CHAPMAN KENNELS PERMIT (K19-000024).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 K 0 02.1/4-\
New Renewal
Name: A/il 11/17'01 i4P-2 Kennel Name: (7.- .
Mailing Address: 47'2, 0i ) 14)Kennel Address: 9).0,/ JrikzzA
City: ,4106-,U()( State: AZ Zip: (S-c-7-5",3 City: Al. e-it)i / Zip: 5y7
County Supervisorial District:
Phone: yut Kennel Phone: &<o.)--
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
1. —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).
2.11 I/We certify that I/We have dogs and that the kennel meets the definition in statute.
3. 11L-----1/We 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).
4. 1A INVe 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. 1/1 I /We certify that 1/We are submitting a valid copy of the rabies vaccination certificate for each
dog with this application.
6. -W iNVe understand that a dog remaining within the kennel is not required to be licensed individually under
A.R.S. § 11-1008. l/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. 11C--- INVe 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.
8. , ne, l/We 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,.
9.17--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.
INVe certify that all of the information I/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
October 2015

Maricopa County Animal Care and Control
2500 S. 27th Avenue
Phoenix, AZ 85009-6797
(602) 506-7387
htto://oets.maricooa.gov
Receipt Number: R19-680282 Receipt Date: 01/17/2019
Person ID: P1246031
Phone: 602 8964019
CHAPMAN KENNELS
4201 W TIERRA BUENA LN 1/17/2019 4:29:12PM
PHOENIX, AZ 85053
Item: Animal ID: Reference No: Price: Each: Amount:
KEN PERMIT A7777777 K19-000024 $350.00 1 $350.00
Total Fees Due: $350.00
Payments: Cash:
Check: $350.00
Credit Card:
Total Payments Received: $350.00
Thank You!
Would you like to share your experience with our service to you? Change: $0.00
Please visit our website at http://pets.maricopa.gov and click on Balance Due: $0.00
"Contact Us" to email your comments for our review.
Animal Information:
A7777777 KENNEL PERM - BORN 9/14/1999, SPAYED, UNKNOWN/MIX, TRICOLOR DOG
License information:
Tag Number: License Expires: Animal# Vacc Date: Vacc Expires:
Please retain this receipt with your pet's records
andrewsa WBUSOFF

M aric op a County
Animal Care & Control
2500 South 27th Avenue
Phoenix, AZ 85009
Phone: (602) 506-7387
pets.rnaricopa.gov
KENNEL PERMIT K19-000024
PREMISE INSPECTION
Number of Dogs: 14
Name: NANCY CHAPMAN Kennel Name: CHAPMAN KENNELS
Mailing Address: 4201 W TIERRA BUENA LN Kennel Address: SAME
City: PHOENIX State: AZ Zip:85053 City: PHOENIX Zip: 85053
County Supervisorial District: 4
Phone: 602-896-4019 Kennel Phone: 602-896-4019
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 RE1NSPECTION. (Note: There will be $49 re-inspect fee payable to the
Inspector by check upon each return visit.)
NONE
On January 22, 2019, Chapman kennels was inspected and passed; 14 rabies certificates
were matched with the 14 dogs residing on the property. All dogs are kenneled in a
controlled area.
Deputy Enforcement Agent & Badge #: Lt. Amber Romero #4 Date: 1/22119
October 2015

