FRIENDS FOR LIFE ANIMAL RESCUE KENNEL PERMIT K19-000010.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
Kennel #19-000010
El New C(Renewal .1,11, 11,Alt
Name: r ;cc-t • LA2)..qt(iy\e,A Kennel Name: r-:,--- r-zy- rf-e ketco-e
Mailing Address: 5 Z L3 0/(04,1 A4ennel Address: 5O LO AdOL-k iç
City: GI kQir42 State: AZ Zip.Cf City: (---;-) 1:)-o4 -I- Zip: 2-?3
County Supervisorial District:
Phone: 2 (C) tC"- (' Kennel Phone: 97) xi co
Please complete and sign this application and return it to the above address with payment in the amount of three
hundred twenty-eight 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 L1V 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
IANe 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).

ci
certify that 1/We have i U dogs and that the kennel meets the definition in statute.
certify that 1/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.--1---1AVe 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 /We certify that I/We are submitting a valid copy of the rabies vaccination certificate for each
dog with this application.
6. iie 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. Ci17We 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. IANe 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. 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 I/We have provided is true and accurate under penalty of law.
Applicant Signature c,-4c—e2Ja Date: /
Applicant Signature Date: 9- 7 d
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: R18-567570 Receipt Date: 09112/2018
Person ID: P1279029
Phone: 480 4978296
FRIENDS FOR LIFE RESCUE 9/12/2018 11:34:47AM
952 W MELODY AVE
GILBERT, AZ 85233
Item: Animal ID: Reference No: Price: Each: Amount:
KEN PERMIT A7777777 K19-000010 $350.00 1 $350.00
Total Fees Due: $350.00
Payments: Cash:
Check:
Credit Card: $350.00
Total Payments Received: $360.00
Thank Yout
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
APODA CAP EBUSOFF

Maricopa County
Animal Care & Control
2500 South 27 1h Avenue
Phoenix, AZ 85009
Phone: (602) 506-7387
pets,maricopa,gov
KENNEL PERMIT K19-000010
PREMISE INSPECTION
Number of Dogs: 8
Name: Erica Wellman Kennel Name: Friends For Life Rescue
Mailing Address: 952 W. Melody Ave. Kennel Address: 952 W. Melody Ave.
City: Gilbert State: AZ Zip:85233 City: Gilbert Zip: 85233
County Supervisorial District: 2
Phone: 480-215-6018 Kennel Phone: 480-497-8296
1. Are all dogs over the age of three months properly vaccinated for rabies and in
possession of a va'id 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 -,ach return visit.)
NONE- The kennel was ir spected on September 19, 2018. There are 8 dogs currently on
the enclosed property tha'. are all currently vaccinated for rabies. Current vaccination
certificates on all 8 dogs included in renewal application.
Deputy Enforcement Agent & Badge #: Lt. Romero #4 Date: 9120/18
October 2015

Humane Society of Yuma, Inc.
4050 SOUTH AVE 4 112E
YUMA, AZ 85365
Phone: (928) 782-1621
SAVE ONE UNTIL THERE ARE NONE
Vaccination Certificate
Vaccination information:
Vaccination ID HSOY
Vaccination Type RABIES
Effective Date 09-12-2018
Expiration Date 09-12-2019
Issued by SAN DIG0/...
Drug administered:
Manufacturer MERIAL
Vaccine IMRAB 3
Lot ID
Serial ID 18386
About this animal
Pet Name TYLER License None on record
Species DOG ID#: 201668 Vacc ID HSOY
Primary Breed TERRIER Microchip None on record
Gender MALE/STERILIZED Registration None on record
Age ADULT ei _
Size SMALL Bites NO
Veterinarian Signature
Veterinary License #
IM1111111p,i1111j111111j11c1,011111,I 111 1 111
Federal Tax ID 86-6053617
Printed using Shelter Pro

