ALPINE KENNELS 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 \I4I Renewal Permit # 0000 Y1,
,
Name. Kennel Name: 41;0( La k—()// 71-didA=
Mailing Address: 29'416 (V16/41-/ Kennel Location: .7 ‘.(77//6 /1../76 (//
•--t1C1.1
c. „ 2 ZtP County Supervisorial District
Home Phone: O 2 332- 4.444-0‘2 Kennel Phone: 6.:; ?(-.52 Zr (I
6 2 2.D :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 ($328.00) within ten (10) days of receipt.
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. 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
1. (,/ -0 I/We assume complete responsibility for the kennel at the premises for which I/we are making
applibbftion 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
I/We certify that1NVe have dogs and that the kennel meets the definition in statute.
3. - INVe certify that INVe have not been convicted of a violation of A.R.S. §§ 13-2910 (cruelty to animals)
or-13-1910.01 (dog lighting), or similar violations of any other state, county or municipal animal welfare law.
(Violations of license and leash laws DO NOT apply).
4; 111/Ve 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. tl NVe - certify that l/We are submitting a valid copy of the rabies vaccination certificate for each
dog with this application.
6." LT-1/We understand that a dog remaining within the kennel is not required to be licensed individually under
A.R.S. § 11-1008. l/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.
17We 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.
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..
The-undersigned understand that that the kennel permit does not authorize the operation of any type
ofliiiihess and is solely used for the purpose of licensing multiple dogs.
Iffle certify that all of the information INVe have,,provided is true and accurate under penalty of law.
X/ /.;
'---) ,. (/ , / /
Applicant Signature ,_—,-- :,.. i. ,-/ 4:_; C. Date: (//// / //, (2) ,/d"i
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

Ttliarioopa County Animal Care and Control
2500 S. 27th Avenue
Phoenix, AZ 85009-6797
(602) 506-7387
http://pets.maricopa.00v
Receipt Number: R18-338453 -Receipt Date: 01/12/2018
Person ID: P1890454
Phone: 623 3885000
ALPINE KENNELS 1/1212018 4:26:07PM
29416 N 161ST AVE
SURPRISE, AZ 85387
Item: Animal ID: Reference No: Price: Each: Amount:
KEN PERMIT A7777777 K19-000039 $328.00 1 $328.00
Total Fees Due: $328.00
Payments: Cash:
6-heck:
Credit Card: $328.00
- 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

Maricopa County
Animal Care & Control
2500 South 27th Avenue
Phoenix, AZ 85009
Phone: (602) 506-7387
pets.maricopa.gov
KENNEL PERMIT K19-000039
PREMISE INSPECTION
Number of Dogs: 23
Name: Zdenen Blabla Kennel Name: Alpine Kennels
Mailing Address: 29416 N 161st Ave Kennel Address: Same
City: Surprise State: AZ Zip:85387 City: Phoenix Zip: 85387
County Supervisorial District: 4
Phone: 605-332-4404 Kennel Phone: 623-388-5000
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 was inspected on 1/24/18 and met all requirments.
Deputy Enforcement Agent & Badge #: G. Bell #17 Date: 1124/18
October 2015

15411 N 31st St. Phoenix, AZ 85032. Phone (602) 971-9651
Certificate of Rabies Vaccination
Date of Rabies Vaccination: 01-07-18 Certificate No: 0
OWNER OF ANIMAL
First Name: Zdenek Last Name: Blabla
Address: 29416 N 161 Ave
City: Surprise State: AZ Zip: 85387
County:
This is to certify...
THAT I HAVE VACCINATED THE ANIMAL DESCRIBED BELOW AGAINST THE
RABIES VIRUS.
Patient Information:
Patient: Zuma Sex: Female
Species: Canine Age: 7Y
Weight: 55.00 Color and Markings: Sable
Microchip:
Breed: Shepherd, German
Signed:
Vaccinations Performed:
Vxn Rabies Vaccination, 3 Year
Next Rabies Vaccination Due: 01-06-21
Rabies Vaccination Information:
Manufacturer: BOE Serial Number: 4150440A
Lot Expiration: Feb.2019 Administered: Sq