OWNER'S COPY RABIES VACCINATION CERTIFICATE
NASPHV Form #51 Rabies Tag Number
Owner's Name and Address Print - use ball point pen or type
PRINT - L31 4,KA.-cy First M.I. Telephone
LPG/mil.)
No. reet_. City A ,, StateR, oil)
901,01 btia herrci, /2114A4 1W A(oerAiilei "I-4
Species: Sex: Age: Size: , Predominant a Breed: ) ( Colors:
Dog El Male 0 3 ma to 12 mo 0 Under 20 lbs.lit ii . 4,
Cat El Female 0 12 moor older* 20 - 50 lbs. 0 r'liAA'd 41 ri'eS %- .
Other: 0 Neutered El Actual Age Over 5Q Ibis. El
(specify) Actual/6 lbs. Name: A 1
DATE VACCINATED: Producer: Veterinarian's: # A..2 )/(Pti
(License No.)
) 1 ) 4) (First 3 letters) 624 0 Z-3 LZ -
Month Day Year (Signaturei
0 1yr. LiciVacc. 3.2); go 45--7./ St.
CV3 yr. Lic./Vacc. Address:
VACCINATION EXPIRED:
Other 7;170.e.,,
/ ja 49.-- d-13Adie
Month Day Year Vacc. Serial (lot) no.
'1):),f1 ,4E.1:1'S C01"/ RABIES VACCINATION CERTIFICATE
Rabies Tag Number
NASPHV Form #51
Owner's Name and Address Print - use ball point pen or type
F11 M.I. TeleRhone
C —r91—
Specie s: Sex: )6, Age: Size: Predominant Breed:
Dog * Male 3 mo to 12 m io yr cle' Un 1111 .e-rli Siep,
Cat 0 Female 0 12 mo or olde 20 - 5111 11
Other: 0 Neutered El Actual Age Over 50 lbs. --Fic e7
(Specify) ActualinClIbs Name
tYqr0 -C
A. ilycj
DATE VACCINATED: Producer: o (License NO /
(First 3 letters)
—I-- -Lk (Signature)
Month Day Year Di 1 yr. LiciVacc. E; /AN IX'.
Address:
igar 3 yr. Lic./Vacc.
VACCINATION EXPIRED: Other A 9-01",r)aki
/ 293ica
Month Day Year Vacc. Serial (lot) no.

OWNER'S COPY RABIES VACCINATION CERTIFICATE
NASPHV Form #51 Rabies Tag Number
Owner's Name and Address Print - use bait point pen or type
PRINT - Lap First M.!. Telephone
(44/0/A4 A.) 44)//r), /
No. "Street bi...i / City , StatA
'I42-0/ W. berr4 Stie",c, L A /61Itsffp,7 Y i ,sz4-1
Species: j, Sex: 1 Age: Size: i Predominant Breed Colors:
Dog id- Male ilill 3 mo to 12 mo 0 Under 20 lbs.-14 /4 ,e,, a ie, 6 iii. 1,11k
0-,7 or -s
Cat 0 Female 0 12 mo or olderg 20 - 60 lbs. 0
Other: 0 Neutered 0 Actual Age i__ Over 50( . 0
(sPecilY) )11 Actual lbs Name:
s 0 IN-0.7 7
)92...ay
DATE VACCINATED: Producer: 1 _p Veterinarian 's: # pc.a(ise7Avayir
-1,A / / o /7 (First 3 letters) 22 re4 • 71. 411J-1
Month Day Year 0 1 yr. Lic./Vacc. (Sign )
Address: 3.2g ri, irtA SrI
yr. Lic./Vacc.
VACCINATION EXPIRED: Other
Aik, A
2g31..21
--/— / 0 4P,67'-
Month Day Year Vacc. Serial (lot) no.
(.,, mi=r4.8t,opy RABIES VACCINATION CERTIFICATE Rabies Tag Number
NASPHV Form #51
Owner's Name and Address Print - use ball point pen or type
First M. Telephone
PRINT ;lost
6-kipapd d .4._ ilA pxy / ,,, _ _ tity /04444 ,5rt 1 4 "
No. LAI 0 )Strax herrri-
p-r-tep-
Species: Sex: , / Age: Size: , Predominant Breed: Colors:
Dog IA Male 4 3 mote 12 mo 0 Under 20 lbs._g je/ 4 / _ r sixitAluil
Cat 0 Female 0 12 me or oldery7,4 20 - 60 lbs. r. d c&rt"--'
Other: 0 Neutered 0 Actual Ager_i..7 "- -I. Over 50 lbs. 0 Name: de)
(8PecliY) Actual,20 lbs.
/IVO;
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DATE VACCINATED: Producer: '2..._ 0 Veterinarian's: # (License No.
___L Al. Ii- (First 3 Letters) 4 e 77rf...7) AAP
Month Day Year 0 1 yr. UC./VEICC, (Signature) 3013- f:t., 15-. As--.-
Address:
R3 yr. Lic./Vacc.
VACCINATION EXPIRED: Other I S A 2-43:,),F,)
.2-93/.2-1
Month Day Year -Vacc. Serial (lot) no.

