SHANTE AFGHANS KENNEL PERMIT (K19-000023).PDF

Mailcopa County
Animal Care and Control
2800 South 27th Avenue
Phoenix, AZ 86009
(602) 506,7387 Tele.
(602) 506-2739. Fax
KENNEL PERMIT
K 9 - 00002
APPLICATION
12 New [2/Renewal
Name:. M/1-6 LfcA i")/0i. Kennel Name: 6.4il an.lyi .4/..,,wc
AddresS: /13( ti),Ar-&r) Kennel Address: 96t-wier
A •
State: AZ Zip: ' $ 2 City: Zip:
County. Supervisorial District:
Phone '.97 5 Kennel Phone: Se2-114-6"-
Please complete and sign this application and return It to the above address with payment In the amount of three -
hundred fifty.dollars ($350.90) 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 waeks in advance' of the
expiration . . data 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 cond.itIona"
§ 11-1001(9). •
An appointment will be scheduled for inspeCtion of the kennel premises by an Animal Control Officer upon
re 01 :1 of this kennel sermit a, slication and fed. This kennel as .lication trasdrl e eouLed.andecos Board of the Of
inspection report will Men be-forwarded to, and must • be approved by, the Marlowe -1COunly
Supervisors. Thelentiel -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 may result in
itiSpootek Return fee of $49 for each additional visit at time of inspection.. FOilure.Ofinspection §,11- .
denial of the kennel permit and require -Individual lieensig cii'aeoh-Vog under the. previsiOns.of
1006,
PLEASE ANSWER THE FOLLOWING QUESTIONS AND INITIAL EACH RESPONSE
• liWe assume :complete responsibility for the kennel at the premises for which . I/we are makin g
application for a permit-and'understand that "kennel" rneartS -an enciesed, controlled area inaccessible to

other animals, in which a person keeps, harbors or maintains five or more 'dogs under controlled
conditicins (ARS 11-1001).
2. )11,r9 INVe certify that INVe , have /a dogs and that the kennel meets the definition In statute
3. f4110 INVe 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. 714K-1,We 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 certiffcate signed by a licensed veterinarian Is
maintained on the premises for each dog,
6../3416_, I /We certify that INVe are submitting a valid copy of the rabies vaccination certificate for each
dog with this application.
6. 33Ma INVe understand that a dog remaining within the kennel is not required to be licensed individually under
A.R.S. § 11-1008. 1/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. Mga I/We 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, jiijj VWe 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. )149 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.
I/We certify that all of the information 1/We have provided is true and accurate under penalty of law..
Applicant Signature Date: A d /7-tx--1 if(
Applicant Signature Date:
For Official Use Only:
Copies of Valid Rabies Vaccination Certificates for each dog attached
_Copy of Person's Valid Identification Attached
f3C$ Approval Date Term of Permit

Maricopa County Animal Care and Control
2500 S. 27th Avenue
Phoenix, AZ 85009-6797
(602) 506-7387
http://pets.maricopa.dov
Receipt Number: R18-633270 Receipt Date: 11/2612018
Person ID: P1224832
Phone: 623 4129739
SHANTE AFGHANS KENNELS 11/26/2018 12:07:02P1
6824 W KAREN LEE LN
PEORIA, AZ 85382
Item: Animal ID: Reference No: Price: Each: Amount:
KEN PERMIT A7777777 K19-000023 $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
tulchins LICENS1N

Maricopa County
Animal Care & Control
2500 South 27th Avenue
Phoenix, AZ 85009
Phone: (602) 506-7387
pets.marieopa,gov
KENNEL PERMIT K19-000023
PREMISE INSPECTION
Number of Dogs: 10
Name: MARILYN DOMHOFF Kennel Name: SHANTE AFGHANS
Mailing Address: 6824 W KAREN LEE LN Kennel Address: Same
City: PEORIA State: AZ Zip:85382 City: PEORIA Zip: 85382
County Supervisorial District: 4
Phone: 623-412-9739 Kennel Phone: SAME
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.)
NONE
On December 28, 2018, Shante kennels was inspected and passed. 10 rabies certificates
were presented and matched to the 10 dogs residing on the property. The property is
enclosed and all dogs are confined to the premises.
Deputy Enforcement Agent & Badge #: Lt. Amber Romero #4 Date: 1/3/19
October 2015

