BURTNER KENNEL PERMIT RENEWAL.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
El New VRenewal Kennel # K19-000036
St.t 86tr-f-nle.k Kennel Name: 2nt4i1er kanne-1,.
Name:
Address: 1 5 Oct I cc c c"44-1- Kennel Address:1,509 n. t ctq c".42-d
Mailing
City: Dtt c etate: AZ Zip:53 S 3940 CitY:Bucke9 e_ Zip: 7s- 3 9 le
County Supervisorial District: 4
Phone:60 a W/D,29„7.8v Kennel Phone:60,2 ligh
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 result in
Inspection Return fee of $49 for each additional visit at time of inspection. Failure of inspection may
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
L.V I/We assume complete responsibility for the kennel at the premises for which I/we are making
1. apiklication 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).
INVe certify that I/We have dogs and that the kennel meets the definition in statute.
3. INVe certify that I/We have not been convicted of a violation of A.R.S. §§ 13-2910 (cruelty to animals)
or -1- 10.01 (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. I/VVe certify that all dogs over the age of three (3) months that are kept, harbored or maintained on the
preia of the above named kennel have been properly vaccinated against rabies by a veterinarian licensed is to
practice in the state of Arizona and that a current vaccination certificate signed by a licensed veterinarian
maintained on the premises for each dog.
I /We certify that INVe are submitting a valid copy of the rabies vaccination certificate for each
5.
doTith this application.
6.(. T) I/We understand that a dog remaining within the kennel is not required to be licensed individually under
A.R.E. § 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.
I/VVe understand that a person who fails to obtain a kennel permit under A.R.S.§11-1009 is subject to a
7. "
penally of twenty-five dollars in addition to the annual fee.
I/We understand that a person who knowingly fails to obtain a kennel permit within thirty days after
wri 8. lWr7otification from the county enforcement agent is guilty of a class 2 misdemeanor..
The undersigned understand that that the kennel permit does not authorize the operation of any type
9.VT of bainess 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.
Date: /0 — 8 - I W
Applicant Signature
Date:
Applicant Signature
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.qov
Receipt Number: R18-591320 Receipt Date: 10/08/2018
Person ID: P1875830
Phone: 602 4862928
BURTNER KENNELS 10/8/2018 4:17:34PM
1509 N 194TH AVE
BUCKEYE, AZ 85396
Animal ID: Reference No: Price: Each: Amount:
Item:
A7777777 K19-000036 $350.00 1 $350.00
KEN PERMIT Total Fees Due: $350.00
Payments: Cash: $400.00
Check:
Credit Card:
Total Payments Received: $400,,00
Thank You!
Would you like to share your experience with our service to you? Balance Change: Due: $50.00 $0,00
Please visit our website at http://pets.maricopa.gov and click on
"Contact Us" to email your comments for our review.
Animal A7777777 Information: KENNEL PERM - BORN 9114/1999, 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
luffmanm EBUSOFF

Maricopa County
Animal Care & Control
2500 South 27th Avenue
Phoenix, AZ 85009
Phone: (602) 506-7387
pets.maricopa.gov
KENNEL PERMIT K19-000036
PREMISE INSPECTION
Number of Dogs: 54
Name: Judy Burtner Kennel Name: Burtner Kennels
Mailing Address: 1509 N. 194th Ave. Kennel Address: Same
City: Buckeye State: AZ Zip:85396 City: Buckeye Zip: 85396
County Supervisorial District: 4
Phone: 602-486-2928 Kennel Phone: 602-486-2928
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.)
No follow up necessary, Kennel property was inspected 10/17/2018; all (54) dogs on
property are properly vaccinated and vaccine certificates have been provided. Property is
enclosed and all dogs are secured to the property.
Deputy Enforcement Agent & Badge #: Lt. Amber Romero Date: 10/17/2018
October 2015

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co( 3 12 3 12 yr. yr.
