BUCKEYE ANIMAL RESCUE & 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 K, in 000059
APPLICATION
El New a Renewal
Name: Lib MtAlk,k Kennel Name:etakAK. ailitnOd Qiuo
A
Mailing Address: lei I N. 2,00 Kennel Address: 19 19 v_vo-ii (44,
citylkt&t4 12_ State: AZ Zip: 00'9' eP City: j&tCkL Lt Zip: 521(o
4
County Supervisorial District:
Phone: 111g- snip 301-5 Kennel Phone: t022)' '824 67,5
Please complete and sign this application and return it to the above address with payment in the amount of three
hundred twenty-eight dollars ($328.00) 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 $4 per month for unaltered dog and $2 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 or A.R.S. §11-
WO.
PLEASE ANSWER THE FOLLOWING QUESTIONS AND INITIAL EACH RESPONSE
1. 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
oditions (ARS 11-1001).
I/We certify that I/We have dogs and that the kennel meets the definition in statute.
3. INVe.certify that l/We have not been convicted of a violation of A.R.S. §§ 13-2910 (cruelty to animals)
or 1 -2910.01 (dog fighting), or similar violations of any other state, county or municipal animal welfare law.
(Vio ions of license and leash laws DO NOT apply).
4. I/We certify that all dogs over the age of three (3) months that are kept, harbored or maintained on the
pre es 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 INVe are submitting a valid copy of the rabies vaccination certificate for each
dos_with this application. •
INVe understand that a dog remaining within the kennel is not required to be licensed individually under
A. . § 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
u • - this section.
7 FA INVe understand that a person who fails to obtain a kennel permit under A.R.S.§11-1009 is subject to a
pe 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
notification 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
mess and is solely used for the purpose of licensing multiple dogs.
1/We certify that all of the information INVe have provided is true and accurate under penalty of law.
Applicant Signature j. OkAadY ,__ Date: 1 4 tZ ab ?)
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 -347940 Receipt Date: 01/2412018
Person ID: P2262784
Phone: 623 8263085
BUCKEYE ANIMAL RESCUE KENNELS
1919 N 200TH AVE 1/24/2018 1:37:45PM
BUCKEYE, AZ 85396
Item: Animal ID: Reference No: Price: Each: Amount:
KEN PERMIT A7777777 K18-000054 $328.00 1 $328.00
Total Fees Due: $328.00
Payments: Cash:
Check: $328.00
Credit Card:
Total Payments Received: $328.00
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
saucedos WBUSOFF

Maricopa County
Animal Care & Control
2500 South 27th Avenue
Phoenix, AZ 85009
Phone: (602) 506-7387
pets.marieopa,gov
KENNEL PERMIT K18-000054
PREMISE INSPECTION
Number of Dogs: 14
Name: Lilia Mutka Kennel Name: Buckeye Animal Rescue and Kennel
Mailing Address: 1919 N 200th Ave Kennel Address: Same
City: Buckeye State: AZ Zip:85396 City: Buckeye Zip: 85396
County Supervisorial District: 4
Phone: 623-826-3085 Kennel Phone: 623-826-3085
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: Kennel has been previously inspected and there have been no violations at the
address
Deputy Enforcement Agent & Badge #: Lt Amber Romero RC4 Date: 1/24118
October 2015

RABIES VACCINATION CERTIFICATE
OWNER'S INFORMATION:
MUTKA LILIA P2285030 (623) 8263085
LAST NAME FIRST RAMS PERSON ID TELEPHONE NUMBER
1919 N 200TH AVE BUCKEYE AZ 85396
STREET ADORESS APT CRY STATE ZIP CODE
ANIMAL INFORMATION
DOG NEUTERED 10/7/2014 LARGE SIBERIAN HUSKY MIX
ANIMAL TYPE ANIMAL srx AN MAL DATE OF BIRTH SIZE PRIMARY BREED SECONDARY BREED
A3839047 KODA BLACK WHITE
ANIMAL ID ANIMAL NAME MICROCHIP NURSER PRIMARY COLOR SgCONDARY COLOR
VACCINATION INFORMATION
RABDOMUN SPEC 12 Months 1/3/2018 1/3/2019 1/3/18
1
VACCINE PRODUCER VACC LENGTH corn VACCINATED VACCINATION EXPIRES PRINT DATE
---?
- -zz ..„,.....-
KILLED -------- Maricopa County
- Animal Care & Control ..
VACCINE TYPE VETERINARIANS SIGNATURE 2500 S 27th Avenue, Phoenix, AZ 85009
(602) 506-7387
SN221615 AZ4096
VACC. SERIAL NO VETERINAR MS LICENSE NURSER