Humane Society of Yuma, Inc.
4050 SOUTH AVE 4 1/2E
YUMA, AZ 86365
Phone: (928) 782-1621
SAVE ONE UNTIL THERE ARE NONE
Vaccination Certificate
Vaccinato information:
Vaccination ID HSOY
Vaccination Type RABIES
Effective Date 04-28-2016
Expiration Date 04-28-2019
Issued by PAUL CARNEY DVM
Drug administered:
Manufacturer ZOETIS
Vaccine NOBIVAC 3 RABIES
Lot ID
Serial ID 110776
About this animal
Pet Name LEXI License 080796
Species DOG ID#: 98907 Vacc ID HSOY
Primary Breed CHIHUAHUA Microchip 982000190651647
Gender FEMALE/STERILIZED Registration None on record
Age ADULT
Size SMALL ' Bites NO
Veterinarian Signature
Veterinary License #
Federal Tax ID 86 -6053617
Printed using Shelter Pro

, Humane Society of Yuma, Inc.
4050 SOUTH AVE 4 1/2E
YUMA, AZ 85365
Phone: (928) 782-1621
SAVE ONE UNTIL THERE ARE NONE
Vaccination Certificate
Vaccination information:
Vaccination ID HSOY
Vaccination Type RABIES
Effective Date 09-12-2018
Expiration Date 09-12-2021
Issued by ERNESTO SANDIGO...
Drug administered:
Manufacturer MERIAL
Vaccine IMRAB 3 TF
Lot ID
Serial ID 18385
About this animal
Pet Name RUSTY License 070889
Species DOG ID#: 175523 Vacc ID HSOY
Primary Breed SPANIEL Microchip 900074001827651
Gender MALE/STERILIZED Registration None on record
Age ADULT
Size SMALL Bites NO
Veterinarian Signature
33 0,
Veterinary License #
Federal Tax ID 86 -6053617
Printed using Shelter Pro

VACCINATION RECORD
Tag fee $: Name
VACCINATION CERTIFICATE Tag #: 10 RABIES
RABIES ADAPTED NASPHV FORM 51 Cert. Serial #: U LYME DISEASE
PRINT - use ballpoint pen or type U CANINE DISTEMPER
Owner's Name & Address MI TELEPHONE U CANINE PARAINFLUENZA
FIRST U CANINE ADENOVIRUS 2
PRINT LAST
STATE 171P U CANINE PARVOVIRUS
STREET CITY El CANINE CORONAVIRUS
NO, PREDOMINANT BREED: COLORS: U CANINE BORDETELLA
SEX: AGE: SIZE: 20 lbs. la et7c, e CI LEPTOSPIFIOSIS
SPECIES: Male es' Months 0 Under FELINE LEUKEMIA VIRUS
Dog 10/P 20-50 lbs. I Ortb U
Cat Female Years Over 50 lbs. U NAME: FELINE PANLEUKOPENIA
Other 0 Altered /Mr U FELINE RHINOTRACHEMS
(Specify) IU FELINE CALICIVIRUS
Veterinarian's # CHLAMYDOPHILA
VACCINATED: PRODUCER: License No. U FELINE
DATE
(First 3 Letters) Name leise print)
L •: Veterinarian's irr >
Month Day Year PRODUCT NAME:
EXPIRES: 1 yr. LicNacc. Signature
VACCINATION
3 yr. LicNacc".-0 k7,:3 Address
1;'
Month Day Year Vacc. Serial (Lot) No.
USCAHNON02066

OWNER'S COPY RABIES VACCINATION
CERTIFICATE
Owner's Name and Address Print NASPHV Form #51 ,' , Rabies Tag Number
PRINT - Last - use bail point pen or type
._ 0- evAcA ErrLifti , First Mi. Telephone
No, Strelti ‘ me it Al .16,s ity. ( ' 6e)rt_
Species: Sex: Age: At W3Z.,9.1
Dog,....)ifj Male )g:1 3 mo to 12 mo,0 Under Size: Predominant Breed: Colors:
Cat El Female 0 12 moor older. Z 20 - 50 20 lbs Z, ' t , ha tY Y1 00--
Other: 0 NeuterA Actual lbs. 0
(Specify) AgeSS_ Over 50 lbs. 0
NIR Actualt,L4lbs, Name: ‘Ptc Op VW
opeeCi \I
DATE VACCINATED:
Producer: 2_ 0 e, Veterinarlan's: # , nse N, ) . ; ;
(First 3 letters) / ' a )j55Y.., ,A .. 0 U if.r1_,
Month Day ear ,
.>Z2, yr. Lic./Vacc. (I Igsatvre). _ , , , . .;' 1 'H 07'2
VACCINATION EXPIRED: 0 3 yr. Lic./Vacc. 41146 VN:'kjtili , k..., i
Other
CI 1 1 el 2- 'g 2-2:771
Month Day Year Vacc. Serial (lot) no. 19 . )0 F Pe ,-e
: 1:,,:! .41
Gilarither AZ. do;423