VACCINATION CERTIFICATE Rabies Tag Number
"V111-11'S CUM RABIES NASPHV Form #51
Print - use ball point pen or type M.6 Telephone
Owner's Name and Address First oil---alt— 1Y0)?
PRINT - La FIAP3
ivIvpity pici-p-i% Xs
No, . , treet 2._ Iterro- gueivq. Predominant Breed: Colo,:
, 14:10 IAA Age: Size: 6 ref/14k
Species: Sex: mote 12 mo 0 Under 20113s . 0 lemicAdrii,s
Dog 'Si Male IA 3 12 mo or older 0 20 - 50 lbs. 0
Cat 0 Female 0 0 Actual Age /1"; 1,,, Over 50 is lbs. 0 Name:Oas.4
Other: El Neutered 1 Actual lbs.
(spedfy) ))al
Veterinarian's: # 11.2--''' (License No.)
DATE VACCINATED: Producer: 2.._ 0 __,F Irri-6.-, 64,
(First 3 letters) 04 .
,L_Lo_i_9_ Lic./Vacc. (Signature) Addrass:30/S IS IS:td 'TA
Month Day Year 0 1 yr.
3 yr. Lic./Vacc. ,7,7)fet 11;4'r9tFi
VACCINATION EXPIRED: Other
_L 10 X e-. Serial 61-9 (lot) 341-t no.
Month Day Year Vacc.
C)WHEITS CC)PY RABIES VACCINATION CERTIFICATE Rabies Tag Number
NASPHV Form #51
Owners Name and Address Print - use ball point pen or type .I. Telephone
First
PRINT - Int AZ-
(AO TherA61 A/V.2/
No. 1.101 'PV; T•cfrer, .81-0--"4-/iglY ,10,e-p-Istak- Bred ifii-3 Colors:
Species: Sex: Age: 0 Under Size: 20 lbs.4 ii.A.L. Predominant - (4,4, c rellYteada
Dog 0 Male 0 3 me to 12 mo 20 - 50 lbs. 0 ' '
Cat 0 Female 0 12 mo or oldeci% 1-9" Over 50 lbs. 0
Other: 0 Neutered 0 Actual Age /*(Actual )3 Ihs Name: /
(spear) (---0 Met
Veterinarian's: # } )-' )1 IV/ r
DATE VACCINATED: Producer: o -E- (Liceose No
(First 3 Letters) ai *, 7.67%1 (7} 4.4
1 JO /7 (Signature)
Month Day Year 0 1 yr. Lic./Vacc. Aw.: 3,?.,s- E., I 576/ V
DK3 yr. Lic./Vacc.
VACCINATION EXPIRED: Other MI ei
i i 0 ,,,7,)' Serial .4931.11- (lot) no.
Month Day Year 1/am

liVVINCI1 :3 kat,Vi mu:situ vAGGINATION CERTIFICATE
NASPHV Form #51 Rabies Tag Number
Owner's Name and Address Print - use ball point pen or type
PRINT -1.3a9t First M.I. Telephone
ther40M-VV, AlArt/n/ /0),--,F;4‘,
No. Street ,./ PI/ quiy
) / rierio, T Sue-ALI LA.4 Alneivijr Stat ,',. riPos3
Species: Sex: Age: Size: Predominant Breed: J Colors:
Dog Male TA 3 mo to 12 mo 0 Under 20 lbs.4 nt
Cat Female 0 12 mo or older5 20 - 50 lbs. 0 ("kirks C.,. ai/eit4-41:.
Other: 0 Neutered D Actual Age ))-:, ,,,,. Over 57. 0
(specify) -1 Y1 Actual/ lbs. Name: ....
iiMiri,
DATE VACCINATED: Producer: 2... . 0 C Veterinarian's: # Al" i nil
(License No.)
_ L ICI / 7 (first 3 letters)
Month Day Year ..+1 0
0 1 yr. Lic./Vacc. (SI atute) irix
Address: 3,2_5.• ,E--4 .53(
...k3 yr. Lie./ Vacc.
VACCINATION EXPIRED:
Other
7-112e, A245;11)
)
Month Day Year Vacc. Serial (rot) no. .
OWNER'S COPY RABIES VACCINATION CERTIFICATE
Rabies Tag Number
NASPHV Form #51
Owner's Name and Address Print - use ball point pen or type
PRINT - Lysj First
144 YMP,
No. treet City
P/a nerre" fil4 "6 P-44
Specie,s1;i4 Sex: Age: Size: Predominant Sire cr
Dog Male ...V 3 mo to 12 rno Under 20 lbs.-4 aciritai
Cat D Female 12 moor older -4 20 - 50 lbs. 0
Other: 0 Neutered 0 Actual Age qVr. Over 50 lbs. 0
(Specify) Actual_h_lbs. Name:
./Z4 net
Veterinarian's: # /
DATE VACCINATED: Producer: 0 (license No.
0/
/ 0 / (First 3 letters)
Month Day 'teat 0 1 yr. Lic./Vacc. (Signature) Lç re S.--tx
Address: 3
jg 3 yr. Lic./Vacc.
VACCINATION EXPIRED: Other 7014, )-0TAF)
) m
Month Day Year Vacc. Serial (lot) no.