• (VACCINATION RECORD
• RABIES VACCINATION CERTIFICATE Tag fee $: Name
ADAPTED NASPHV FORM 51 Tag N• 0 RABIES
• PRINT- use balipoldpen or type Cert. Serial #:
Owner's Name & Address 0 LYME DISEASE
PRINT LAST 1 FIRST MI TELEPHONE - 0 CANINE DISTEMPER
J7am h . Ma r-ILe ri A my —az- 9 9,P2 0 CANINE PARAINFLUEKA
NO. STREET CRY STATE ZIP . 0 CANINE ADENOVIRUS 2
..4& W A/a /-- el e_ 4 0 CANINE PARVOVIRUS
SPECIES: SEX: SEX: AGE: SIZE PREDOMINANT BREED COL95: ' 0 CANINE CORONAVIRUS
Dog . if--- Male • 0 Months.4 0 Under 20 lbs. 0 (--Y-e-a4-i CANINE SORDETELLA
Cat 0 Female %(---- . ,/ 20-501be. Ef)-- il 0-A o LEPTOSPIROSIS
Other El Altered 0 Years ' '2.?..0 Over 50 lbs, 0 NAM . 0 FELINE LEUKEMIA VIRUS
(Speolfy) 0 FELINE PAINLEUKOPENIA
El FELINE RHINOTRACHEMS
DATE VACCINATED; PRODUCER: Vetennerlan's N
O FEUNE CALICIVIRUS
• \ '0 • vca License No,
(Firsts Leiters) 0 FELINE CHLAMYDOPHILA
Month Day Year . PRODUCT NAME Veterinarians Name (please pnnt)
VACCINATION EXPIRES: ••1 yt, Licivaco., D
_ 3 yr. LIcNeco.OK
... _ <4 4)---5-; (in k dress
Month Day Year
Vac°, Serial (Lot) No.
VACCINATION RECORD
Tag fee $: Name
• RABIES VACCINATION CERTIFICATE
ADAPTED NASPHV FORM 51 Tag N: . .0 RABIES
PRINT -ruse ballpoint pan or type Cart Senal N:
Owner's Name & Address 0 LYME DISEASE
PRINT LAST ARST . MI TELEPHONE OCANINE DISTEMPER
iYlay %-, 0 CANINE PAFIAINFLUENZA
Dot k r
O. STREET/. • ..3 1, CITY STATE ZIP 0 CANINE ADENOVIRUS 2
61aq iv ii ot.c.„e c, t.. L-r, 49 ri r---- A z--- 0 CANINE PARVOVIRUS
SPECIES' , SEX: AGE: .. SEE: PREDOMINANT BREED: or br if 0 CANINE CORONAVIRUS
' Dog ck male g Months 0 Under 20 lbs. 0 /)._, p 1 i., ,,-,(10..." 0 CANINE BORDETELLA
Cat 0 Female 0 20-50 lbs. CI 9- Li 0 '1 LEPTOSPIROSIS -
, Other 0 Altered 0 Years i Over 50 lbs. t:),_, NAME' CI FELINE LEUKEMIA VIRUS .
- (Specify) c\Atp 0 FELINE PANLEUKOPENIA
0 FELINE RHINOTRAOREMS
DATE VACCINATED: PRODUCER; MEI Veterinar/an's N Sik.)0
0 FELINE CAUCNIROS
11 Li 1- i 6 (First 3 Letters) ,---- , License No El FELINE GHLAMYDOPH1LA
-.... -Month . Day Year PRODUCT NAME Vetarinadan's N,ame (please print)
17-14•P)A-C-, 2I \\ . 'Etc, Ai r cul
.. VACCINATION EXPIRES: 1 yr, LicNaco, 0
SIgnaht
3 yr, LIcAteco. 'dress v4 -i-c
LI/ SDLISN/ &
Month Day Year
_ Vaco, Sent . (Lot) No