eqi care and kin
15411 N 31st St. Phoenix, AZ 85032. Phone (602) 971-9651
Certificate of Rabies Vaccination
Date of Rabies Vaccination: 01-07-18 Certificate No: 0
OWNER OF ANIMAL
First Name: Zdenek Last Name: Blabla
Address: 29416 N 161 Ave
City: Surprise State: AZ Zip: 85387
County:
This is to certify...
THAT I HAVE VACCINATED THE ANIMAL DESCRIBED BELOW AGAINST THE
RABIES VIRUS.
Patient Information:
Patient: Zigge Sex: Female
Species: Canine Age: 4Y
Weight: 60.00 Color and Markings: Sable
Microchip:
Breed: Shepherd, German
Signed: 4•10
Kef y Hehn, DVM License: 4188
Vaccinations Performed:
Vxn Rabies Vaccination, 3 Year
Next Rabies Vaccination Due: 01-06-21
Rabies Vaccination Information:
Manufacturer: BOE Serial Number: 4150440A
Lot Expiration: Feb.2019 Administered: Sq

15411 N 31st St. Phoenix. AZ 85032. Phone (602) 971-9651
Certificate of Rabies Vaccination
Date of Rabies Vaccination: 01-07-18 Certificate No: 0
OWNER OF ANIMAL
First Name: Zdenek Last Name: Blabla
Address: 29416 N 161 Ave
City: Surprise State: AZ Zip: 85387
County:
This is to certify...
THAT I HAVE VACCINATED THE ANIMAL DESCRIBED BELOW AGAINST THE
RABIES VIRUS.
Patient Information:
Patient: Wolfie Sex: Female
Species: Canine Age: 6Y
Weight: 55.00 Color and Markings: Sable
Microchip:
Breed: Shepherd, German
Signed:
Nhn, DVM License: 4188
Vaccinations Performed:
Vxn Rabies Vaccination, 3 Year
Next Rabies Vaccination Due: 01-06-21
Rabies Vaccination Information:
Manufacturer: BOE Serial Number: 4150440A
Lot Expiration: Feb.2019 Administered: Sq

15411 N 31st St. Phoenix, AZ 85032. Phone (602) 971-9651
Certificate of Rabies Vaccination
Date of Rabies Vaccination: 01-07-18 Certificate No: 0
OWNER OF ANIMAL
First Name: Zdenek Last Name: Blabla
Address: 29416 N 161 Ave
City: Surprise State: AZ Zip: 85387
County:
This is to certify...
THAT I HAVE VACCINATED THE ANIMAL DESCRIBED BELOW AGAINST THE
RABIES VIRUS.
Patient Information:
Patient: Tiger Sex: Female
Species: Canine Age: 6Y
Weight: 60.00 Color and Markings: Sable
Microchip:
Breed: Shepherd, German
Signed: "0"N.
Ke y e ii, DVM License: 4188
Vaccinations Performed:
Vxn Rabies Vaccination, 3 Year
Next Rabies Vaccination Due: 01-06-21
Rabies Vaccination Information:
Manufacturer: BOB Serial Number: 4150440A
Lot Expiration: Feb.2019 Administered: Sq

15411 N 31st St. Phoenix, AZ 85032. Phone (602) 971-9651
Certificate of Rabies Vaccination
Date of Rabies Vaccination: 01-07-18 Certificate No: 0
OWNER OF ANIMAL
First Name: Zdenek Last Name: Blabla
Address: 29416 N 161 Ave
City: Surprise State: AZ Zip: 85387
County:
This is to certify...
THAT I HAVE VACCINATED THE ANIMAL DESCRIBED BELOW AGAINST THE
RABIES VIRUS.
Patient Information:
Patient: Tank Sex: Male
Species: Canine Age: 7Y
Weight: 65.00 Color and Markings: Sable
Microchip:
Breed: Shepherd, German
Signed: 4
Kelly" Hehn, DVM License: 4188
Vaccinations Performed:
Vxn Rabies Vaccination, 3 Year
Next Rabies Vaccination Due: 01-06-21
Rabies Vaccination Information:
Manufacturer: BOE Serial Number: 4150440A
Lot Expiration: Feb.2019 Administered: Sq

9te
gt care and kill
15411 N 31st St. Phoenix, AZ 85032. Phone (602) 971-9651
Certificate of Rabies Vaccination
Date of Rabies Vaccination: 01-07-18 Certificate No: 0
OWNER OF ANIMAL
First Name: Zdenek Last Name: Blabla
Address: 29416 N 161 Ave
City: Surprise State: AZ Zip: 85387
County:
This is to certify...
THAT I HAVE VACCINATED THE ANIMAL DESCRIBED BELOW AGAINST THE
RABIES VIRUS.
Patient Information:
Patient: Largo Sex: Male
Species: Canine Age: 8Y
Weight: 65.00 Color anti Markings: Sable
Microchip:
Breed: Shepherd, German
Signed:
Ke ly DVM License: 4188
Vaccinations Performed:
Vxn Rabies Vaccination, 3 Year
Next Rabies Vaccination Due: 01-06-21
Rabies Vaccination Information:
Manufacturer: BOE Serial Number: 4150440A
Lot Expiration: Feb.2019 Administered: Sq

