HARQUAHALA KENNEL PERMIT RENEWAL (K20-000018).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.2.0 0000\
0 New Renewal
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Name: e_rtf d U hl-I/ Kennel Name:
Mailing Address: / 53t 411A' Kennel Address: /0(r)69() 5 S346 it
City:101-6/9A-11 State: AZ City: 9D/Lb/a5, 114,Zip: S',5-3 5-9
2
County Supervisorial District: 5
Phone:Gc Kennel Phone: I9'3
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 AR. S. §11-
i 006.
PLEASE ANSWER THE FOLLOWING QUESTIONS AND INITIAL EACH RESPONSE
INVe assume complete responsibility for the kennel at the premises for which 1/we are making
Opplication 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 I/We have (e dogs and that the kennel meets the definition in statute.
3. ANe certify that I/We have not been convicted of a violation of A.R.S. §§ 13-2910 (cruelty to animals)
or -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. VVe certify that all dogs over the age of three (3) months that are kept, harbored or maintained on the
pr&s-l/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. NVe certify that I/We are submitting a valid copy of the rabies vaccination certificate for each
do with this application.
. (711-4, I/We understand 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,
INVe understand that a person who fails to obtain a kennel permit under A.R.S.§11-1009 is subject to a
peWaity of twenty-five dollars in addition to the annual fee.
8.0.-.A..!kiNVe understand that a person who knowingly fails to obtain a kennel permit within thirty days after
w en notification from the county enforcement agent is guilty of a class 2 misdemeanor..
k".. . 74-v1/The undersigned understand that that the kennel permit does not authorize the operation of any type
of 02fusiness and is solely used for the purpose of licensing multiple dogs.
I/We certify that all of the information IANe have provided is true and accurate under penalty of law.
Applicant Signature azi:bvi/4,6fr.„„ty. Date: 1/z 3(20 / 7
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: R19-693114 Receipt Date: 01/30/2019
Person ID: P0610901
Phone: 928 3722262
HARQUAHALA KENNELS 1/30/2019 3:36:21PM
10602 S 540TH AVE
TONOPAH, AZ 85354
Item: Animal ID: Reference No: Price: Each: Amount:
KEN PERMIT A7777777 K20-000018 $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
aguayot WBUSOFF

Maricopa County
Animal Care & Control
2500 South 27th Avenue
Phoenix, AZ 85009
Phone: (602) 506-7387
pets.maricopa.gov
KENNEL PERMIT K20-000018
PREMISE INSPECTION
Number of Dogs: 6
Name: Arthur McKay Kennel Name: Harquahala Kennels
Mailing Address: 10602 S. 540th Ave. Kennel Address: Same
City: Tonopah State: AZ Zip: 85354 City: Tonopah Zip: 85354
County Supervisorial District: 5
Phone: 623-399-3623 Kennel Phone: 928-372-2262
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.)
On February 4, 2019 I, Lt. Romero. Inspected the Harquahala Kennel Property. There are
six dogs on the property, matching the six rabies vaccination certificates, provided in the
renewal application. The kennel property is enclosed and all dogs are secure within the
property.
Deputy Enforcement Agent & Badge #: Lt. Amber Romero #4 Date: 214119
October 2015

RABIES VACCINATION CERTIFICATE
Rabies Tag Number
NASPHV Form 5
PRINT - use ballpoint pen or type (
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RABIES VACCINATION CEFATIFICAT,L,
WiliA&V Form 5 I tfilriliS ra'F--'4 ..,:t.1* Rabies Tag Number
Owner's Name &Address PRINT - use ballpoint pen or type
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Dog ilii'f" Male Di 3 me.- 12 mo. DJ Under 20 lbs. 0 I
Cat 0 Fernate ......:. - 12 mo or old 20 - 50 lbs. 0 Art
Other 0 Neutered 111- i'.. 4 Over 50 lbs. MA NAME.
Please specify
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DATE VACCINATED: gig VETERII AA RIA
, tar PRODUCER;
Veterinarian's #:
Month Day Year 144 lc ns e No
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VACCINATION EXPIRES: 1 yr. Lic./Vaccine 0
3 yr. Li /V Veterinar ian's
Signa ture —
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Month Day ' Yea ItlEM Address:
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Vaccine Serial (Log No, • A , ?AO

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RABIES VACCINATION CERTIFICATE
_ NASPHV Form .5 Rabies Tag Number
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DATE VACCINATED: VETERIN RI ,
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Month Day ' Year Veterinarian's #:
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VACCINATION EXPIRES: EXPIRES: I yr. Lic./Vaccine 114..4 [
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Month Day ' Year LIC8T1-43' Address: 1-40 • 1 (-6
Vaccine Serial (Lot) No. lir csa- , z_.52.110
RABIES VACCINATION CERTIFICATE
NASPIAV Form 5 I Rabies Tag Number
Owner's Name &Address PRINT - use ballpoint pen or type
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Cat D Female 12 mo. or olde 20 - 50 lbs. •r •p 11 —.., MI
Other 0 Neutered 0 Over 50 lbs. 'rA 41110
Please specify
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DATE VACCINATED: VETERINARIAN
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Month Day ' Year . g A , ..Ucerne No
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Month Day ' Year 0 AddresTO
Vaccine Serial (Lot) No. Me:6=N( 4 z.-
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NASPFIV Form 51
Owner's Name &Address PRINT - use ballpoint pen or type
PRINT: Lest First ML Telephone
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No City
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140
SPECIES: AGE: SIZE. PRED MINANT BREED: COLORS:
Dog 3 mo. - 12 me'. Under 20 lbs,
Cat 0 12 mo. or older 20- 50 lbs. '4kY6 P
Other 0 Over 50 lbs. 0 NAME:
Please specify
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1 yr. Mt./Vaccine 0
3 yr. Lit./Vaccine ii Veterinarian1442'
Signature
Addresd-6ek
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RABIES VACCINATION CERTIFICATE
Rabies Tag Number
NASH-14, Form 5/
Owner's Name &Address PRINT - use ballpoint pen or type
PRINT: Last First M.I.j Telephone
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SPECIES: SEX: / AGE: SIZE: PREDOMINANT BREED: COLORS:
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Cat 0 Female 0 12 mo. or olden 20 - SO lbs. -1-40,5ky5nop
Other 0 -* a Over 50 Lb s. 0 NAME:
Please sp i --r-tirp BiA.1) '
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DATE VACCINATED: VETERINARIAN
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Month Day ' Year License No.
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3 yr. Lie. /Vaccine r Veterinarian's
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Vaccine Serial (Lot) No.
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