Pulse: 108
Respiration: 27 Petco 1173
Weight: 63 1985 N Pebble
Creek Pkwy
Normal: Circulation, Respiratory, Lymph, Peoria, AZ 85395
Appearance, Skin, Eyes, Ears,
VetcoClinics.com
Mouth, Mucus Membanes,
Musculo Skeletal
Visit Summary
Abnormal. None
Unable None uttorner1n orrnation --1.05
To
Examine: . Customer Name: Buckeye Animal Rescue
Kennel
ASSESSMENT: Ok to vaccinate . Spouse/Other
. Address: 1919 N 200th Ave
PLAN: Buckeye, 85396
Vetco Wellness Examination $0.00 I County Maricopa County
Rabies Vaccination 1 Year $19.00
Phone: 623-826-3085
Vaccination information: Vaccine Name: R
abeac3 I Alternate.
Serial #: 4150443A I Email:
Manufacturer: Boehringer ingelheim
Exp Date: 3/3/2019 First Visit 08-17-2017
Virus Type: K I Last Visit 09-14-2017
Administered: SO
Site of Injection: RS
Bravecto Blue 44-88 lbs 3 Months (1 $48.00 Pet Intermation . '
Tablet) Pet Name Little bit
Discount -$3.80
Record #: 123643
Estimated Tax: $0.00
Species: Canine
Pet Visit Total: $63.20
Breed: Pit bull Terrier
COMMENTS: Nail trim. Color Brown
Sex: Spayed Female
Weight 63
overview
DOB: 09-15-2011
Date Given Description Due Date I Age: 5 yrs 11 months
09/14/2017 Bravecto Blue 12/13/2017 I Microchip #:
44-88 Ibs I Rabies Tag:
09/14/2017 Rabies 09/14/2018 I Medications
Vaccination Last Visit 0914-2017
09/14/2017 Vetco Wellness 09/14/2018
Examination
Thank you for visiting vErco Clinics. Below s a
summary of Little bith visit today.
Date of Service: 09-14-2017
Veterinarian
HISTORY: Pet presented for vaccines..
ATTENDING VETERINARIAN: Dr. Augustine
SUBJECTIVE Owner reports pet is healthy eating
LICENSE #. 3635
normally, active and showing no signs of illness.
OBJECTIVE: Vetco Wellness Exam
Tamnarztt lrA i fli A

RABIES VACCINATION CERTIFICATE Tag fee $:
ADAPTED NASPHV FORM 51 Tag #:
Ow'ner's Name & Address PRINT - Use ball point pen or type Cert. Serial #:
PRINT FIRST MI TELEPHONE
NO. STREET CITY STATE ZIP
SPECIES: SEX: AGE: SIZE: P DOMINANT BREED: CO S:„,,, ( y
Dog Mate 0 3 Mo. to 12 Mo. 0 Under 20 lbs. 0
Cat 0 Female 12 Mo. or older 20 - 50 lbs 0 V- I 4- CI
Other 0 Altered Over 50 lbs. Li NAME: iNck_ek
(Specify) ,C'''
,
OAT VACCINATED: PRODUCER: n
Veterinarian's # ,..• _.: •
I 0
Month Day Year (First 3 Letters)
Vetorinars1.4
1 yr. Lic.Nacc. 0 Sign re
VACCINATION EXPIRES: N
i j (30 3 yr. Lic.Nacc, NI Ad • ress
q 1,(,-- x/S-i-1,4 vu-Q.0
Mo th Day Year 3--)3
Vacc. Serial (Lot) No.
VAC0410001
RABIES VACCINATION CERTIFICATE Tag fee $:
ADAPTED NASPHV FORM 51 Tag #:
Owner's Name &Address PRINT - use ball point pen or type Cert. Serial #:
FIRST MI TELEPHONE
NO. STREET CITY STATE ZIP
SPECIES: SEX: AGE: SIZE: PREDOMINANT BREED: COLORS:
Dog Male 3 Mo. to 12 Mo. o Under 20 lbs. LI kkr-\
Cat 0 Female 12 Mo. or older sg-20 - 50 Ibs .>ef
Other 0 Altered Over 50 lbs. 0 NAME:
(Specify) (,0% Of\ ‘ e____
...3 , . 5.
DIE‘ VAC.CINATED: PRODUCER: Veterinarian's #
License
_—
Month Day Year (First 3 Letters) Veterinarian's
, ..
1 yr. Lic.Nacc.W Signature
1/,.. CINATI12 EXPIRE7i_
3 yr. Lic.Nacc. 0 Address
CY q t -5ctid(i,‘ A
Month Day ear
Vacc. Serial (Lot) No.
VAC0410001