Qt care and kill
15411 N 31st St. Phoenix, AZ 85032. Phone (602) 971-9651
Certificate of Rabies Vaccination
Date of Rabies Vaccination: 01-07-18 Certificate No: 0
OWNER OF ANIMAL
First Name: Zdenek Last Name: Blabla
Address: 29416 N 161 Ave
City: Surprise State: AZ Zip: 85387
County:
This is to certify...
THAT I HAVE VACCINATED THE ANIMAL DESCRIBED BELOW AGAINST THE
RABIES VIRUS.
Patient Information:
Patient: Jet Sex: Male
Species: Canine Age: 9Y
Weight: 60.00 Color and Markings: Sable
Microchip:
Breed: Shepherd, German
Signed: #71;-I —j7"
Kell ehn, DVM License: 4188
Vaccinations Performed:
Vxn Rabies Vaccination, 3 Year
Next Rabies Vaccination Due: 01-06-21
Rabies Vaccination Information:
Manufacturer: BOE Serial Number: 4150440A
Lot Expiration: Feb.2019 Administered: Sq

15411 N 31a St. Phoenix, AZ 85032. Phone (602) 971-9651
Certificate of Rabies Vaccination
Date of Rabies Vaccination: 01-07-18 Certificate No: 0
OWNER OF ANIMAL
First Name: Zdenek Last Name: Blabla
Address: 29416 N 161 Ave
City: Surprise State: AZ Zip: 85387
County:
This is to certify...
THAT I HAVE VACCINATED THE ANIMAL DESCRIBED BELOW AGAINST THE
RABIES VIRUS.
Patient Information:
Patient: Jager Sex: Male
Species: Canine Age: 24M
Weight: 65.00 Color and Markings: Black and Tan
Microchip:
Breed: Shepherd, German
Signed:
Kelly liehn, DVM License: 4188
Vaccinations Performed:
Vxn Rabies Vaccination, 3 Year
Next Rabies Vaccination Due: 01-06-21
Rabies Vaccination Information:
Manufacturer: BOE Serial Number: 4150440A
Lot Expiration: Feb.2019 Administered: Sq

t care anclki
15411 N 31st St, Phoenix, AZ 85032. Phone (602) 971-9651
certificate of Rabies Vaccination
Date of Rabies Vaccination: 01-07-18 Certificate No: 0
OWNER OF ANIMAL
First Name: Zdenek Last Name: Blabla
Address: 29416 N 161 Ave
City: Surprise State: AZ Zip: 85387
County:
This is to certify...
THAT I HAVE VACCINATED THE ANIMAL DESCRIBED BELOW AGAINST THE
RABIES VIRUS.
Patient Information:
Patient: Haka Sex: Female
Species: Canine Age: 12M
Weight: 60.00 Color and Markings: Sable
Microchip:
Breed: Shepherd, German
Signed: ,11 —.' 111--b/-- / -\ ,---, /)(" 71 \
Kelly fn, eh DVM License: 4188
Vaccinations Performed:
Vxn Rabies Vaccination, 3 Year
Next Rabies Vaccination Due: 01-06-21
Rabies Vaccination Information:
Manufacturer: BOB Serial Number: 4150440A
Lot Expiration: Feb.2019 Administered: Sq

‘444 Care and
15411 N 31st St. Phoenix, AZ 85032. Phone (602) 971-9651
Certificate of Rabies Vaccination
Date of Rabies Vaccination: 01-07-18 Certificate No: 0
OWNER OF ANIMAL
First Name: Zdenek Last Name: Blabla
Address: 29416 N 161 Ave
City: Surprise State: AZ Zip: 85387
County:
This is to certify...
THAT I HAVE VACCINATED THE ANIMAL DESCRIBED BELOW AGAINST THE
RABIES VIRUS.
Patient Information:
Patient: Gus Sex: Male
Species: Canine Age: 12M
Weight: 65.00 Color and Markings: Sable
Microchip:
Breed: Shepherd, German
Signed: Piz\
Kelly ehn, DVM License: 4188
Vaccinations Performed:
Vxn Rabies Vaccination, 3 Year
Next Rabies Vaccination Due: 01-06-21
Rabies Vaccination Information:
Manufacturer: BOE Serial Number: 4150440A
Lot Expiration: Feb.2019 Administered: Sq

