CHAPMAN KENNELS PERMIT RENEWAL.PDF

Maricopa County Animal Care and Control
2500 S. 27th Avenue
Phoenix, AZ 85009-6797
(602) 506-7387
htto://pets.maricopalov
Receipt Number: R17-322311 Receipt Date: 12/26/2017
•
Person ID: P1246031
Phone: 602 8964019
CHAPMAN KENNELS
4201 W TIERRA BUENA LN 12/26/2017 12:48:19P1
PHOENIX, AZ 85053
Item: Animal ID: Reference No: Price: Each: Amount:
KEN PERMIT A7777777 K18-000024 $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 9/1411999, SPAYED, UNKNOWN/MIX, TRICOLOR DOG
License Information:
Tag Number: License Expires: Aninnal# Vacc Date:•Vacc Expires:
Please retain this receipt with your pet's records
schenone WBUSOFF

Maricopa County
Animal Care and Control
2500 South 27th Avenue
Phoenix, AZ 85009
(602) 506-7387 Tele.
(602) 506-2739 Fax
KENNEL PERMIT K17-000024
APPLICATION
ED New 'It/Renewal
Name: Nancy Chapman _Kennel Name: Chapman Kennels_ _
Mailing Address: 4201 W Tierra Buena Ln Kennel Address: Same
City: Phoenix State: AZ Zip: 85053 City: Phoenix Zip: 85053
County Supervisorial District: #4
Phone: 602-896-4019 Kennel Phone: 602-896-4019
Please complete and sign this application and return it to the above address with payment in the amount of three
hundred twenty-eight dollars ($828.00) 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 property 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 AR. S. §11-
1008.
PLEASE ANSWER THE FOLLOWING QUESTIONS AND INITIAL EACH RESPONSE
I. in 1/We assume complete responsibility for the kennel at the premises for which liwe 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).
2. (PQ. I/We certify that INVe have / I dogs and that the kennel meets the definition in statute.
3. V._,-INVe 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.
(Violations of license and leash laws DO NOT apply).
4. 7X—INVe 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. -71 e---INVe certify that INVe are submitting a valid copy of the rabies vaccination certificate for each
dog with this application.
6. C----INVe understand that a dog remaining within the kennel is not required to be licensed individually under
A.R.S. § 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.
7. IICAIWe 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. 11C---- 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. 11C-1-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.
INVe certify that all of the information 1/We have provided is true and accurate under penalty of law.
Applicant Signature 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

Maricopa County
Animal Care & Control
2500 South 27th Avenue
Phoenix, AZ 85009
Phone: (602) 506-7387
pets.maricopa,gov
KENNEL PERMIT K18-000024
PREMISE INSPECTION
Number of Dogs: 18
Name: Nancy Chapman Kennel Name: Chapman Kennels
Mailing Address: 4201 W Tierra Buena Ln Kennel Address: Same
City: Phoenix State: AZ Zip:85053 City: Phoenix Zip: 85053
County Supervisorial District: 4
Phone: 602-896-4019 Kennel Phone: 602-896-4019
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.)
This is a kennel permit renewal and property has already been inspected; no history at the
home and no further action required.
Deputy Enforcement Agent & Badge #: Lt Amber Romero #4 Date: 12126/17
October 2015

OWN E(I'S C.OPY RABIES VACCINATION CERTIFICATE
Rabies Tag Number
NASPHV Form #51
Owner's Name and Address Print - use ball point pen or type
PRINT - Last First MI Telephone
60).19(-- . IQ)
Ole; „ill tli-/ )1C),"
No. Street. ,r) City ,/)/ State_ Zip
11),710/ 1A/r P rrr. -, ,6/ I e, PA Demi( /42-- 10 05111
..." '
Species: Sex: Age: Size: Predominant Breed: Colors:
Dog * Male El 3 me to 12 mo 0 Under 20 lbs ..0 cA '.1- T:z14 6 ,--,„,,,,,..1,k
Cat 0 Female 0 12 mo or older-4 20 - 50 lbs. D . i '...