Tag fee $:
RABIES VACCINATION CERTIFICATE
ADAPTED NASPHV FORM 51 Tag #:
PRINT - use ballpoint pen or type Cert. Serial #:
Owner's Name & Address
PRINT LASb n pteRST MI TELEPHONE
NO. STREET CITY STATE ZIP
SPECIES: SEX: AGE: SIZE: PREDOMINANT e BR ED: caofisi
Dog )!P Male 124) Months fj Under 20 lbs. U vitt_
Cat U Female 0 ..5 20-50 lbs. U ,.
Other 0 Altered JO Years V' Over 50 lbs. INC NAME: Mat
(Specify)
gi't/P 1 il) i
il oil
DATE VACCINATED: PRODUCER: Veterinarian's # 36 3
9 . /i-I . /1- (First 3 Letters) License No.
Month Day Year PRQRUCT NAME: ----, Veterinarian's Name (please rint)
VACCINATION EXPIRES: 1 yr. LicNacc.
Signature
3 yr. LicNacc. 0 Li ,
Li Is° Li 3 y4) Address , — 4
Month Day Year
Vacc. Serial (Lot) No.
USCAHNON02066

'—'572t725i7 Multi Vaccination Certificate
Vaccination Certificate - Tel: 928-445-2666
Receiving
1605 Sundog Ranch Road
PRESCOTT Arizona 86301 USA
info@yavapaihumane,org
www.yavapaihumane.org
Animal Information
Animal ID: A35263242 Name: Mile Types: Dog Gender: Female
ARN: DOB: 11/2/2014 Breeds: Siberian Husky, Mix Altered: No
Chip #: Current Age: 2y 6 m23 d Colors: White/Grey Size: Medium
Type: Age Group: Adult Pattern: Weight: 31.70 pound
Vaccination Certificate
Vaccine:Naramune 2- Status: Completed Status Date: 05/25/2017 Dose: 1.00 vial
Intranasal
Length: 6 months Re-Vac 11/25/2017 Body Part: Nose Route: Intranasal
Date:
Product:Naramune-2 Provider: Gabriel Assistant: Matthew Type:
Alexander Buchhoitz
Mfg: Boehringer Ingelheim Serial / Lot 1040731a Expiry Date: 08/24/2018 Container
#: #:
ID #: issued: ID Issuer: Is License? No
ID Type: Expires: Issuer
Phone:
Vaccine:Defensor 1 (Rabies 1 Status: Completed Status 05/25/2017 Dose: 1.00 mL
year) Date:
Length: 1 years Re-Vac 05/25/2018 Body Part: Rear right leg / Route: Subcutaneous
Date: paw
Product: Defensor 1 Provider: Gabriel Assistant: Matthew Type: Killed
Alexander Buchhollz
Mfg: Zoetis Serial / Lot 188817B Expiry 04/10/2018 Container
#: Date: #:
Vaccine:Duramune DAPP - Status: Completed Status 05/25/2017 Dose: 1.00 mt.
Vaccine Date:
Length: 1 years Re-Vac 05/25/2018 Body Part: Front left leg! Route: Subcutaneous
Date: paw
Product: Galaxy DA2PPv Provider: Gabriel Assistant: Matthew Type:
Alexander Buchhoitz
Mfg: Merck Animal Health Serial/Lot 9160269A Expiry 04/05/2018 Container
#: Date: #:
hereby certify that this animal has been vaccinated in accordance with the manufacturer's recommendation for the
vaccine used on the above date.
Date Issued:
Leo Eger D.y.m. tiIese 4t6
Miles Killian D.V.M. License: 1431
Richard Fisher D.V.M. Lic4nsel 736
https://srns.petpoint.corn/sms3/embeddectreports/MultiVaccinationCertificate.aspx?AnimatID=.35263242 1/2