Address .\ E IS"' E -I -1S. El D 1 3
EXPIRED: X9C) n
COPY and Stt Female Neutered ,t-01 Year Year Address Female Altered Igi Year EXPIRES: `1".w
, Sex: STREET SEX: Male
Name Last 131/Male VACCINATED: & I ' 15 Day
OWNER'S 5c5.1 E E Day I924 Day Name (Ar 509' VACCINATED: Day
- VACCINATION LAST Te.---, ID El A
Owner's PRIXT ) Species: Other: (Specify) DATE Month Month SPECIES: (Specify) VACCINATION Moth
No. Dog Cat 5 -C; Owner's PRA 7 Dog Other DATE MOnth
Cat
OWNER' S COPY RABIES VACCINATION CERTIFI CATE
NASPHV Form #51 Rabies Tag N umber
Owner's Name and Address Print - use ball point pen or type
PRINT.c Last First M .I . Telephone
, ir.74 Lia te61c0
- - • . p,z.t -- ya_eue _State
No Streek cc
1 . — -
Sex: r;--------- :ge: • Size:
Male El 3 mo to 12 mo 0 Under 20 ibs. El
Female ‘71„ b 12 mo or older 20 - 50 lbs. El
Neutered El .c..r.h ial Am., k•-•\C Over 50 lbs. Ef \OA. N
Actual Ablbs. Name:
m -1 > < > 2 z > -1 M -o 3 c n (D l'- \ < (i) 5. = 1# •
.......c. st 3 letters) -:lithi
•< ii) — Vacc . 14 . es5
m-< co Vacc . > a o. F? •b. -),...- f
0 > .t- 0 z x 5 m P )ther _ 4
• ....c. DV, „,...., Vi, oc) .., —
, E -c -< ca Vacc. Serial (14 no.

-- )74'
Number :k. ri-C
Colors: C\ Number LiC6(0 t3cit Colors:
Tag Wad Loh R I K5,..g1 UO)Vs1 i
\ Tag 4 4
Rabies Telephone No.) /4 _5'im Telephone No.) '--7
State AZ , Rabies 1'12 , i
(LIcense /1z State (License
M.I. 7. Breed: C\ if blepp'ec — ill
A # E M.I. j\_.),_ Breed: #
/1610 RRALLIi ,pe ,_5
CERTIFICATE Predominant Veterinarian's: 3-5. CERTIFICATE
type (2)t.e Name: (Signature) Address: 7,-- type Predominant fc, Veterinarian's: 114 (Signaturel 3
or '--e t Name; Address:
#51 pen i e E 2r lbs. #51 or pen E 0
Form point k lbs. lbs. lbs. Form , '\) c''.6t' lbs. °,Ibs
First bit 20 50 point no-c 20 lbs. lbs. '7
VACCINATION NASPHV ball 1 3 Size: Under 50 - Over Actuallv- E VACCINATION ball First 50 - 50 — t_
use 20 0: letters) L. NASPHV '\._ Size: Under 20 Over Actual letters)
- , E 11 {Fret 3 Lic./Vacc. Lic./Vacc. Other L/3 no. use - rfr 3 Other no.
Print mo 1-4 7_ (lot) , 0 (First Lic./Vacc. Lic./Vacc. (lot)
Jerre older e ;55 Print . .A\-€,_ mo older 3 -2_
12 to or Ag yr. 1 Ell.r. Serial , 12 or Age 1.yr. yr. Serial
RABIES g mo mo Actual Producer: El ) Vacc. RABIES LI to mo Producer: 0 hir-3
Fi Age: 3 12 ''- , n Age: mo 12 Actual Vacc.
, \ 3
Address 0 EY' 0 Address rfr E 0
N -7 EXPIRED: EXPIRED: awu c—Vr\-e EXPIRED:
COPY and , Street Street Female Neutered Year Year COPY and Street r‘,.) Neutered ‘ Year Year
Name Sex: r'Male VACCINATED: ag Sex: Male Female VACCINATED:
OWNE-P,'S Last C El E Day Day OWNER'S Name Last _ N.?) (.-)`-\ i ,N Day Day
- _5 VACCINATION - r -41 El 0 VACCINATION
Owner's PRINT No. Species: Dog Cat Other: (Specify) DATE Month 5 Month Owner's PRINT } t Species: Other: (Specify) DATE 5 Month C) Month
No. Dog Cat

'
Month _ Month DATE (Specify) Other Cat Dog NO. PRINT Owner's VAC0410001 Month Month DATE (Specify) Other Cat Dog SPECIES: PRINT Owner's
VAC0410001 SPECIES:
VACCINATION fy 0 0 0, VACCINATION 0 LAST.