Other: 0 Neutered '''( Actual Age r Over 50 lbs. 0
(Specify) Y Actual r lbs. Name: r-r- •
-1 lilt- 1 /Al
A ,--A
DATE VACCINATED: Producer: 2._. 0 ç _ez Veterinarian's: lr:7i) # (Licerrse ,..,.. No.) ei/
L - IS /7 (First 3 letters)
Month Day Year 0 1 yr. Lic./Vacc. (Signature) E. is--7,,,,,t st,._
Address: 3.2.5
X3 yr. Lic./Vacc.
VACCINATION EXPIRED: Other ..---7 5-p
/X0‹, 2
1 15 - .- .4.
Month Day Year Vacc. Serial (lot) no.
OWN MS COPY RABIES VACCINATION CERTIFICATE
Rabies Tag Number
NASPHV Form #51
Owner's Name and Address Print - use ball point pen or type
PRINT - _.. .t First Mi. Telephone
to.1---e-v-1/0 I 9
C.-Aalynart.i, 14.44-IL y
No. „ 6treet ,./ City P4,,,v,A2-St-ateiF.00h
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Species: _ Sex: Age: Size: . Predominant Breed: Colors:
Dog -0 Male 0 3 mo to 12 mo-ii Under 20 lbs".1g /4b.9 C . 61)4.
Cat El 0 Female 14. 12 mo or older 0 20 - 50 lbs. 0 k../ '' .
Other: CI Neutered 0 Actual Age Over 50 lbs. 0
(specify) Actual lbs. Name:
4/1,44-4 A
DATE VACCINATED: Producer: o E Veterinarian's: # Weenie No.)
a
/S' /7 (First 3 letters) a 4,
i_.2 (Signatdre)
-Month Day Year Ne yr. Lic./Vac.c. 34.).6.- E / 5-7.4/
Address:
03 yr. Lic./Vacc.
VACCINATION EXPIRED: Other
7 - 2- /5:7-?) 1
.2-i71 93-6 /
4)- —LC /8"
Month Day Year Vacc. Serial (lot) no.

CW6IER LS copy RABIES VACCINATION CERTIFICATE
NASPHV Form #51 Rabies Tag Number
Owner's Name and Address Print - use ball point pen or type
PRINT - List First M.I. Telephone
0154111Ci A./ i MA/Cy
No. „ Street --, City ,07/ State Ai. zip_ ,..,
ila 0 i t,-,/- herm. efezAxx t--AryeivAc, - "3—e!Ly
/
Species: Sex: Age: Size: Predominant Breed: Colors:
Dog * Male 0 .. 3 mo to 12 moth, Under 20 lbs.0..
Cat 0 Female -1)4 12 mo or older 0 20 - 50 tbs.
Other: 0 Neutered 0 Actual Age24cbAo. Over 50 lbs. 0
(SPecifY) Actuall_041bs. Name: .. j_
4.7:01‘10k 1k
DATE VACCINATED: Producer: Veterinarian's: it A2-94 -7
0 E" (License NO
1.1 /5- /7 (First 3 letters) &e.4- 7") "-Zyr,3: VD(2e,
Month Day Year yr. (signat.)
Lio./Vacc. E-,.
Address: 3 is
0 3 yr. Lic./Vacc.
VACCINATION EXPIRED:
Other
12. / C a
Month Day Year Vacc. Serial (lot) no.
OkAlIFR'S COPY RABIES VACCINATION CERTIFICATE
NASPHV Form #51 Rabies Tag Number
Owner's Name and Address Print - use ball point pen or type
PRINT - Last First M.I. Telephone
It L/
aaprel 1 iv 4.&-, eye ' (UT ,
No. Street L. City Sta ,...,_ Zip Th.
