EAST VALLEY RESCUE.PDF

Maricopa County
Animal Care and Control
2500 South 27th Avenue
Phoenix, AZ 85009
(602) 506-7387 Tele,
(602) 506-2739 Fax
KENNEL PERMIT K17-000009
APPLICATION
0 New IN Renewal
Name: Linda Shively Kennel Name: East Valley Rescue
Mailing Address: 8125 E 5th Street Kennel Address: Same
City: Mesa State: AZ Zip: 85208 City: Mesa Zip: 85208
County Supervisorial District: #2
Phone: 480-984-5960 Kennel Phone: 480-984-5960
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 of AR. 5. §11-
1008.
PLEASE ANSWER THE FOLLOWING QUESTIONS AND INITIAL EACH RESPONSE
INVe 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).
27---sletAIAA/e certify that INVe have 4 / dogs and that the kennel meets the definition in statute.
3. .4.1/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.
(Violations of license and leash laws DO NOT apply).
4. 'UAW/ye 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. -47411--NVe certify that I/We are submitting a valid copy of the rabies vaccination certificate for each
dog with this application.
il/Ve 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 ,7aA,IINVe 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.
89 l/We 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 Nrhe 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 1/We have provided is true and accurate under penalty of law.
Applicant Signato.g::-.., Date: Od—ree
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.00v
Receipt Number: R16-251646 Receipt Date: 10/15/2016
Person ID: P0858375
Phone: 480 9845960
E VALLEY RESCU KENNELS 10/15/2016 12:04:52P1
8125 E 5TH AVE
MESA, AZ 85208
(tern: Animal ID: Reference No: Price: Each: Amount:
KEN PERMIT A7777777 K17-000009 $328.00 1 $328.00
Total Fees Due: $328.00
Payments: Cash: $0.00
Check: $328,00
Credit Card: $0.00
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:fipets.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
shawcrof EBUSOFF

Maricopa County
Animal Care & Control
2500 South 27th Avenue
Phoenix, AZ 85009
Phone: (602) 506-7387
pets.maricopa.gov
KENNEL PERMIT K17-000009
PREMISE INSPECTION
Number of Dogs: 24
Name: Linda Shiveley Kennel Name: East Valley Rescue
Mailing Address:8125 E 5th Ave Kennel Address: Same
City: Mesa State: AZ Zip: 85208 City: Mesa Zip: 85208
County Supervisorial District: #2
Phone: 480-984-5960 Kennel Phone: 480-984-5960
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
Deputy Enforcement Agent & Badge #: Sgt Jason True Date: 10-19-16
October 2015

CERTIFICATE Rabies Tag Number
VACCINATION
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Number ,..,, Colors: . Number Colf7s: .._(.. / 7-
.Zip )IF- I F-Y-c).i) Tag i 0
Tag /1 5-7/ I 42-d-5-
Telephone >4 Rabies Telephone -9IFY—FC/(C) StatteAp -7-4^// No.) J/
Rabies ,....C- No.) I
do , A (License E. A3, A (License E.
M.F. ..._ ) ri_)7- .0<7 sii Mi. "i(fC A Breed: # :i_cr l'f2(97
r Br # 3.1;16-
CERTIFICATE - C_Cz /1, -741/642 CERTIFICATE Cfc71 3
Predominant Veterinarian's: type Predominant Veterinarian's: (Signature)
type Name: (Signature) Address: /.1/ Name: Address:
or or
#51 pen E E #51 pen lbs.4 El E lbs.
lbs.Z lbs
Form point • lbs. lbs. -i•-• .1-- Form point City 20 lbs. lbs. 1-/
First City 20 50 50 3 ball First 50 50
VACCINATION NASPHV ball Size: Under - Over Actual sc::- VACCINATION NASPHV Size: Under - 20 Over Actual letters)
use 20 0 letters) use 3 Vacc. Other sA no.
- i .: CI 3 •/Vacc. Lic./Vacc. Other no. - mo-10 CI i'M, (First Lic./Vacc. (lot)
Print mo.214- 2 (First Lic /51-olis-A (lot) Print older iii 2 Lic./
12 older Age yr. yr. Serial 12 or Age yr. 3 yr. tr-Dii Serial
RABIES ti to or mo Producer: E 3 RABIES " -e to mo mo Actual Producer: -.TZ1 CI Vacc.
, Ave Age: mo 12 Actual Vacc. it- A ft Age: 3 12
3
Address • El il4. CI Address ./1 II CI
_ EXPIRED: /Lid/ r., EXPIRED: I2
and ... e Neutered i-C Year 12 Year and Str.ee Female Neutered A Year Year
Sex: Male Female VACCINATED: Sex: Male VACCINATED:
Name t 5 Day Day , 1 Name Las , ., I1-;1) TA, El CI S Day ,r; Day
- t., IEI VACCINATION - r , VACCINATION
Owner's PRINT Species: Other: {Specify) DATE Jo Month o 1 Month Owner's PRINT No. Species: Dog Cat Other: (Specify) DATE /0 Month /0 Month
No. Dog Cat