...., LAST. Name VACCINATED: Name
Day Day' VACCINATED: & Day Day EL
EXPIRES: Altered Female Male SEX: STREET EXPIRES: Altered Female Male SEX: STREET Address
Year Year Address Year 'Yeir
, _
3 1 0 0 3 yr. 1 yr. [71 17-
yr. yr. Q......12
PRODUCER: 3 AGE: PRODUCER: 12 3 AGE: FIRST
Lic.Nacc. Mo. Mo. Lic.Nacc. Lic.Nacc. Mo. Mo.
Lic.Nacc":0' or to RABIES or to RABIES
0 older 12 0 older 12 .
Vacc. (First Mc. Vacc. (First Mo. PRINT ADAPTED
3 0 -0:. PRINT ADAPTED Serial 3 0' '!0 -
Serial Letters) CITY use - Letters) 20 CITY use VACCINATION
(Lot) Over 20 - „Under SIZE: ball VACCINATION (Lot) Over - Under SIZE: ball
No 50 50 NASPHV No. 50 50 20 point NASPHV
lbs. lbs 20 point lbs lbs.
lbs. pen lbs. pen
0 0 0 or FORM 0 p or FORM
type type
Address Signature , NAME: 51 CERTIFICATE Address Signature Veterinarian' NAME: 51 CERTIFICATE
Veterinan."— Veterinarian's PREDOMINANT — Veterinarian's PREDOMINANT MI
STATE MI STATE
It # #
License BREED: License BREED:
,3 -' = .
........ No .- — No - Tag Tag
ZIP Cert. Tag Tag ZIP_ Cert.
COLORS: TELEPHONE #: fee COLORS: TELEPHONE #: fee
,..4.ry..,e, -' Serial $: Serial $:
.._ . - #: 114111111P.e.. 4:
. ..-
, - , .
_

VAC0410001
No. (Lot) Serial Vac°.
a D 0 ' -2., fi X h -F Year Day Month
175 Address ip -7t( r2 Li LiciVacc' Yr. 3 ii gs cl
76
Signature EXPIttE,Sc VACCINATION
pdi:' 1.51.fr Lic./Vacc.r-- yr. 1
4:14.:".
Veterinarian's etters) 3 (First Year Day Month
No. License orrittri F-6 'Ds 9
66(3 izi- oft Ve PRODUCER: VACCINATED: DATE
(1 rinarials:L: # s tei-ci
(Specify)
(e.., .110(do NAME: C lbs. 50 Over 71 Altered 0 Other
V4 Fri' ii lbs 50 - 20 'IA older or Mo. 12 ris, Female Cat
1
1 e--, CV e...C, p..,_ lbs. 20 Under LI Mo. 12 to Mo. 3 Male Dog
kr : 13 CO_Li.)/ BREED: DOMINAVTI P SIZE: AGE: SEX: SPECIES:
alcil.! /a6e----- , fi 9 5 t
ZIP E STA in TY CI STREET' _ NO.
936 4.0 3 0 b6 Do 0/1
.e.P-C—j-, TELEPKONE NAL . _ is isi 61.46 4 Fito thver PRINT&
It: Serial Cert. type or pen point ball use - PRINT Address & Name Owner's
tt: Tag 51 FORM NASPHV ADAPTED
$' Tagfee CERTIFICATE VACCINATION RABIES

, i
...ci-af,., il st -
, S-581 Number tncit,
Number , .) C.: 01 Colors: „ (-7
. Colors: -6 - aL-t-f-'` „,..., /5+/-)Ls-f- IS26-Zi
Tag V86, \\ )5--1-6 Tag r/5
' i Telephone 5 I
Telephone -N2. z Rabies WK No.)",
Rabies 6,to No.) L A State AZ E /12_
State --)P-0-)' (License .T.--,
(License
M.I. Breed: -C) ' CATE M.I. Breed: LC_ # g,ps
.- # , 302_5 --.7ifism 2-- 7:/-)7
' V-'00C)sieS .