15411 N 31st St. Phoenix, AZ 85032. Phone (602) 971-9651
Certificate of Rabies Vaccination
Date of Rabies Vaccination: 01-07-18 Certificate No: 0
OWNER OF ANIMAL
First Name: Zdenek Last Name: B labia
Address: 29416 N 161 Ave
City: Surprise State: AZ Zip: 85387
County:
This is to certify...
THAT I HAVE VACCINATED THE ANIMAL DESCRIBED BELOW AGAINST THE
RABIES VIRUS.
Patient Information:
Patient: Fury Sex: Female
Species: Canine Age: 3Y
Weight: 60.00 Color and Markings: Sable
Microchip:
Breed: Shepherd, German
Signed: V LA
Kel y ehn, DVM License; 4188
Vaccinations Performed:
Vxn Rabies Vaccination, 3 Year
Next Rabies Vaccination Due: 01-06-21
Rabies Vaccination Information:
Manufacturer: BOE Serial Number: 4150440A
Lot Expiration: Feb.2019 Administered: Sq

15411 N 31st St. Phoenix, AZ 85032. Phone (602) 971-9651
Certificate of Rabies Vaccination
Date of Rabies Vaccination: 01-07-18 Certificate No: 0
OWNER OF ANIMAL
First Name: Zdenek Last Name: Blabla
Address: 29416 N 161 Ave
City: Surprise State: AZ Zip: 85387
County:
This is to certify...
THAT I HAVE VACCINATED THE ANIMAL DESCRIBED BELOW AGAINST THE
RABIES VIRUS.
Patient Information:
Patient: Cibule Sex: Female
Species: Canine Age: 8Y
Weight: 60.00 Color and Markings: Sable
Microchip:
Breed: Shepherd, German
Signed:
Kell _Kehl?, DM License: 4188
Vaccinations Performed:
Vxn Rabies Vaccination, 3 Year
Next Rabies Vaccination Due: 01-06-21
Rabies Vaccination Information:
Manufacturer: BOB Serial Number: 4150440A
Lot Expiration: Feb.2019 Administered: Sq

Certificate of Rabies Vaccination
Date of Rabies Vaccination: 01-07-18 Certificate No: 0
OWNER OF ANIMAL
First Name: Zdenek Last Name: Blabla
Address: 29416 N 161 Ave
City: Surprise State: AZ Zip: 85387
County:
This is to certify...
THAT I HAVE VACCINATED THE ANIMAL DESCRIBED BELOW AGAINST THE
RABIES VIRUS.
Patient Information:
Patient: Chubo Sex: Male
Species: Canine Age: 8Y
Weight: 60.00 Color and Markings: Sable
Microchip:
Breed: Shepherd, German
Signed: K-1/7 111-N
kelly He/in, DVM License: 4188
Vaccinations Performed:
Vxn Rabies Vaccination, 3 Year
Next Rabies Vaccination Due: 01-06-21
Rabies Vaccination Information:
Manufacturer: BOE Serial Number: 4150440A
Lot Expiration: Feb.2019 Administered: Sq

15411 N 31st St. Phoenix, AZ 85032. Phone (602) 971-9651
Certificate of Rabies Vaccination
Date of Rabies Vaccination: 01-07-18 Certificate No: 0
OWNER OF ANIMAL
First Name: Zdenek Last Name: Blabla
Address: 29416 N 161 Ave
City: Surprise State: AZ Zip: 85387
County:
This is to certify...
THAT I HAVE VACCINATED THE ANIMAL DESCRIBED BELOW AGAINST THE
RABIES VIRUS.
Patient Information:
Patient: Chula Sex: Female
Species: Canine Age: 6Y
Weight: 55.00 Color and Markings: Sable
Microchip:
Breed: Shepherd, German
Signed:
Ke ly flehn, DVM License: 4188
Vaccinations Performed:
Vxn Rabies Vaccination, 3 Year
Next Rabies Vaccination Due: 01-06-21
Rabies Vaccination Information:
Manufacturer: HOE Serial Number: 4150440A
Lot Expiration: Feb.2019 Administered: Sq