14,1 0 i W. // 6"7-611/4 ,gii_ek/k /61./eie.0-41Y) , ..itic105:1
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Species: Sex: Age: Size: Predominant Breed: Colors:
Dog * Male IA 3 mo to 12 m Under 20 lbsia 6, 6- 10. goeitj i iz
Cat 0 Female 0 12 mo or older 0 20 - 50 lbs. El
Other: 0 Neutered 0 Actual Agef.../ Over 50 lbs. 0
(speetto Name:
Actual lbs.
/5•
01'
DATE VACCINATED: Producer: -2_ Veterinarian's: # A )--' lirci
r (License No.) /
a /5 /-?_ (First 3 letters) .C., 7., Zr.t.T. 4..--- 4') ..),..e 1,-//1
Month Day Year (Signature)
14 1yr. Lio./Vacc. 3;1_5 E, i t-7.-1 3---r.
Address:
0 3 yr. Lic./ Vacc.
VACCINATION EXPIRED: Other
-7,--7 -,...e A z-i'Lly)
i.z /5-- i Y 217) 9 -2C
Month Day Year Vacc. Serial (lot) no.

OWNER'S COPY RABIES VACCINATION CERTIFICATE
Rabies Tag Number
NASPHV Form #51
Owner's Name and Address Print - use ball point pen or type
PRINT - Last/ First MI Telephone
(Iv, eV-1 A/a Ai .9,./ C Ca- n(--1-i0 i 9
No. vloi pt. 7;r•rifie.c... 1.),,Ltko„..4.7 City A,,,
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Species: . Sex: Age: Size: Predominant Breed: Colors:
Dog -0, Male 0 3 ma to 12 mo 0 Under 20 lbs. 0
Cat 0 Female 'V... 12 moor older-10. 20 -50 lbs.
Other: 0 Neutered 0 Actual Age), Over 50 lbs. 0
(Specify) Yr Actual .10 lbs. Name:
AkA°
DATE VACCINATED: Producer: Veterinarian's: It (License No.)
0 /1
/2 IS /7 (First 3 letters) i./..1 - Zr\." LT (eleetAPdli
Month Day Year 0 1 yr. Lic./Vacc. (Signature) 1.2s- Et icy/
$3 yr. Lic./Vacc. Address: , _ )
VACCINATION EXPIRED: Other Ai_rs-
il l /C .2..0 )4 7 /91C
Month Day Year Vacc. Serial (lot) no.
(AMER'S COPY RABIES VACCINATION CERTIFICATE
NASPHV Form #51 Rabies Tag Number
Owner's Name and Address Print - use ball point pen or type
PRINT - Ly s t First .!. Telephone
1 6 4 111 A /4/y , M‘ .2.- - 2-j0/9
No " t_J _ City
1 .0 / VV Ii-6"-rro. peue,A.4.-- 71)(6'el...iiie StatY5-0,5" r
i
Species: Sex: Age: Size: Predominant Breed: Colors:
Dog '11 Male ..0, 3 ma to 12 mo* Under 20 lbs.Sti i
/ ,t_i ' ,..1- C' /44.
Cat CI Female 0 12 mo or older CI 20 - 50 lbs. 0 &L./ •--(1
Other: 0 Neutered 0 Actual Ageez. Over 50 lbs. 0
(SPecifY) Actual IS lbs Name:
DATE VACCINATED: Producer: 2._ Veterinarian's: # (License No.)
.4
/ )-- /S" /7 (First 3 letters) ael ' ZN J.", 6jag'
Month Day Year sti4 1 yr. Lic./Vacc: (Signatcire) .„ /5-d sy.:
Address: 3)—,ç F
0 3 yr. Lic./Vacc.
VACCINATION EXPIRED: Other
1.2 /3- Pt? .:,?-, 7 /9./.
Month Day Year Vacc. Serial (lot) no.