CERTIFICATE al s tr ' Predominant Veterinarian's: -1
Predominant . L.- Veterinarian's: ) CERTIF type D Name: (Signature) Address:
type Name {Signature Address: or
#51 or #51 pen E C: lbs.
pen E lbs. lbs.
Form lbs. Form point r ibs. lbs. 0
point lbs. lbs. 5 20 50 ‘
First c_g 20 50 ball First Buckt-Ve 50 E
VACCINATION ball 50 - Actual. E VACCINATION NASPHV Size: Under - Over Actual letters)
NASPHV '-,i-m-)6s Size: Under 20 Over letters) use 20
-use 0 - 0 E14 0 3 Other no.
El Er 3 Other no. , 15' (First Lic./Vacc. Lic./Vacc.
(First Lic./Vacc. Lic./Vacc. 146ki- Print mo 2_ (lot)
Print mo older .3 "1 (lot) older a33L/S
ve_ 12 or Age yr. yr. Serial
12 Age yr. CO Serial FdAne to 1
RABIES to moor 1 ErTyr. \ RABIES : rno mo Producer: E EI-S.
mo Actual Producer: El Vacc. Age: 3 12 Actual Vacc.
Age: 3 12
f.v- Address E E
Address E R' E
EXPIRED: ga),0
`),,0\—) EXPIRED: kDO COPY and Street Neutered Fi Year Year
Copy and oc'A- Street Female Neutered Year Year Sex: IVIale Female
Sex: VACCINATED: Name Last 61,w-7/Loci- VACCINATED: I 04
NIF.-.R'S Name Last M-"Iilale L. Day ak Day OWNER'S e LI El Day Day
- 6 E E VACCINATION - 3i.-2 VACCINATION
OW Owner's PRINT , Species: Other: (Specify) DATE Month Month
Owner's PRINT Species: Other: (Specify) DATE Month Month No. Dog Cat
No. Dog Cat 5
A fli t OTC AI A C OLA / CI-1DR A Tea # :
/i. Oir C> 'ENN K TELEPHONE
Z1 lila .29,22
z trs co N. -0
N,.. g........,„ 1/4.n C4 1.,
0) WI SEX : AGE: SIZE: ; PREDOMINANT BREED :
o Male •el 3 Mo. to 12 Mo. 0 U nder 20 lbs. IP 1 re.9
0 Female E! 12 Mo. or older 20 - 50 lbs E
o 0 Altered Over 50 lbs. 0 ni
(-d'il 3 rt
TB ro m
DATE VACCINATED : ii Zi 0 tri _
q r) V License No . '—
k
Moi-#11 Day Year _. -ii a . n7. I
•-c i- _. p o P
VACCINATION EXPI RES:
.-< f- -. 0 .t3 o P Addresfl iLA tj
:IS
K o z... ,c — • .
'am Serial (Lot) No .

° V2-21
r%F. to D
La IlliliiI 740."":":0 e- - 111111kAk
#: 72. r • #: 6 1-39 —TC711C-Ti---- /do
$: Serial VI 701- gIST 426 : 7 '''' - ... ^ SS15A1 $: Serial TELEPHONE a Y Li
fee #: COLORS: .24.1 K • fee #: zip3 COLORS: Gi
Tag Tag Cert. 7LF aDoi ZIP :imp ' Tag Tag Cert. 672 No. 0..).
No.
fj-,2„,
, BREED: ri License ...; BREED: Ve-- License
te # -a, # q
STATE /3-1. INANT Ph,‘ MI co kTATE 7 j7
MI (r) Veterinarian's Veterinarian's 3 ft PREDOMINANT COock, Veterinarian's Veterinarian's Signature
CERTIFICATE 51 PREDOM gi_Nv,„:c,c4,„ NAME: --c\l'a Signature Address CERTIFICATE 51 NAME: Address
FORM type or 4 D 0 FORM type or omo i 4:L Ei P
pen 3 lbs. iv pen lbs. lbs. (9
point 20 lbs lbs. 50 No. NASPHV point t? 20 lbs 50 50 No.