15411 N 31st St, Phoenix, AZ 85032. Phone (602) 971-9651
Certificate of Rabies Vaccination
Date of Rabies Vaccination: 01-07-18 Certificate No: 0
OWNER OF ANIMAL
First Name: Zdenek Last Name: Blabla
Address: 29416 N 161 Ave
City: Surprise State: AZ Zip: 85387
County:
This is to certify...
THAT I HAVE VACCINATED THE ANIMAL DESCRIBED BELOW AGAINST THE
RABIES VIRUS.
Patient Information:
Patient: Chubra Sex: Female
Species: Canine Age: 12M
Weight: 55,00 Color and Markings: Black and Tan
Microchip:
Breed: Shepherd, German
Signed:
KellyTlehn, DVM License: 4188
Vaccinations Performed:
Vxn Rabies Vaccination, 3 Year
Next Rabies Vaccination Due: 01-06-21
Rabies Vaccination Information:
Manufacturer: BOE Serial Number: 4150440A
Lot Expiration: Feb.2019 Administered: Sq

15411 N 31st St. Phoenix, AZ 85032. Phone (602) 971-9651
Certificate of Rabies Vaccination
Date of Rabies Vaccination: 01-07-18 Certificate No: 0
OWNER OF ANIMAL
First Name: Zdenek Last Name: Blabla
Address: 29416 N 161 Ave
City: Surprise State: AZ Zip: 85387
County:
This is to certify...
THAT I HAVE VACCINATED THE ANIMAL DESCRIBED BELOW AGAINST THE
RABIES VIRUS.
Patient Information:
Patient: ChiChi Sex: Female
Species: Canine Age: 3Y
Weight: 60.00 Color and Markings: Sable
Microchip:
Breed:
Signed:
License: 4188
Vaccinations Performed:
Vxn Rabies Vaccination, 3 Year
Next Rabies Vaccination Due: 01-06-21
Rabies Vaccination Information:
Manufacturer: BOE Serial Number: 4150440A
Lot Expiration: Feb.2019 Administered: Sq

eqt Care and kin
15411 N 31st St. Phoenix, AZ 85032. Phone (602) 971-9651
Certificate of Rabies Vaccination
Date of Rabies Vaccination: 01-07-18 Certificate No: 0
OWNER OF ANIMAL
First Name: Zdenek Last Name: Blabla
Address: 29416 N 161 Ave
City: Surprise State: AZ Zip: 85387
County:
This is to certify...
THAT I HAVE VACCINATED THE ANIMAL DESCRIBED BELOW AGAINST THE
RABIES VIRUS.
Patient Information:
Patient: Burdette Sex: Female
Species: Canine Age: 6Y
Weight: 55.00 Color and Markings: Sable
Microchip:
Breed: Shepherd, German
Signed:
DVM License: 4188
Vaccinations Performed:
Vxn Rabies Vaccination, 3 Year
Next Rabies Vaccination Due: 01-06-21
Rabies Vaccination Information:
Manufacturer: BOE Serial Number: 4150440A
Lot Expiration: Feb.2019 Administered: Sq

15411 N 31st St. Phoenix, AZ 85032. Phone (602) 971-9651
Certificate of Rabies Vaccination
Date of Rabies Vaccination: 01-07-18 Certificate No: 0
OWNER OF ANIMAL
First Name: Zdenek Last Name: Blabla
Address: 29416 N 161 Ave
City: Surprise State: AZ Zip: 85387
County:
This is to certify...
THAT I HAVE VACCINATED THE ANIMAL DESCRIBED BELOW AGAINST THE
RABIES VIRUS.
Patient Information:
Patient: Boxa Sex: Female
Species: Canine Age: 7Y
Weight: 55.00 Color and Markings: Sable
Microchip:
Breed: Shepherd, German
Signed:
License: 4188
Vaccinations Performed:
Vxn Rabies Vaccination, 3 Year
Next Rabies Vaccination Due: 01-06-21
Rabies Vaccination Information:
Manufacturer: BOE Serial Number: 4150440A
Lot Expiration: Feb.2019 Administered: Sq

15411 N 31st St. Phoenix, AZ 85032. Phone (602) 971-9651
Date of Rabies Vaccination: 01-07-18 Certificate No: 0
OWNER OF ANIMAL
First Name: Zdenek Last Name: Blabla
Address: 29416 N 161 Ave
City: Surprise State: AZ Zip: 85387
County:
This is to certify...
THAT I HAVE VACCINATED THE ANIMAL DESCRIBED BELOW AGAINST THE
RABIES VIRUS.
Patient Information:
Patient: Borg Sex: Male
Species: Canine Age: 8Y
Weight: 60.00 Color and Markings: Sable
Microchip:
Breed: Shepherd, German
Signed:
License: 4188
Vaccinations Performed:
Vxn Rabies Vaccination, 3 Year
Next Rabies Vaccination Due: 01-06-21
Rabies Vaccination Information:
Manufacturer: BOE Serial Number: 4150440A
Lot Expiration: Feb.2019 Administered: Sq