Humane Society of Yuma, Inc.
4050 SOUTH AVE 4 1/2E
YUMA, AZ 85365
Phone: (928) 782-1621
SAVE ONE UNTIL THERE ARE NONE
Vaccination Certificate
Vaccination information:
Vaccination ID HSOY
Vaccination Type RABIES
Effective Date 08-21-2018
Expiration Date 08-21-2019
Issued by ERNESTO SANDIGO...
Drug( administered:
Manufacturer MERIAL
Vaccine IMRAB 3 TF
Lot ID
Serial ID 18384
About this animal
Pet Name HAMMY License None on record
Species DOG 10#: 166688 Vacc ID HSOY
Primary Breed TERRIER Microchip 900074001755215
Gender MALE/STERILIZED Registration None on record
Age ADULT
Size LARGE Bites NO
Veterinarian Signature
Veterinary License #
Federal Tax 113 86-6053617
Printed using Shelter Pro

Humane Society of Yuma, Inc.
4050 SOUTH AVE 4 112E
YUMA AZ 85365
Phone: (928) 782-1621
SAVE ONE UNTIL THERE ARE NONE
Vaccination Certificate
Vaccination information;
Vaccination ID HSOY
Vaccination Type RABIES
Effective Date 09-05-2018
Expiration Date 09-05-2019
Issued by ERNESTO SANDIGO,..
Drug administered
Manufacturer MERIAL
Vaccine IMRAB 3
Lot ID
Serial ID 18386
About this animal
Pet Name SIMON License None on record
Species DOG ID#: 201617 Vacc ID HSOY
Primary Breed CHIHUAHUA Microchip None on record
Gender MALE/STERILIZED Registration None on record
Age ADULT
Size SMALL Bites NO
Veterinarian Signature
Veterinary License # 330; tqwpopygpol
Federal Tax ID 86-6053617
Printed using Shelter Pro

RABIES VACCINATION CERTIFICATE
OWNER'S iNFORMATION:
RESCUE FRIENDS FOR LIFE P1279029 (480) 4978296 SHELTE
1..A6T RAVE NMI NAME PERSON II:i TELEpHoNE NUHRER EX1
_.
952 W MELODY AVE GILBERT AZ 85233
FOR ET ADDRESS WI Cfry SWF IT CODE
ANIMAL INFORMATION
DOG NEUTERED 8/31/2016 SMALL CHIHUAHUA SH MIX
MOM TYPE ANDAA1. SEX AN,VAL DAIS OF RIR-SH SW PAVARY 6FIE) 6-ECONOMY BREED
1, , BLACK WHITE
A4115385
AMMAh_13 b&l.c,)clf--) ...I::VAL NAVE It.CROCKP NO/SECI PROAARY COLOR SECONIJARY COLOR
VACCINATION INFORMATION
ZOETIS 12 Months 9/4/2018 9/4/2019 9/4/18
VACCiNE PRONICER VACC. LENOIH DAT E VCINAT) AC E( VAccLUArION EXP=RES PRNT CATE
I
KILLED maricona County
Animal Carc & Control
VP,CONE PIPE VE'rERKMAYP 661NATURF 2500 S 27th Avenue, Vhoen ix, AZ 85009
(602) 506-7387
SN267254 Az4096
MC $ERLAL NO VETE-RN/JIM-6 CLENSE NVVEIER