NASPHV ball 051) . SIZE. Under -50 Over t..„ (Lot) VACCINATION ball K. CITY, acc4cgy SIZE: Under - 20 Over '20 (Lot)
VACCINATION use b ITy ..."-- Letters) use _ t Letters) 4
- c6 IP ''(;=1--20 Serial - E 3 7 Serial
ADAPTED PRINT \-4 ,TBL ZD 3 ADAPTED PRINT Mo. —2.6 (First Vacc.
Mo. (First Vacc. older
12 older 0 P 1\013 12 D
RABIES cuts_ to or RABIES to or Lic.Nacc54—'
MeLS ..t Mo. Mo. Lio.Nacc. Lic.Nacc. n czic_s, AGE: Mo. Mo. Lic.Nacc.
FIRST AGE: 3 12 PRODUCER: FIRST 3 12 PRODUCER:
9 1 pi..... 0 Li yr. yr. , i*2,, , 0 ')K 0 yr. 1 Syr.
1 3
°Re-0 i. Year (fC1 Year Year et Year
Address EET SEX: Male Female Altered EXPIRES: Address snREETI SEX: Male Female Altered EXPIRES:
r STRn ,g5-tZi &
& VACCINATED: Day exA Day VACCINATED: Day Day
Name one, Name LAST Rad-n(2( gIf)
LAST A D D VACCINATION [6r,f1 V; P El VACCINATION
Owner's PRINT a 13 Nr609 SPECIES: Other (Specify) q DATE Month h MCo3rIti VAC0410001 Owner's PRINT NO SPECIES: Dog Cat Other (Specify) DATE Month . 9 Month
Dog Cat

Hi-der40/ ,2,F..2k t
iirDt' 4111p.
$: Serial #: ZIP353Cgal 6 6-// #: g53/i., 4— P\ 03 4760 64e4aot, SSoa
fee #: TELEPH9 COLORS: 14' Lit fee $: Serial TELEPHONE h
Tag Tag Cert. Ef), Af.0-41 10 #: Cert. o,i(E5-6 COLORS: 10 Al
No. Tag Tag ZIP o. Id
fltz_
BREED: License 045 hy. BREED: CTL, Af4 License
# # /19Y Ciy<
MI ST PREDOMINANT Veterinarian's Veterinarian's MI STATE ii. lks ra
CERTIFICATE 51 Signature Address CERTIFICATE 51 PREDOMINANT i ( Veterinarian's Veterinarian's Signature Address
type ildpt UV NAME: ge)
FORM or 0 zy FORM type
pen lbs. Lo or i-s-/S&ezytse.; E 1: cil,....
point 20 lbs lbs. pen ibs. lbs.
NASPHV 50 50 No. point 20 lbs
VACCINATION ball slfaJ SIZE Under 20 - Over -7 (Lot) NASPHV ball Under -50 50 476)Lp No.
- use Letters) cf VACCINATION use ln' SIZE: Over (Lot)
ADAPTED PRINT eiAckCITI rirt) 3 Serial - 60-c-k E 1.20 00- Letters) Serial
Mo. (First Vacc, ADAPTED PRINT 3 27
12 older LII Mo. older (First Vacc.
RABIES to or RABIES 12 or El
EIRST AGE: Mo. 12 Mo. Lic.Nacc. Lic.Nacc. V<Ig_xin.(21-s Mo. to Mo. Lic.Nacc'Z' Lic.Nacc.
aLui, 3 PRODUCER: yr. yr. FiRST AGE: 3 PRODUCER:
1 3 0 e112 0 yr. yr.
1 3
Address SEX: Male Female Altered Year Address Year Year
& nSTRT 41-nrZr STREET SEX: Male Female Altered Expl i
Name VACCINATED: Day & VACCINATED: Day Day
LAST tal E Name LAST 14, IF ,,,,AioN a'45
Owner's PRINT SPECIES: Dog Cat Other (Specify) DATE Month VAC0410001 Owner's V) SPECIES: 0 E (Specify) E Month
914,T NO. Dog Cat Other i D D v7 Month

Number IV_ fib " ,44;71.4114,„„A.,..,
Colors: h S. #: •NE 0 111111111111PA. .01•74,7.17,-
Tag Ogg $: Serial PlkfiOGOn .