!I Account #: 6316 Animal: Donte
Owner: LBW Mutka 3115/74 BARK Species: Canine
Address: 1919 N. 200th Ave Breed: German Sborthaired Pointer
Buckeye, AZ 85396 Color: CHOCOLATE/WHITE
Gender: Male Neutered
Phone: (623)826-3085 Birthdate:
(602)212-6700 Age:
Weight: 29.10
Chip #:
09/06/2017 Rabies-Rescue 1 year ZOE 188844 Killed 09/05/2018
(w/Surgety)
'I
-
IJulia Neufeld, DVM 09/06/2017
3538
Account #: 6316 Animal: Lucious
Owner: Lilia Mutka 3/15/74 BARK Species: Canine
Address: 1919 N. 200th Ave Breed: German Shorthaired Pointer
Buckeye, AZ 85396 Color: Wit/BROWN
Gender: Female Spayed
Phone: (623)826-3085 Birthdate:
(602)212-6700 Age:
Weight: 22.00
Chip #:
09/06/2017 Rabies-Rescue 1 year
(w/Surgery)
) &A-414k D 01
Julia Neufeld, DVM 09/06/2017
3538

RABIES VACCINATION CERTIFICATE Tag fee S.
ADAPTED NASPHV FORM 51
Owner's Name & Address PRINT - use ball point pen or type Cert. Serial #:
PRINT LAST MST ..„.. MI TELEPHONE
/"A _A -A0 411/ 4s A ..1 ..,..-C. . 2raf'
NO. c......140 S,TRa EET I or , TATE ziF216.s44._
SPECIES: ' . SEX: SE : PREDO N NT BREED: OLOFiS: i i ,
Male E :1VElo: 5 . o 12 Mo. 0 U ade r 20 lbs. D
Cat lil Female Mo or older 'Er- 20 -50 lbs 0 A '0
Other 0 Altered Over 50 lbs. NAME:
(SPacifY)
DA r VACCINATED: PRODUCER:
---z...." Veterinari an's # 4833
0 17 No
Month Day Year yirst 3 Letters)
Veterinan
1 yr. UcJVacc. FEr
VAC NATION PI ES: SignattkUStin Avenue Anima( Hospital
is 3 yr. Lic.Nacc. 0 r, Address John Y. Tarlton, D.V.M.
Month a Year a -4-- 2201 South Austin Avenue
Vacc. Serial (Lot) No. -faeorgetovirrc-Teralia326---
512-883-5319
VAC0410001
RABIES VACCINATION CERTIFICATE Tag fee $.
ADAPTED NASPHV FORM 61 Tag #:
Owner's Name &Address PRINT - use bell point pen or type Cert. Serial #:
PRINT LAST Fl T -- MI TELEPHONE
-ttd 5 m —4 2—c1 -14
NO. - STREET .A4LULea"e CITY 1.-\ ) ATE
ZIP
4 66 ..--' ( 1 6
SPECIES: ...,„...SEX:- AGE: 7t, _ SIZE: PREDOMINTT BREED: COLORS: S—Il l?
Dog kli- 11=2:1,....11kf."0, .: 1021deMro.,E r}tiorid-e5r02tObsIbs. DE]
Cat 0 Female X
Other 0 Altered Over 50 lbs.
(SPecifY) 12
DATE ACCINAT D: 0 PRODUCER:
Veterinarian's # N4833
enle A
mo a Year (prst 3 Letters) /2 0,16ic-k-6,7 - ' 1 fill-36,/in
Veterinariqp'e
1 yr. Lic.Nacc, ile
VACCINATIO EXPIRES: 3 u SignattiretStirl Avenue Animal Hospital
),-/ iv yr. c.Nacc. 0 Address JOhfl Y. Tarlton, D.V.M.
mo th y Year a. IA.13 vs--- 2201 South Austin Avenue
Vacc. Serial (Lot) No. • (.Aeorgetovin, exa5 786
VAC0410001 512-883-5319

