BUCKEYE BULLDOGGES KENNEL PERMIT RENEWAL.PDF

P23 3Z3
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 #19-000060
X Renewal
Name: Kennel Name: eigkCy( J314)ideWcS.
Mailing Address: 1131/8.S cQ0641-tsne, Kennel Address: C-k YYI e
City: State: AZ Zip: g(5-,39& City: Zip:
County Supervisorial District: C
Phone: 6a2 7-034d, Kennel Phone: 440 -75;27-&3
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 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.
LEASE ANSWER THE FOLLOWING QUESTIONS AND INITIAL EACH RESPONSE
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).

e certify that I/We have S-."-- dogs and that the kennel meets the definition in statute.
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.
(ViolationsAf license and leash laws DO NOT apply).
I/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 t e state of Arizona and that a current vaccination certificate signed by a licensed veterinarian is
maintaine n the premises for each dog.
/We certify that I/We are submitting a valid copy of the rabies vaccination certificate for each
is application.
/We understand that a dog remaining within the kennel is not required to be licensed individually under
A7R.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
uncterthis section,
1/We understand that a person who fails to obtain a kennel permit under A.R.S.§11-1009 is subject to a
pvatty of twAthy-five dollars in addition to the annual fee.
INVe 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..
he 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.
IIWe certify that all of the information INVe have provided is true and accurate under penalty of law.
Applicant Signet 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
http://pets.maricopa.gov
Receipt Number: R18-532353 Receipt Date: 0810712018
Person ID: P2381323
Phone: 602 5270366
BUCKEYE BULLDOGGES KENNELS 8/7/2018 10:42:52AM
13411 S 208TH DR
BUCKEYE, AZ 85326
Item: Animal ID: Reference No: Price: Each: Amount:
KEN PERMIT A7777777 K19-000060 6350.00 1 $350.00
Total Fees Due: $360.00
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
APODACAP WBUSOFF

Maricopa County
Animal Care & Control
2500 South 27" Avenue
Phoenix, AZ 85009
Phone: (602) 506-7387
pets.marieopa.gov
KENNEL PERMIT K19-000060
PREMISE INSPECTION
Number of Dogs: 5
Name: Donna Williams Kennel Name: Springbrook Kennels
Mailing Address: 13411 S 208th Dr Kennel Address: Same
City: Buckeye State: AZ Zip:85326 City: Phoenix Zip: 85326
County Supeivisorial District: 5
Phone: 602-527-0366 Kennel Phone: 602-527-0366
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 8/14/18; all 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: 8/14/18
October 2015

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Has your pet had any coughing or sneezing in the past week? YES
Has your pet had any diarrhea or vomiting in the past week? YE Special notes:
Has your pet ever had any reaction to any vaccination? YES
Is your pet on antibiotics or anylither.medications? YES
How did you hear about us?
I understand that vaccinations can cause reactions in some patients and that I will Jae responsible for any costs related to
I agree to indemnify and hold harmless Shot Spot Vaccinations, LLC and the attending veterinarian(s) from and
their treatment. any and au i liability arisinv, out of the performance of all procedures that 1h ,a'Ve copented to today.
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Exam notes
Veterinarian Signature:
Cat Care Provided Today:
Dog Care Provide, t/cfr'd o ay.
2-0 0 1 year Rabies (RR) SQ Expires: 0 1 year
Rabies (RR) SQ Expires:5' Manufacturer : Pfizer 0 3 year
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