RABIES VACCINATION CERTIFICATE -RABIES TAG NUMBER
WASPHV FORM 51 (Revised 20b7)
MICROCHIP NUMBER
Owner's Name & Address Print Clearly .
LAST FIRST M,I, TELEPHONE
Dornhoff . Marilyn (823)412-9739
NO STREET CITY " STATE ZIP
6624 W. Karen Lee Lane Peoria AZ 85382
SPECIES SEX AGE SIZE PREDOMINANT BREED PREDOMINANT
Dog N Male 0 Months 0 Under 20 lbs 0 Afghan Hound COLORS/MARKINGS
Cat 0 Female N 8 Years 0 20 -50 lbs N Blue & Cream
Other 0 Neuter 0 Over 50 lbs • NAME
(Specify) Joy . •
Animal Control License 0 1 Yr 0 3 Yr 0 Other
DATE VACCINATED PRODUCT NAME Veterinarian: Dr. Michele Johnson
08/06/2018 License No: AZ 4189
MANUFACTURER
(First 3 Letters) F
NEXT VACCINATION Veterinarian's M/It:
//Ude& P•0•44"I't
DUE BY: 0 1 yr USDA Licensed Vaccine Signature
08/05/2021 : N 3 yr USDA Licensed Vaccine Address Grand Paws Animal Clinic.
0 4 yr USDA Licensed Vaccine 11310 W. Bell Rd Suite 11103
0 initial dose 0 Booster dose Surprise, AZ 85378
174704
Vacc. Serial (Lot) No.
VACCINATION RECORD
RABIES VACCINATION CERTIFICATE Tag fee $: Name •
ADAPTED NASPHV FORM 51 Tag V: 0 RABIES
Owner's Name &Address PaINT- sou bnIlpoIN p on or typo Cart Semi ii:
CI LYME DISEASE
PRIP,,IT_LAST I ci-,-, FIRSIF •A mi . TELEPRONE ' o CANINE DISTEMPER
)1-.
NO. c' ).„).), - STREET , .. ii • CIF( .1 STATE, ZIP: .. _.,.._, ... - 0 CANINE PARAINFLUENZA.
v . 4 0 /Kg. i--e--,- 44.....,- - 1-,:ii P-6'erieL. ...,5-4Z--- . :- ) . - 1 .-• '-'" ' D CANINE ADENOMUS 2 -
SPECIES: SEX AGE: SIZE: PREDDIryFIEED: O0/4.0F1'S: n CANINE PARVOV1RUS
Dog '0.- Male 0 3 Mo. to 12 Mo. 0 Linder 20 lbs. 0 4 • C.', / ? °CANINE CORONAVIRUS
Cat 0 Female g 12 Mo. or older - /4-1-(2"'11:----- • 0 CANINE BORDETELLA
Other 0 Ahead 0 Over-50 lbs 0 NAME' • 0 LEPTOSPIROSIS
ppeolly) - 0 FELINE LEUKEMIA VIRUS
DATE VACCNATED R°DUCES Veterinarian's ti Ar . .0 FELINE PANLEUKOPENIA •
c . .., 0 FELINE RHINOTRACREITIS
fit
Month Day ... year . (Fi(st 3 Letters) 0 FELINE CAUCIVIRUS
Veterinarian's FELINE ONLAMYDIA
1 yr. Lle.Neco. 0 Signature
VACCINATION 9 . ...0 El<PIFIE 1. • UoNaco. ' , 0 FELINE IMMLINODEFICIENG(' •
3 yr. • Address iliP viniera.a.w.„ VIRUS
Month Day Year litialeallIMP —
Vase. Senall.Lot) No. Boehringer
iugelheim