15411 N 31st St. Phoenix, AZ 85032. Phone (602) 971-9651
Certificate of Rabies Vaccination
Date of Rabies Vaccination: 01-07-18 Certificate No: 0
OWNER OF ANIMAL
First Name: Zdenek Last Name: Blabla
Address: 29416 N 161 Ave
City: Surprise State: AZ Zip: 85387
County:
This is to certify...
THAT I HAVE VACCINATED THE ANIMAL DESCRIBED BELOW AGAINST THE
RABIES VIRUS.
Patient Information:
Patient: Bimba Sex: Female
Species: Canine Age: 6Y
Weight: 55.00 Color and Markings: Sable
Microchip:
Breed: Shepherd, German
Signed:
Ily He/n, DVM License: 4188
Vaccinations Performed:
Vxn Rabies Vaccination, 3 Year
Next Rabies Vaccination Due: 01-06-21
Rabies Vaccination Information:
Manufacturer: BOE Serial Number: 4150440A
Lot Expiration: Feb.2019 Administered: Sq

e
q( care and kin
15411 N 31st St. Phoenix, AZ 85032. Phone (602) 971-9651
Certificate of Rabies Vaccination
Date of Rabies Vaccination: 01-07-18 Certificate No: 0
OWNER OF ANIMAL
First Name: Zdenek Last Name: Blabla
Address: 29416 N 161 Ave
City: Surprise State: AZ Zip: 85387
County:
This is to certify...
THAT I HAVE VACCINATED THE ANIMAL DESCRIBED BELOW AGAINST THE
RABIES VIRUS.
Patient Information:
Patient: Bady Sex: Male
Species: Canine Age: I lY
Weight: 55.00 Color and Markings: Sable
Microchip:
Breed: Shepherd, German,
Signed:
'111(1,717 el Hehn, DVIvI /"\ /7°' License: 4188
Vaccinations Performed:
Vxn Rabies Vaccination, 3 Year
Next Rabies Vaccination Due: 01-06-21
Rabies Vaccination Information:
Manufacturer: BOB Serial Number: 4150440A
Lot Expiration: Feb.2019 Administered: Sq

15411 N 31st St. Phoenix, AZ 85032. Phone (602) 971-9651
Certificate of Rabies Vaccination
Date of Rabies Vaccination: 01-07-18 Certificate No: 0
OWNER OF ANIMAL
First Name: Zdenek Last Name: Blabla
Address: 29416 N 161 Ave
City: Surprise State: AZ Zip: 85387
County:
This is to certify...
THAT I HAVE VACCINATED THE ANIMAL DESCRIBED BELOW AGAINST THE
RABIES VIRUS.
Patient Information:
Patient: Babetka Sex: Female
Species: Canine Age: 16Y
Weight: 60.20 Color and Markings: Sable
Microchip:
Breed: Shepherd, German ,
Signed: 117\-
ell0 Ifehn, DVM License: 4188
Vaccinations Performed:
Vxn Rabies Vaccination, 3 Year
Next Rabies Vaccination Due: 01-06-21
Rabies Vaccination Information:
Manufacturer: BOE Serial Number: 4150440A
Lot Expiration: Feb,2019 Administered: Sq

15411 N 31st St. Phoenix, AZ 85032. Phone (602) 971-9651
Certificate of Rabies Vaccination
Date of Rabies Vaccination: 01-07-18 Certificate No:
OWNER OF ANIMAL
First Name: Zdenek Last Name: Blabla
Address: 29416 N 161 Ave
City: Surprise State: AZ Zip: 85387
County:
This is to certify...
THAT I HAVE VACCINATED THE ANIMAL DESCRIBED BELOW AGAINST THE
RABIES VIRUS.
Patient Information:
Patient: Apache Sex: Female
Species: Canine Age: 9Y
Weight: 60.00 Color and Markings: Sable
Microchip:
Breed: Shepherd, Germa
Signed:
liehn, DVM License: 4188
Vaccinations Performed:
Vxn Rabies Vaccination, 3 Year
Next Rabies Vaccination Due: 01-06-21
Rabies Vaccination Information:
Manufacturer: BOE Serial Number: 4150440A
Lot Expiration: Feb.2019 Administered: Sq