AZ 85374 623-474-3877

Vaccine Clinic Animal Care Record
LOW COST CM=
Date 02117/2019
Patient Information
Name SpeciesCCtflUl i_.Sex Age < DLI
Breed j r-vir) /X, Color and Markings ,•EIZOLL.\--n ,I77<t-ered
Microchip Weight lbs (estimated)
Owner Information
Name 5C c-Ft KIrS \rvne...r Phone _.f) 1n I — 4-1)LD
Address PC) 17pc. ,4 Li5
City G/DCO,Lkea State AZ Zip Code c? (23
Services- To be filled out by veterinary staff!
Rabies Vaccine
If selected, this record hereby notifies that the animal identified here has been vaccinated against rabies
Ei Midwestern University Rabies vaccine, 3 year Date of Next Vaccine: 02/17/22
Product Name: Rabvac 3 Manufacturer: Boehringer Ingelheirn Serial: 4150464A
MDPetCare Rabies vaccine, 3 year Date of Next Vaccine: 02/17/22
Product Name; Nobivac 3 Manufacturer: Zoetis Serial: 321086
Other Services:
Ofore vaccine (FVRCP for cats, HPP for dog)) Date of Next Vaccine 2 /1-1 / 22
111 Microchip — Maintain registration at www.found.org (Place sticker here)
Comments:
Attending Veterinarian:
„....0 D Mi d es tern University I 5715 W. Utopia Road I Glendale, AZ 85308
MDPetCare 1 30 N. 40th PI I Phoenix, AZ 85034

Vaccine Clinic Animal Care Record
Patient Information
Name e-fiN(.2ude.)Cg--) Species D Sex Age 5ff-5
Breed 0. Color and Markings b1.6c. A Altered
Microchip Weight CI lbs (estimated)
Owner Information ,
Name DM- KIG Sniw Phone a 051 - H3Le
Address VA ---1
City 0_,Thd, State AZ Zip Code <63
Services - To be filled out by veterinary staff
Rabies Vaccine
If selected, this record hereby notifies that the animal identified here has been vaccinated against rabies
LII Midwestern University Rabies vaccine,/ year Date of Next Vaccine:
Product Name: Rabvac 3 Manufacturer: Boehringer I ngelheim Serial: 4150464A
/1? PetCare Rabies vaccine, / year Date of Next Vaccine: Zfrl (2 (-)
Product Name: Nobivac 3 Manufacturer: Zoetis Serial: 321086
Other Services:
vECore vaccine (FVRCP for cats, D Date of Next Vaccine ( •7 [1D
Li Microchip — Maintain registration at www.found.org (Place sticker here)
Cornments:
Attending Veterinarian:
"" Ili Mid stern e University I 5715 W. Utopia Road I Glendale, AZ 85308
r;/iv MDPetCare I 30 N. 40th P1 I Phoenix, AZ 85034

Mobile Clinic Animal Care Record
Dater
Patient Information
Name Species Sex Age Liezur5
BreedC::)eA— MD- Color and Markings Altered
Microchip OS Weight 4C51/- lbs
Owner Information
Name A-C\C f4) 1(N Phone 7x7) c-tc5 4-7-)Le
Address C) 'F--x- 5)(
City C,--c)c'1/4 &or State AZ Zip CodeS 5320%
Services
Rabies Vaccine
If selected, this record hereby notifies that the animal identified here has been vaccinated against rabies
abies vaccine, 1 year / Date of Next Vaccine: t' / I /
Product Name: Rabvac 3 Manufacturer: Boehringer Ingelheim Serial: 4150445A
Other Services
[ 'Core vaccine (FVRCP for cats, DFIPP for dogs) Date of Next Vaccine 9-12 024
III Microchip— Maintain registration at www.found.org
Comments:
Attending Veterinarian
Name: License:
Midwestern University I 5715 W. Utopia Road I Glendale AZ 85308

L.J1. Aiy 0 IVIULAIG 9 _Aar ILJ1 IlL
Spay/Neuter/Vaccine Record
Date: 4 12A-k k
Pet's Name: Or\ lo-e
Owner's Name: Sekval (she(
Breed: ra4- rfier Sex: M OE Age:
Color and/or Markings:
I I This animal has been surgically sterilized today.
A scar has been found indicating this animal has been previously surgically sterilized.
71
This animal did not receive a sterilization surgery today
The following vaccines were administered to the animal. today:
3u4ir
Dog Vaccine: Rabies DA2PP-11-- DA2PP-F Leptoft Bordetella
Cat Vaccines: Rabi FVRCP
This animal did not receive any of the above vaccines today
The following in-house blood tests were performed:
Heartworm/Ehrlichiosis/Lyme Disease Results:
Feline Leukemia (FeLV) Results:
Feline Leukemia Virus (FeLV)/ Feline Immunodeficiency Virus (FIV) Results:
Microchip # Manufacturer
Veterinarian's: # AZ-3463
Veterinarian's Signature:
Dr. Kelly's Mobile Surgical Unit, 602-909-6383
Veterinarian: Dr. Kelly Patriquin. DVM License Number 3463