OSAiNEFt'S GOPY RABIES VACCINATION CERTIFICATE
NASPHV Form #51 Rabies Tag Number
Owner's Name and Address Print - use ball point pen or type
PRINT ; Vast First M.I. Telephone
thaPMC1161 1110X-X I:4-9
No. I $trpet . tiilty/ State A
10-0,1 livv ntrrekilitte-Prl 10yri' .71-0 13
Species: Sex: ,,. . Age: Size: Predominant Breed: Colors:
Dog Male NI 3 ma to 12 mo 0 Under 20 lbs. 0 ,aadli,,-1,te
Cat CI Female 0 12 ma or older 0 20 - 50 lbs. 0 1C10),
Other: 0 Neutered 0 Actual Age ',yr Over 50 lbs. 0
(Specify) Actuali_9_lbs Name: 7'
1--144.5y A
DATE VACCINATED: Producer: o E Veterinarian's: # (License 1-17" No.) 11 Pi
Er _ti, (First 3 tatters) 0 ailn,vs,
Month y Year 0 1 yr. Lic./Vacc. (S19 trre)
Address: 3 2,5 E4 i ct) Sr,
yr. Lic./Vacc.
VACCINATION EXPIRED:
Other
70-fc, ./42.. iFS4i
a 1 / 7 is-0)4q,5-A
lai Day Year Vacc. Serial (lot) no.
-
Ok,APIER'S copy RABIES VACCINATION CERTIFICATE
Rabies Tag Number
NASPHV Form #51
Owner's Name and Address Print - use ball point pen or type
First M.I. Telephone
PRINT - ir 7 '-i 0/7
L-- ace0)714A6 ilia0X--1/ ‘ 0)----raf`-
41104t.iy„ At ercEli
z/ 7ieh,440e0._ /41%-itY
No. Species: Sex: Age: Size: Predominant Breed: Colors:
Dog--K, Male 0 3 mo to 12 mo 0 Under 20 lbs.4
Cat Female 12 moor older- 20 - 50 lbs. 0
Other: 0 Neutered D Actual Age Over 50p. 0
PlaecifY) ri Actual lbs. Namez
A
Veterinarian's: # /1 2-4' //4".7
DATE VACCINATED: Producer: 0 C (License No)
II F /I (First 3 letters) api., 76-07,001.-ge
Month Day Year 0 1 yr. Ue./Vacc. (Sign tire) f. )r-iki
' Address: 3 e),..S- -
,0 yr. Lic./Vacc.
VACCINATION EXPIRED: Other 7:9-"vfie, .4
_a I- I? /L-)Jlis-A
Month Day Year Vacc. Serial (lot) no.