Telephone 1,) LO , --1-1,\ fee #: TELEP zi,6,,s COLORS: __BALV 1
Rabies A2- No.) Tag Tag Cert. No.
State license /5 ' k)
M.I. Breed: (-- ---- BREED: VA: License riA.5
AI # .L, # 7
ze MI STATE 7 ilkdk
CERTIFICATE Predominant Os"---e Veterinarian's: 3Z CERTIFICATE 51 09- PREDOMINANT V‘A•4:3 Veterinarian's Veterinarian's Signature Address
type Sp Name:, (Signature) Address: NAME:
or FORM type
#51 pen E ER' E pen or 7 SE- Li
Form point lbs. .lbs. point 20 lbs. Itis lbs. 66
20 lbs. [las. X) NASPHV 50 50 No.
balt First 50 50 E. VACCINATION ball SIZE. Under 20 - Over 7 (Lot)
VACCINATION NASPHV Size: Under - Over Actual I letters) - use Letters) q
- use 7--20 0] 3 Vacc. Other no. ADAPTED PRiNT E 0 ZC) 3 7 Serial
Print ma El , (First Lic./Vacc. Lic./ 061-)5L (lot) 1,5' Mo. older (First A Vacc.
older 12 D
12 or Age yr. Serial RABIES pc) to or Lic./VacoGr.rP
RABIES to mo Producer: E 1 &<r. 1 0.4-La__ AGE: Mo. Mo. Lic.Nacc.
LI Age: mo 12 Actual Vacc. fIRST Aan 3 12 PRODUCER:
3 1 q 'dV 7 0 1 yr. 3 yr.
Address E e E
\e 900 EXPIRED: M Year Year
COPY and Street N Female Neutered Year aitk9b ear Address STaETR SEX: Male Female Altered vci EXPIRES:
Name Last ,oSex: Male VACCINATED: SILI & tubsior VACCINATED: ?NS Day 5.5 Day
OWNER'S - -6Cfi El E ICI bay VACCINATION Day Name LAST 609 El 0
-..e VACCINATION
Owner's PRIN 1 Species: Dog Cat Other: (spec,fy.) DATE 5 Month 5 Month Owner's PI:11T lb . SPECIES: Dog Cat Other (Specify) DATE Ci Month c‘, Month
N

0
q-
leira -6:-.4Q,AkiziA,
#: #:
$: Serial )--\ pr-LAG6,2_4 $: Serial
fee 4: Cert. TELEP COLORS: fee #: COLORS:
Tag Tag No. 1)N Tag Tag Cert.
No.
BREED: ?Ac, 4 License Lis cAsA5Neep,Efr BREED: License '—
It rz cA(N4- # _ 7—d–'
INANT
CERTIFICATE 51 Ltbr PREDOMINANT NAME: Veterinarian's Veterinarian's Signature Address CERTIFICATE 51 Veterinarian's Veterinarian's Signature
type type Address
FORM or O 21 El FORM or
pen lbs. pen lbs..V
NASPHV point 20 lbs 50 lbs. -WC° No. NASPHV point 20 lbs lbs.
VACCINATION ball SIZE: Under 20 - 60 Over (Lot) VACCINATION bail /f/i SIZE: Under - 50 Over 50 No.
- use S Letters) - use 20 Letters) (Lot)
ADAPTED PRINT E E 3 "D-77q Serial PRINT ir Serial
QL Mo. Mo. Qt) (First Vacc. ADAPTED older 3
12 12 oider oider /9ei-e7o or (First Vacc.
RABIES to to or or Lic.Nacg.;igo' RABIES /({01R:./3e/2,_5' 142,...ta_12_ Mo. Lic.Nacc.:#-
AGE: AGE: Mo. Mo. Mo. Mo. Lic.Nacc. Lic.Nacc.
ST 12 12 PRODUCER: AGE: 12 PRODUCER:
CI LI 1 yr. 3 yr. yr. yr.