OWN ERTS COPY RABIES VACCINATION
CERTIFICATE
Owner's Name and Address NASPHV Form #51 Rabies Tag Number
I PRINT -,Lfst Print - use ball point pen or type
Chap inci.A.) 4/47 First MI Telephone
No. 1410 1 'Sb:1e /fa: lc ,i_ierre, tkelt,e,/,0„pity Lioi 5-
Species: Sex: Age: P4r--A4;e1 7q1-, 17813V
Dog Male 0 3 mo to 12 mo 0 Under Size: 20 lbs - .y4 Predominant /6 3..,„ d Eiregd: j r Colors:
Cat Female '''Xr 12 ma or older < 20 - 50 lbs. 0 °."--e--/
Other: D Neutered 0 Actual Age Over 50 lbs. D "LI---
(sPecify)
Actual/7 lbs. NameA /
inb .jr"
DATE VACCINATED: Producer: 2._ 0 r Veterinarian's: #
{License
_i_o_ _t_a_. )5 (First 3 letters)
Month Day Year
0 1 yr. Lici Vacc. (Signature)
i>n yr. Lic./Vacc. Address: 3 IS- E ic-tis't
VACCINATION EXPIRED: ---
Other
/ 0 1J- IF ie_ore_,A7_,_T-s-cm ,
Month Day Year Vacc. Serial 5773- (lot) no. 51-)=8
.
OWNER'S COPY RABIES VACCINATION
CERTIFICATE
Owner's Name and Address NASPHV Form) #51 Rabies Tag Number
PRINT - LI Print - use ball point pen or type
First Mi. Telephone
No. , ,.., ,S 'treet -1 1 - 0.)---15‘-- 21 0 i 9
7.4 0/ ViA J ) fr+c, 06)6M'',.e...C. City i.,..7,kowiStat
Species: Sex: Age: }- 1ii-42120 /3
Dog X Male 0 3 mo to 12 mo Eli Size: Under 20 Predominant Breed: Colors: ,.
Cat D Female 14 12 ma or lbs.4 , ( CIAV Z ,1 ) , 1 ,. _.f. ,
Other: n Neutered CI older-0 --- - ''' /1-'71°7(W
(specify) Actual Age Over 50 lbs. 0
Actual /7.5)bs. Name:
rAettl Y
DATE VACCINATED: 1
Producer: "7 Veterinarian's: # A .2-' /lir
i i Is- 0 (License No.)
(First 3 letters) ,,<3
Month Day Year (.." 1-1 Z)-`: a•'t al
0 1 yr. lic./Vacc. (signature)
VACCINATION I6 yr. LiciVacc. Address: 3.2 5- Et • ,/, (-7'i S't-
EXPIRED:
Other ,.,----7
LI /3- 2o 20 7/ 47.2, ( z.,..z.,./..24 , A)- - Pni;
Month Day Year Vacc. Serial (lot) no.

OWNER'S COPY RABIES VACCINATION CERTIFICATE
NASPHV Form #51 Rabies Tag Number
Owner's Name and Address Print - use ball point pen or type
PRINT - Last / First ML l ph o n e "
LOfY eit W 4 VC t pT l e— eir i v o
No. 9cio 5tree / rerrm City k L r/o s r,p S ater y i , ) ... c Es i Po
/ Le l -
Species: Sex: Age: Size: Predominant Breed: Col o :
Dog X Male 0.. 3 mo to 12 mo 0 Under 20 lbs.*
Cat 0 Female 12 moor older li- 20- 50 lbs. 0 P") 6/1 (c- C
Other: 0 Neutered 0 Actual Age/ -1-." Over 50 lbs. 0
(specify) -1-Yr Actual /6 Ms. Name: z•
(_614,--e-
DATE VACCINATED: Producer: ),...,_ 0 Veterinarian's: # A 20-/g9
(License No
it_ (First 3 fetters) it2/ 1 1.' Oirt(Td
Month Day Year El 1 yr. Lic./Vacc. (Signature) 3.2 s /
Address: E_ 7% s-- t
7(3 yr. Lic./Vacc.