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Month Month 0 DATE (Specify) Other Cat Dog NO. PRINT
USCAHNON02066 VACCINATION 1 ID SPECIES: Owner's
Day If Day Dr LAST
if VACCINATED: Name
Year 1 EXPIRES: Year / Altered Female Male SEX: STREET &
D ID °I Address
3 1
yr. yr. Years Months AGE:
LicNacc. PRODUCER: FIRST
LicNaccA PRODUCaMbu2
Vacc. CI RABIES
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Serial 3 PRINT ADAPTED
9 Letters) Over uyer 20-50 Under SIZE: CITY —
(Lot) roticL634}. 5u use VACCINATION
No. fros. tL lbs. lbs. 20 ballpoint NASPHV
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Address Signature NAME: type or FORM
Veterinarian's Veterinarian's PREDOMINANT 51 CERTIFICATE
Fir e STATE MI
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No COLORS: ZIP Cert. Tag Tag
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Serial $:
#:
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Tag fee
RABIES VACCINATION CERTIFICATE
ADAPTED NASPHV row 51 Tag #:
PRINT - use ballpoint pen or type Cert. Serial #:
Owner's Name &Address
PRINT FIRST MI TELEPHONE
LA6A Qii
-
NO. STREET CITY STATE ZIP
SPECIES: SEX: AGE: SIZE: PREDOMINANT BREED: COL6SLaUL
Dog )41 Male 6 Months iu Under 20 lbs. 0
Cat U Female 0 i n 20-50 lbs. 10 5k-1/1 1o/;
Other 0 Altered t Years I Li- Over 50 lbs. cr N4ME: k_
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DATE VACCINtTEDI: 7 PRODUCER: c 0 E.., Veterinarian's # _.. .
I i (First 3 Letters) License No.
Month Day Year PRODUCT NelE: Veterinarian's Name {please print)
A_ , --s
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VACCINATION EXPIRES: 1 yr. LicNacc. U
Signature
:51 W 3 yr. LicNacc.17 )1C, Lit5014W4—
Address
Month Day Year cie sc--EiV 5. 75-
Vacc, Serial (Lot) No.
USCAHNON02066
Tag fee $:
RABIES VACCINATION CERTIFICATE
ADAPTED NASPHV FORM 51 Tag #:
PRINT- use ballpoint pen or type Cert. Serial #:
Owner's Name & Address
PRINT LAST FIRST MI TELEPHONE
PD4-04----
NO. STREET CITY STATE ZIP
SPECIES: SEX: AGE: SIZE: PREDOMINANT BREED: COLORS:
Dog t9 Male A Months u Under 20 lbs. U
Cat 0 Female U k 20-50 lbs. CI il-K.J-Skl.
Other D Altered p Years \ Ce( Over 50 lbs. pc. NAME:
(Specify) • maabc-A
DATE VACCINATED: PRODUCER: pipe= Veterinarian's 4 Cpg
Milirala
1 License No.
(First 3 Letters)
Month Day Year PRODUCT - Veterinarian's ame (p,i -se •ri t)
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VACCINATION EXPIRES: 1 yr. LicNacc. Ix-
I r5"---- Signature
( — 3 yr. LicNacc. 0
1,..1 6 01414 Address
Month Day Year
Vacc. Serial (Lot) No. ,
USCAHNON02066

Rabies Vaccination Certificate
Owner's Information
GARCIA ARTHUR P2610418 (623) 5223291
Last Name First Name Person ID Telephone Extension
7007 W INDIAN SCHOOL RD 1210 PHOENIX AZ 85033
Street Address Apartment/Unit City State Zip
Animal Information
DOG Neutered 07/2112011 MED SIBERIAN HUSKY
Animal Type Animal Sex Animal Date of einh Animal Size Primary Breed Secondary Breed
A3965428 --41AA1OQK /4 tte-L- 985112006296229 TRICOLOR WHITE
Animal ID Animal Name Microchip Number Primary Color Secondary Color
Vaccination Information
RABDOMUN SPEC 12 Months 08/04/2017 08/0412018 08/04/2017
Vaccine Producer Vaccination Length Date Vaccinated Vaccination Expires Ptint Date
kairc\I ---
KILLED -
Maricopa County
Vaccine Type Veterinarian Signature Animal Care and Control
SN182850 2500 S. 27th Ave, Phoenix, AZ 85009
Vaccination Serial Number Verterinarian's License Number (602) 505- 7387