▪
VACCINATION RECORD
RABIES VACCINATION CERTIFICATE Tag fee at Name
ADAPTED NASPi-N FORM 51 Tag 0: 0 RABlES
FRUIT- use ballpoint pen or type Cert. Serial #: 0 LYME DISEASE • •
Owner's Name &Address
PRINT LAST FIRST . MI TELEPHONE - 0 CANINE DISTEMPER
/15 4(/.2 ?9 • 0 CANINE PARAINFLUENZA
NO. STREET • CITY 4 STATE .0 .CANINE ADENpviRus 2
(Fa ilt et,i )4 cic_r to -8. r, •P-gei ry a— ,./ 7---- • 51-52S- g-- 0 CANINE PARVOVIRUS :
SPECIES: SEX: AGE:, SIZE: PREDOMINANT BREED: MOSS: O CANINE CORDNAVIRUS
Dog V male Cl Months Q Under 20 tbs, 0 A4,07, 10 ri 0 ,414, OCANINE BOROETELLA
Cat 0 Female et 20,60 lbs. k /7 Lc,' LEPTOSPIROSIS
Other Cl Altered 0 Years 13 Over 60 lbs. 0 NAmE. • Cl FELINE LEUKEMIA Virus
(Speolfy) kel FF.LINEyANLEUKOPENIA:
r. --71 0 FELINE RHINOTRACHEITIS
DATE VACCINATED: PRODUCER "7 nib. I. I m- A Veterinarian's 0 ,-, i i 0 FELINE CALICI VIRUS •
1 {Firsi, 3 Letters) License No. 0 FELINE CHLAMYDQPHILA
Month Day Year PRODUCT NAME: , Vete Na e (please pOnt)
rzwi-Aearc .5 cr i
VACCINATION EXPIRES. 1 yr. LteNacc, la .-17 1
agnate . - WA_ • •
f 1 1.7 2.," 1 17yr, LicNaco el
' ' ‘"IT'-'71-t cl --S- C
Month . Day Year
VaCC, Serial (Lot) No.
USCAHNON02000
• VACCINATION RECORD
RABIES VACCINATION CERTIFICATE Tag fee $: kiarne
' ADAPTED IVASPRV FORM 51 mop,. ▪ RABIES
PRINT- use ballpointpen or typo Cert. Sena! 4: • LymE DISEASE
Owners Name & Address
PRINT LAST FIRST MI TELEPHONE - 0 CANINE .DISTEMPER
4,t0 —/// Z- P735" 0 CANINE PARAINFLUENZA
DO tr. \ -1C 1\10-1. 1 \• I•Arn
...I STATE ZIP 0 CANINE ADENOVIRUS 2
ND. STREET f
6'Uti L) Kav-14--, 1--e-f--• +1 .10-3.4.- - (4- -- 4.- T58 g- c9- O CANINE PARVCARLIs
SPECIES: SEX: AGE: , SIZE: PREDOMINANT BREED: COLORS: 0 CANINE CORONAVIRUS
Dog p Male 0 Months 0 Under 20 lbs. 0 ) eVear..-44-1 .0 CANINE DORDETELLA
Cat 0 Female tli 20-50-tbs. 0- (7 c9-ri •LEPTOSPIROSIS
Other I:I Altered 0 Years Over 50 iba. 1:1 NAME 0 FELINE LEUKEMIA . VIRUS . •
•
(Specify) (0 t)0(12--Q- 1I LI'FELINE PANLEUKOPENIA . -
6 .0 .FELINE RFIINOTFtACHEMS •
DATE VACCINATED: PRODUCER: Veterinarian's # () 08 0FEUNE CALICIVIRUS . •
License No.
(First 3 Letters) 6 FELINE CHLAMYDOPHILA
Month Day Year PRODUCT NAME VelerinerJan'e N.,cne (please print)
V,NAJAC., 3 • •
VACCINATiokr,ExpiriES: ri yr. WA/am, 0 Signe -1,1Fp 5 61 i .d.k. fip
Address VL.-- i CO -... ,
Month Day Year
Vacc. Serial (Lot) No.
USCAHNON02066