VACCINATION EXPIRED: Other
1/
Month Day Year Vacc. Serial (lot) no.
OWNER'S COPY RABIES VACCINATION CERTIFICATE
NASPHV Form #51 Rabies Tag Number
Owner's Name and Address Print - use ball point pen or type
PRINT - Lask First M.I. Telephone
440-cy
No. ycLo T rrx, 7.7,i.,, , i3cArea tity
/4;64 OIL FA 53
..
Species: Sex: Age: Size: Predominant Breed: Colors:
Dog Male 0 3 ma to 12 mo 0 Under 20 lbs. 0
Cat El Female 12 ma or olderyl 20 - 50 lbs. -.0. /' c,r.
Other 0 Neutered Actual Age r Over 50 lbs. 0
(Specify) Actual) 0 lbs. Name:
&fig
A , )
DATE VACCINATED: Producer: 7._ 0 _F Veterinarian's: # License All• No.) F --," / 1
1/ ,F- ift (First 3 letters) 04,
C01-0`/‘41
Month Day Year 0 1 yr. Li c./Vacc. (Signature)
Address: 3,2s- Ef 417'457'-
4.yr. Lic./Vacc.
VACCINATION EXPIRED: Other
/../ _, 17 /S;21 5' SA
Month Day Year Vacc. Serial cot) no.

COP( RABIES VACCINATION CERTIFICATE
NASPHV Form #51 Rabies Tag Number
Owner's Name and Address Print - use bail point pen or type
PRINT - Last First M.I. Telephone
/43 a4r' M7P / 0 )-4—eit — 4/0) 9
No. ,, phe.....rn t.i : e Zip /
fierYr" b<tjtet /L -Cils tY 3 0
i v 1
Species: Sex: Age: Size: Predominant Breed: Colors:
Dog ....qr Male 0 3 mo to 12 mo 0 Under 20 lbs. hi
Cat DINIr Female IX, 12 mo or older-4- 20 - 50 lbs. 0 is---) Cs 6
Other: 0 Neutered 0 Actual Age Over 50ilbs. 0 .
Prtecifyi is Name/
Actual lbs.
DATE VACCINATED: Producer: 2 ._ 0 Veterinarian's: #
(License No.)
1/ jt (First 3 letters)
0.4., C7P0-419
Month Day Year El 1 yr. Lic./Vacc. (Signature)
Addres: .s
R3 yr. Lic./Vacc.
VACCINATION EXPIRED:
Other !ile A 2.-
t7 t /9 1C-1MM
Month Day Year Vacc. Serial (lot) no.
OWNER'S COPY RABIES VACCINATION CERTIFICATE
Rabies Tag Number
NASPHV Form #51
Owner's Name and Address Print - use ball point pen or type
PRINT - First M.I. Tgieph9ne
)7
c( ptivem,)6 /2 ltate is.0 sfy
No. St --*
11 0) .17(,) 17e fr-e, 6 Ltr-p-z- a.ltY
tio
Species: Sex: Age: Size: Predominant Breed: Col s
Dog Male .f7c 3 mo to 12 mo 0i Under 20 lbs. 0
Cat Ell Female 0 12 mo or olderV 20 -50 lbs. 1:1 6----r---e' Slef
Other: 0 Neutered* Actual Age r Over 50 lbs. -4
(5pecm Actual 95 lbs. Name:s-art.
_
DATE VACCINATED: Producer: -- 0 __E Veterinarian's: # / nse No.)
10 (First 3 letters) 04 0`.'
)c)- S (Signature)
Month Day Year 0 1 yr. Lic./Vacc. 41_5 E. i 5- 7i-4- at
Address: 3
Nt13 yr. Lic./Vacc.
VACCINATION EXPIRED: Other 73,"peA -24,5-w)
/0 a )r s-173-7...1_
Month Day Year Vacc. Serial (lot) no.