1 3
Address F STREET 'rjaUrj1 SEX: SEX: Male Male Female Female AItered AItered Year EXPIRES: \ Ydar &Address le/r/ Female Altered 5 Year EXPIRES: (:)1 '"&'
SEX: Male
Name & ' VACCINATED: Day e3 Day Name NO./STET7) VACCINATED: .25 Day J)Iv
Pe3Tull" 'etPf''' l El El VACCINATION LAST El E .2C
Owner's NO SPECIES: Dog' Cat Other (Specify) DATE Month Month VAC0410001 Owner's PR SPECIES: Dog Other (Specify) 5, DATE Month VACCINATION IHIcilhHi
Cat

-.147 4 (---../
Number D:ii3sc: ,p. Number Z59 ):4C,_ I / 5
I ' Colors:
Tag tibl ROei 10'4 tee F,5c4S1 Tag L.V'il, S,1
. is ho!:198./ 5
Rabies Telephone A-z_ Na.) Rabies No.) /
E 0, State ,4 -:
(License frz-) .__. (Licerfse
M.I. Breed:State 3:- M.I. t, Breed:
re. # 347.5 r \\LP1 #
'3- •ei
CERTIFICATE Predominant 6656- Veterinarian's: _ ' P, . CERTIFICATE uominant , Veterinarian's: 77,44/x
type Name: (Signature) Address: type L, r' Name: WQ (Signature) Address:
or or PreN
#51 pen E CI lbs #51 pert ---,E- E E lbs.
Form point , lbs: lbs. lbs. '40 Form point lbs. lbs. lbs. --()
First City- 20 50 50 First ttt 20 50 50
VACCINATION NASPHV ball Size: Under - Over Actual E. _.. VACCINATION NASPHV ball Size: Under - Over Actual letters)
use 20 letters) use 20 u
- E Er 0 3 Lic./Vacc. Lic./Vacc. Other no. - Ei 3 LiciVacc. Lic./Vacc. Other 5 no.
Print mo older -IA 7 (First (lot) Print \NW mo older AgeA..._ 7,_ (First H (lot)
ES 12 or Age yr. r. Serial 12 or yr. -Yr. s Serial
to mo Producer: 1 CI 52-1-:--y RABIES \O to mo ma Actual Producer: 1 0 U-S
RAB V-)H Age: mo 3 12 Actual Vacc. Age: 3 12 1 Vacc.
Address E E 0 Address M./ E 7 i
0 EXPIRED: CO K,r) 9a EXPIRED: EXPIRED: so9-0
COPY and Street N.) Female Neutered Year Year COPY and Street Female Neutered Year Year
Name ....Sex: Male VACCINATED: L-1 i-) Name Last ....Sex: Male VACCINATED: uc
OWNER'S Last WM( El El Day Day OVJNER,'S I 'DCF\ 2 El i: '-'-\, Day a Day
- VACCINATION i VACCINATION
Owner's PRINT , No. 1 Species: Dog Cat Other: (Specify) DATE 5 Month 5 Month Owner's PRINT,- • No. Species: Dog Cat Other: (Specify) DATE 5 Month 5 Month

CO e,
' t
166 trarD ..,,FW.,' ck, Number ga Colors: S\IN\NIZ , cl/
#: 41111114k 7 6 4--jdi 51-
$: Serial , ilia Tag LiaC ' / 1 p g6;281
fee #: TELEPHONE 4 COLORS: si---1 - -,•°: (mar, Telephone \T - A
Tag Tag Cert. ir Rabies IC&2 4-2 No.
No. State /S
"rerel*— li,h, (License 41I
iC1-1,.. ,-,dJ
e__ BREED: License S M.I. Breed: \ 1"
i,.\C # ,..........,
a, # 6114 I
MI STATE Veterinarian's CERTIFICATE 3,a5 -7-cirmsx
pce,, PREDOMINANT Veterinarian's Predominant 1 Veterinarian's:
CERTIFICATE 51 NAME: Signature Address type Name: (Signature) Address:
type or
FORM or iACI-C. ‘g E 7 #51 pen a/ El o
pen lbs. lbs. lbs
point 20 lbs lbs. Form point 1,6 yi lbs. !tn. "-k
NASPHV 50 50 b/a No. City 20 50 _
VACCINATION se ball CITY SIZE: Under 20 - Over ..- 7 (Lot) VACCINATION NASPHV ball First )(Ye- , Under - 50 Actual
- u Letters) Li use I Size: 20 Over fetters)
ADAPTED PRINT 0-Q,_. E X D 3 Serial - C E [e 0 3 Other 5t,
Mo. Z (First 497 Vacc. Print mo 1.--P —2_ (First li./Vacc. c LIc./Vacc. - /
a older X olger
RABIES to 12 or E 12 or Age yr.