RABIES VACCINATION cERTIPtcATE
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1 Date Vaccinated: 04-15 ,2316
1 Soal s51./.5$7
1 if* VacCunatiOn egpices in tram telltale fivataa-sokfi
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951 ,350-73v .9$1-736-3SCA
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• VACCINATION RECORD
RABIES VACCINATION CERTIFICATE Tag fee S: Name
ADAPTED NASPHV FORM 51 Tag II' 0 RABIES.
Owner's Nemo &Address PRINT- USG bali point pen or Iwo Cert. Send II:
El LYME DISEASE
PRINT LAST PIM, MI TELEPHONE ' ' b CANINE DISTEMPER
1 , i 1 g /71.Agi d o CANINE PARAINFLUENZA
NO STFt ETA '
,t /0 e / ey— / C / ePp //....- 0 CANINE ADENOVIRUS 2
SPECIES: SEX. AGE; Si PREDOMINANT BREED: COLORS: 0 CANINE PARVOVIRLIS
Dog -1-- Male V, 3 MD to 12 Mo. 0 Under 20 Ibs. 0 • 0 CANINE CORONAVIRUS
Cat 0 Female • 0 12 Mo or older ir; 20 - 50 1bs 0 • 1 0 CANINE BORDETELLA
Other D Altered 0 Over 50 lbs j-z•NAME1 i • 0 LEPTOSPIFIOSIS
13peeiry) /IPA 1 0 FELINE LEUKEMIA VIRUS
0 FELINE PANLEUKOPENIA
DATE VACCINATED: PRODUCER: Vetenrianen's ir
• .; — 1 "7 - 17 1.; License No. 0 FELINE RHINOTRACHEITIS
Month Day •Year (Firm 3 Letters) 0 FELINE CALICIVIRUS
Veterinarian's 0 FELINE CHLAWDIA
1 yr. Uc./Vacc. 0 Signature 0 FELINE IMMUNODEFICIENCY
VAIDOINA1 ION EXPIRES; ,
-- ......, ao 3 yr. MI./Yam. \I- 33A Address' VIRUS.
Mo'slh Day Ye- OT CO 37
Vase. Serail (Loly No. • -' (di) 13noodagmer
VAC3410001
VACCINATION RECORD
RABIES VACCINATION CERTIFICATE Trig fee T: . . Name
ADAPTED NASPHV FORM 51 • Tag tr: 0 RABIES
PRINT I uio bull point pen or typo • Cart Sent if
Owner's Name & Address • 0 LYME DISEASE
PRINTLAST . ' i ri-, Hist IA 1ELEPHONE 0 CANINE DISTEMPER
O LCANINE PARAINFLUENZA
140. . STREET.. , GI;IY '. STATE ZIP . • -
11 CANDO ADENOVIRUS 2
• 6:6W. 4 '1 . rA9--, /". ,(....1.- .4-4, 2 . 4 C'.., 0 CANINE PARVO VIRUS
SPECIES:" SEX: .- AGE - SIZE ' PREDOMINAWBREED: COLDFISI- .
Dog vr Male • 0 3 Mo. to 12 Mo rj'Under 20 tbs. 0 - 0 CANINE CORONAVIRUS
Oat 0 Female 0" 12 1v1o. or otder 0 20. - 00 lbs g 4 .) I- 0 CANINE BORDETELLA
Other 0 Altered 0 Dyer 50 lbs. NAME: - LEPTOSPIROSIS •
1SpeciPy) o FELINE LEUKEMIA VIRUS.
.0 FUME PANLEUKOPENIA
DATE VACCINATED; PRODUCER:. Veterinarian's # ' 3(.0 35
0 .FELINE RHINOTRACHEJTIS
Lt - 1 - ti - 3 e 0 FELINE CALICIV.IRUS
Month Day. Year . (First 3 Letters) . • Veterinanan'S - • 0 FELINE CHLAMYDIA
1 yr . Lic Nacc.0 L Signature 0 FELINE IMMUNODEFICIENC‘
VACCINATION EXPIRES: .
' 3 yr. lio./Vace. • Address
. Lt -.' --1 --() . • LA 1,5GLI -S.16- \ ,e4C.,6 . 3-)5
Month - Day. Year
Vasa. Serrs111..oll -No. .
VAC01.100D1
1.1

• RA$1ES VACCINATION CERTIFICATE RABIES TAG NUMBER
NASPHV FORM 51 (Revisecl 2007)
MICROCHIP NUMBER
Owner's NaMe & Address Print Clearly
LAST FIRST • TELEPHONE
Domhoff Marilyn (623)412-9739
NO STREET CITY STATE ZIP
6824 W. Karen Lee Lane Peoria AZ 85382
SPECIES SEX AGE SiZE PREDOMINANT BREED PREDOMINANT
Dog FO Male Months LI Under 20 lbs LI Afghan Hound COLORS/MARKINGS
Ca t 0 Female Years 20 - 50 lbs Blue & Cream
Other 0 Neuter Over 50 lbs NAME
(Specify) Jennifer
Animal Control License 0 1 Yr 0 3 Yr 0 Other
DATE VACCINATED PRODUCT NAME Veterinarian: Dr. Michele Johnson
08/06/2018 License No: AZ 4189
MANUFACTURER
(First 3 Letters)
NEXT VACCINATION Veterinarian's Vr,e41-0-4 A-40f4isa ZWIPeir;
DUE BY: 0•1 yr USDA Licensed Vaccine Signature
08/0512021 3 yr USDA Licensed Vaccine Address Grand Paws Animal Clinic.
0 4 yr USDA Licensed Vaccine 11310 W. Bell Rd Suite #103
D Initial dos 13 Booster dose Surprise, AZ 85378
174704
Vacc. Serial (Lot) No.