OMER'S COPY RABIES VACCINATION CERTIFICATE Rabies Tag Number
NASPHV Form #51
Owner's Name and Address Print - use ball point pen or type
PRINT - ,..t First M.I. Telephone
CACtr iriC141/1, hiVeLAZ
No. treet ,-- 4-` City ftemje./A )4 Sp SliP
La()) 4' ht.fr6.. trfA.< jA..-C
Species: Sex: Age: Size: Predom'dant 4 Breed: Colors*.
Dog * Male 0 3 mo to 12 mo 0 Under 20 lbs+6, r- i C
Cat 0 Female IP.A. 12 mo or older-A 20 - 50 lbs. 0 J 0-11
Other: 0 Neutere. A Actual Age (yr Over 50/ lb! 0 1 ,0,..
(Specify) Actual ni lbs. Name: /
QS- CI,
2, i tid
DATE VACCINATED: Poducer: 2._ n Veterinarian's: # cense No.)
kJ
_LI, IS (First 3 letters) 0
1 0 (Signature)
Month Day Year 0 1 yr. LiciVacc. r qk is- IL' st:
Adtimss: 3)-S
fti 3 yr. I:ie./Vac°.
VACCINATION EXPIRED: Other /e,,,,Q, A 7-IFY2F)
a. IF 577 Crol-,_.8
/CI
Month Day Year Vacc. Serial (lot) no.
owidEH.F: -c,opy RABIES VACCINATION CERTIFICATE
NASPHV Form #51 Rabies Tag Number
Owner's Name and Address Print - use ball point pen or type
PRINT - 7t First IVI.I. Telephone
i.... , aernet Ali a 6' ol-211`-'Yo17
No. i ,, i 7,;ei-rA agefetx.. 41%4 filoem, Me. FRO
7 -01-0/ TA /
Species: Sex: Age: Size: Predominant Breed: Colors:
Dog Male 3 mo to 12 mo 0 Under 20 lbs.4 IVACI04
Cat Female 12 ma or older4 20 - 50 lbs. 0 546- fib/
Other: 0 Neutered 0 Actual Age Over 504139. 0
(8p) Actual oir lbs. Name/ e-
A ,
DATE VACCINATED: Veterinarian's: # PI 7" " ti r,
Producer: (License No.)
11 F it (First 3 iefters -F ) //e X;YI07.,‘&ree
Month Day Year 0 1 yr. Lic./Vacc. (Sign ure) 5 ir-i‘v.
Addr.: -
yr. Lic./Vacc.
VACCINATION! EXPIRED: Other 7 ai-P7Q?, 42_,-.,,rs-,4)
ei? inzpis-A
Month Day Year Vacc. Serial (lot) no.

ovvNER'scoPY RABIES VACCINATION CERTIFICATE Rabies Tag Number
NASPHV Form #51
Owner's Name and Address Print - use ball point pen or type
PRINT - Lajstr First M.1. Telephone
MM c ? Pa-1W- Li 0 i?
tActp 'AGA/J.
No. Lilo/ tv... Rirrc, atteAx.ku, 04 Pt0e e/ i StatkO Y
Species: Sex: Age: Size: Predominant Breed: Colors:
Dog >11 Male r 3 me to 12 mo., Under 20 lbs. 0 R t a cp. 13 kx*,41 tc_
Cat 0 Female 12 me or older 20 - 50 lbs. Id lit'. q ri
Other: 0 Neutered 0 Actual Age2.yr Over 50 lbs. El
(Specify) Actual lbs. Name:
CliC
# A 2..., I . _ ire/ .
DATE VACCINATED: Producer: 2 a Veterinarian's: (License N 4
/0 11- 15 (First 3 letters) 4 . 7ar--0./
Month Day Year 0 i yr. Lic./Vacc. (Sigare) 3 .2,5- E I 5'I yr
Address:
›f3 yr. LiciVacc.
VACCINATION EXPIRED: Other m, ,
AI
i o /J- /F ./ifsci2S-S,
Month Day Year "Vacc. Serial (lot) no.