CI Mo. Mo. Lic./Vacc. Lic.Nacc. RABIES to mo Producer: D 1 alrTyr.
FIRST I AGE: 3 12 PRODUCER: ici Age: mo Actual
X D yr. yr. irlar 3 Ifr'12
r r. 1 3 Address Ni E 0 T.),o(401S.Sgi
Address emale Year 1 PIRE? 19 Year COPY and L) Street Neutered fl Year EXPIRED:
STREET SEX: Male F Altered Male Female
& 75)( p...„S, R Name Last, 0 100C) ,Sex: VACCINATED:
Name VACCINATED: Day 1-- Day OWNE... - -- lOi( D D Day
C431/ X O E VACCINATION
Owner's PRINTST 1 SPECIES: (Specify) Month IINATION (it ACO410001 Owner's PRINT No. Species: Dog Cat Other: (Specify) DATE 5— Month 5
NO. Dog Cat Other DATE Month
1
Rabies Tag N umber
ephone ojcj,,ott
5;1
I No. _ Street . ty si
) 501 19 LI tVve- ev- e 47_
Colors:
F --1 m < c'=") g Fr i Si -cs a a C (-) c.D
Fil
u) 9_, ...a. -- -,_j a E
. '< < 0 Po --' E (SfgnatuK
i-c 8
U)g C R m x 31 FTI p -‹ ,c; Address:
i. c 35
ci..) 0 9,. o 7— 04. r:K
5 -< c.p, ''' Vacc. Serial (lot) no. 7647,t 4-2) 3:5, I

g,-12/4 -, -
Number tt2% (f)V 2fdct-
Colors: 0 (do0 1411I4k
&TAJO #: PS53,Co reciivr%
Tag L;196 // 5 S: Serial TELEPHONE -71I3 '7'55
Rabies Telephone Z No.), / fee #: Zak COLORS: 2-1
4)J. /1 se E Tag Tag Cert. z C
State To.
(Licef
M.1. Breed: I-e- A Ali Lic-n-e 3\
# - .
#
r5 3 TATE )co
CERTIFICATE Pceci Veterinarian's: .// c
type Predominant /ICY (signature PPADOMINANT NAm%01/47 Veterinarian's Veterinarian's
Name: Address: CERTIFICATE 51 3(,),; Signature Address
or type
#51 pen Er' [7 FORM or
lbs.
Form lbs. pen lbs.
point City 20 lbs. 50(lbs. 1 point igom 20 lios lbs. No.
First e i 50 E-___ NASPHV 50 50
VACCINATION NASPHV ball Size: Under - Oyer Actual VACCINATION bail SIZE: Under - 20 Over aff (Lot)
use 20 letters) use CITY Letters)
, L., 3 Vacc. Other no. - 0 X, Serial
- 1_. E 05 (First Lic./Vacci 51 ADAPTED PRINT 3
Print 196 ma older ---z_ Lic./ (lot) Mo. older (First Vac.
4119- 12 or Age yr. yr. 57157171. Serial 12 or
ken to 1 RABIES to Lio.Nace*
RABIES mo mo Actual Producer: El Nei / 4',P4Je Mo. Mo. Lic.Nacc.
Age: 12 Vacc. FIRST AGE: 3 42 PRODUCER:
Address /5' 1213 E E P# 0 yr. yr.
0 1 3
,, -2 EXPIRED: )-()Z :
cop and Street ,i) Neutered 1 Year Year Year 'Warr
Sex: Male Female &Address SEX: Male Female Altered EXPIRE
Name PpUrchiliier- VACCINATED: VACCINATED: ti ,4. &VT:
owNER.s Last E?" D LI a Day Day rd-Wr VACCINATED: Day Li,
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