ovvtlEri ,s Copy RABIES VACCINATION CERTIFICATE Rabies Tag Number
NASPHV Form #51
Owner's Name and Address Print - use ball point pen or type
First M.1. Telephone
PRINT - 4st. a? )-19(— 9o) 9
06/J111 6 bk'VamLy-- , Stah,,osiiZip
No , i Stret . ../ atedc.,6. City ,_)/* 6( 142—
P7010/ A./. / ejr-r6, Colors:
Species: Sex: Age: Size: Predominant Breed:
Dog IA Male 0 3 mo to 12 rno.4 Under 20 lbs.O. c )./- 7-iii
Cat 0 Female 0 12 mo or olcier 20 -50 lbs. CI - / -
Other: 0 Neutered* Actual Age Over 50 lbs. 0
(SPsFifY) CY( Actual r lbs. Name_ r—r....
J _ 17 hi if- /M.,
Veterinarian's: # b-2L22:_i_______
DATE VACCINATED: Producer: (License No)
0 c
/7 (First 3 lettere) .70/1 J:6_,AJel,
1.) 1$ (Signatuse)
Month Day Year 0 1 yr. Uc./Vacc. Address: 1 1 r E. ../Dr.,‹ St:
Ist(3 yr. LiciVacc. 01.'4"J
VACCINATION EXPIRED: Other 7 ..--; 7...rs-..287
i.1 ./,s-
Month Day Year Vacc. Serial (lot) no.
OWNER'S Copy RABIES VACCINATION CERTIFICATE
Rabies Tag Number
NASPHV Form #5/
Owner's Name and Address Print - use ball point pen or type
PRINT- Last/ First M.I. Telephone
LA ,) 4,, 1 0_4--cic—tto)ri
No. / City Ate Zip ,
Li /0 Vii• rie. acitel /--- gce-r):1, '-- 2-. cFs0.0
Species: Sex: Age: Size: Predominant Breed: J Colors:
Dog 1 Male 0 3 mo to 12 me 0 Under 20 lbs. /4 6
Cat Female -rik 12 moor older-4- 20- 50 lbs. 0 f C.4
Other: 0 Neutered 0 Actual Age Over 50ilbs. 0
(sPecitY) Actual /5 lbs Name/'
fira4/4/
DATE VACCINATED: Producer: 2_ 0 _e Veterinarian's: # {license No)
if, k-- 1--( (First 3 letters) _ili/vigriTi
Month Day Year 0 1 yr. Lic./Vacc. (Signature) 3x- F.:. /a*
Address:
yr. LiciVacc.
VACCINATION EXPIRED: Other
7;12e/ A 24-S-€.2fl
I/ /9
Month Day Year Vacc. Serial (lot) no.

OWNEFI'S COPY RABIES VACCINATION CERTIFICATE
Rabies Tag Number
NASPHV Form #51
Owner's Name and Address Print - use ball point pen or type
PRINT- Lasti First MI Telephone
No. Si t J em .r.0,,-: City Ma..teiTtio6P
v.101 ra, Xerr-c- "hey,4y, ,
Species: . Sex: Age: Size: Predominant Breed: Colors:
Dog -56, Male 0 3 mo to 12 ma 0 Under 20 lbs. 0
Cat 0 Female --§et.. 12 ma or older"94, 20 - 50 lbs.
Other: 0 Neutered 0 Actual Agelyr Over 50 lbs. g ..
(Specify) Actual 2_0 lbs. "ame: J it -) r
it
DATE VACCINATED: Producer: Veterinarian's: # (License ,A.2.,»T9 No.)
0 E ,n ...
/2 _ /S /7 (First 3 letters) 't•'.4 • T.,
Month Day Year 01 yr. lic./Vacc. (Signature)
Address: 3.2_S E. ink/
$3 yr. Lic./Vacc.
VACCINATION EXPIRED: Other
] .)- i,S.
Month Day Year Vacc. Serial (tot) no.
OWNER'S OOP,' RABIES VACCINATION CERTIFICATE
Rabies Tag Number
NASPHV Form #51
Owner's Name and Address Print - use ball point pen or type
First M.I. Telephone
PRINT - l79t
(---Adiarriclox" ) .IVELA..". ''' /174.edviva.. _Isp.o Erj
No. , , , Street ', .___ . City
'7./. 0) 1,"/.. pfy-rc, aReikic,
Age: Size: Predominant Breed: Colors: ,
Species: Sex:
Dog X Male _ 0, 3 mo to 12 mo 0 20 llos.4 / , 6,6 a (
Cat 0 Female IA 12 ma or older--Fg 20 -50 lbs. 0 - y -- *
Other: 0 Neutered 0 Actual Age Over 50 lbs. 0
(specify) Actual/ 7., 5-lbs. Name:
„A
1.1.ir
DATE VACCINATED: Producer: "? 0 C2 Veterinarian's: # cense No.) 4
LI /3 n (First 3 letters) • v Crrli:
(sig4iature}
Month Day Year 0 1 yr. LicJVacc. Address: 3)_c .2_t- 0 E. , i (-V
)E6 yr. LiciVacc. ....----e
VACCINATION EXPIRED: Other A)-- ' Pay)
/ )-- 1.5". . .-0:) .27 7/ c1-2. (-
Month Day Year Vacc. Serial (lot) no.
-