RABIES VACCINATION CERTIFICATE Rabies Tag Number
owmars car,' NASPHV Form #51
Print - use bell point pen or type M.1. Telephone
I Owner's Name and Address First 110) 6
PRINT - J.,afit
(.4l6k2 frail Ah City
No. Breed: Ajor/oxej tors : tot
I-P4)rtt Size: Predominant
Species: z Sex: Age: mote 12 mo 0 Under 20 lbs* ddrieF eT
Dog -711 .1 Male -14- 3 roe or oldei'S 20 - 60 lbs. 0
Cat 0 Female 0 12 Age At( Over 50 lbs. 0
Other: 0 Neutered 0 Actual Actual W' lbs. /vet'
(Specify)
Veterinarian's: It (Gowen
DATE VACCINATED: Producer: 0 - AniTi
- (First 3 letters)
io /5 (Sly-riatlire) 3)-5 E:
Month Day Year A1 yr. Lic./Vacc. Address "
17.11,3 yr. Lic./Vacc.
VACCINATION EXPIRED: Other
S./ S-3— c14-6
/ ji Va'c'd. Serial (lot) no.
Month Day Year

EMNER'S CGPY RABIES VACCINATION CERTIFICATE
NASPHV Form #51 Rabies Tag Number
Owner's Name and Address Print - use ball point pen or type
PRINT -__Litst First M.!. Telephone
4-Actlfil nviv Al tidLAC.!- ( (0)---Felk- 1/0) 7
No. if Street 6 CitA,,
il.t1-0 ) Wo 1-ierfr,_ Li r_AA PX0e4,,,,kst,4 , 1„ trze5-
Species: Sex: Age: Size: Predominant Breed: Colors:
Dog 3>ie Male s'A 3 mo to 12 mo 0 Under 20 lbs.
Cat 0 Female 0 12 mo or olderg 20 - 50 lbs. 0
Other: Cr Neutered 0 Actual Age 9y r . Over 50 lbs. 0
(Specify) Actual gs.lbs. Name: r
-)6111513 IN)
DATE VACCINATED: Producer: t-, 1.-- Veterinarian's: # A2-,- 1179 .
I_/ (License No.)
_a ---6 / 4. (First 3 letters) 70: L;
Month ay Year (Signature) 104 4
1 yr. Lic./Vacc.
sr), 3 yr. Lic./Vacc. Address:
VACCINATION EXPIRED:
Other 7,,,flei A 7,. Fir02-V
/4-00)/9S—A
KA i -2 Vacc. Serial (lot) no.
owNER.s co,,,, RABIES VACCINATION CERTIFICATE
NASPHV Form #51 Rabies Tag Number
Owner's Name and Address Print - use ball point pen or type
PRINT.; east First M.I. Telephone
ch6pir\61+11 A4.yt/9/ X 0)----trit — 4/0)?
No. t ie deAte A.I. 7-ros3
Wilt rirrr ek 0(1 efi-i6 ek
Species: Sex: Age: Size: Predominant Breed: Colors:
Dog male )4 3 mo to 12 mo 0 Under 20 lbs. 0 .4 - •"` c tali"-Lte
Cat 0 Female 0 12 mo or older ID 20 - 50 lbs. El
Other: El Neutered 0 Actual Age4Zf Over 50 lbs. 0
(Specify) Actual) 7.1bs. Name: 7'
A
DATE VACCINATED: Veterinarian's: # si- 14) 11 Pi
Producer: i 0 (License No.)
11_, 1, (First 3 letters) 0 11 r %-ivlOs4
Month My Year (Sig urn)
0 1 yr. Lic./Vacc. Address: 3 af; E, 1 rt.) St
14.3 yr. Lic./Vacc.
VACCINATiON EXPIRED: Other
7-1--ile-i A2--.
17 is)4 Li .cifq
M n h Day Yea Vacc. Serial (lot) no.