Extracted text (via pymupdf_layout)
13663 characters
Maricopa County Animal Care and Control 2500 South 27th Avenue Phoenix, AZ 85009 (602) 506-7387 Tele. (602) 506-2739 Fax KENNEL PERMIT K17-000018 APPLICATION El New enewal Name: Arthur McKay Kennel Name: HARQUAHALA Kennels Mailing Address: 10602 S 5401h Ave Kennel Address: Same City: Tonopah State: AZ Zip: 85354 City: Tonopah Zip: 85354 County Supervisorial District: 5 Phone: 928 -372-2262 Kennel Phone: 928-372 -2262 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 A.R.S. §11- 1008. PLEASE ANSWER THE FOLLOWING QUESTIONS AND INITIAL EACH RESPONSE trt t1 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). 2. I/VVe certify that I/We have /C dogs and that the kennel meets the definition in statute. 3.I/We certify that I/We have not been convicted of a violation of A.R.S. §§ 13-2910 (cruelty to animals) or ft10.01 (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. ‘)1v .i I/We certify that all dogs over the age of three (3) months that are kept, harbored or maintained on the prerhises 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. 411 f I NVe certify that I/We are submitting a valid copy of the rabies vaccination certificate for each dogwith this application. 6.U?- tAA INVe understand that a dog remaining within the kennel is not required to be licensed individually under A.R. § 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. (.3. .41 ki INVe understand that a person who fails to obtain a kennel permit under A.R.S.§11-1009 is subject to a perYalty of twenty-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.. 9. 1/4 r 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 I/We have provided is true and accurate under penalty of law. „ Applicant Signature Date: :_etitA .,-,4e7 "r 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 & Control 2500 South 27 th Avenue Phoenix, AZ 85009 Phone: (602) 506-7387 pets.maricopa.gov KENNEL PERMIT K17-000018 PREMISE INSPECTION Number of Dogs: 10 Name: Arthur McKay Kennel Name: Harquahala Kennels Mailing Address: 10602 S 540th Ave Kennel Address: Same City: Tonopah State: AZ Zip: 85354 City: Tonopah Zip: 85354 County Supervisorial District: #5 Phone: 928-372-2262 Kennel Phone: 928-372-2262 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 #: Lt Timothy Rummel Date: 11/1/16 October 2015 Maricopa County Animal Care and Control 2500 S. 27th Avenue Phoenix, AZ 85009-6797 (602) 506-7387 http://bets.maricopa.gov Receipt Number: R16-219861 Receipt Date: 09/09/2016 Person ID: P0610901 Phone: 928 3722262 HARQUAHALA KENNELS 9/9/2016 10:02:58AM 10602 S 540TH AVE TONOPAH, AZ 85354 Item: Animal ID: Reference No: Price: Each: Amount: KEN PERMIT A7777777 K17-000018 $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://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 shawcrof EBUSOFF RABIES VACCINATION CERTIFICATE Naspvt V Form 5 Rabies Tag Number Owner's Name &Address PRINT - use ballpoint pen or type PRINT: Last , First M.1 Telephone r") HA rl bt Cit-i(VA Lf !' <sal, re-L t47-6 -3q9--.3 No. Street SF State Zip 10t-9e2 A, t'6171!) A e 0143-N\ )42--- g5351) SPECIES: ., SEX: .„.. , AGE: SIZE: PREDOMINANT BREED: COLORS: g" i Dog Male k,T1 3 mo.- 12 mo. Under 20 lbs. 0 . n Cat Female El 12 [no. or olderC 20 - SO lbs. 117 IlL4-01(1- .`z..-vief., Other 0 Neutered 0 Over 50 lbs. LYJ NAME: Please specify Th r4n-af DATE VACCINATED: VETERINARIAN PRODUCER: Veterinarians #: 1 14112:' Month Day Year ,./j. Li_erpse No. First 3 letters) /.1 1V41 VACCINATION EXPIRES: I yr. tic. /Vaccine CI 3 yr. Lic./Vaccine Veterinariat442 z:7 I 9 Signapre Month Day Year (2)F5oLl AdclressrPr: C). :741-7,5 Vaccine Serial (Lot) No, fnez5tx, Ftz 352.1r Lc RABIES VACCINATION CERTIFICATE Tag fee $: ADAPTED NASPHV FOF?M 51 Tag #: Owner's Name & Address PRINT - use ball point pen or type Cert. Serial #: PRI T rsT _ i FIRST. i . . TELEPHONE VA, Ken ix 1 " cas CI rOk_g_CADI A NO. STRE CITY ,.......— STATE _ ,_ Z11±% _ Okio, S , S- q0 Ftv 1 OMprAh A-2 i SPECIES: - SEX: AGE: J SIZE PREDOMINANT BREED: COLORS: Dog Male 3 Mo. to 12 Mo. El Under 20 lbs. E ,,LI )e brOW r1 Cat Female 12 Mo. or older 20 - 50 lbs o Other C] Altered o Over 50 lbs. NAME: (Specify) (Abbk, DATE VACCINATED: PRODUCER: Veterinarian's # 1 L10-4C: 1 '29/ 11-4 License No. PDO Month Day Year (First 3 Letters) Veterinarian's e,,..,-- ,(3,.... , yr. Lic.Nacc. CI SignattePAY AND warrog CUM VACCINAXPIR EXPIRES: E ‘ -21 1 3 yr. Lic.Nacc Addresi342 W. Indian School Rd., Ste 108 Phoenix, AZ 85033 Month Day Year )2A S A G23-840-39-79 Vacc. Serial (Lot) No. Month Month DATE Please Other Cat Dog SPECIES: No PRINT: Owner's Month „ Month i DATE Please Other Cat Dog No. PRON Owner's SPECIES: VACCINATION 3.--,.2_, VACC specify D rd _ /-Irr Last VACCINATION specify D D Ai Las : Day Day a Name Day 227 Day 21 Name Female Male SEX: r VACCINATED: Male SEX: Stre ' NATED: Neutered t ' . ' Neutered Female ) "(ear EXPIRES: Year i &Address Year EXPIRES: Year t c) - &Address 0 El -Er / CotOlinOICA 1-9 6 E 0 al / 0 - 12 3 AGE: r- RA 12 3 RAE Vaccine 7,40.2_• 3 I mo. mo.- i-lcb Vaccine t<.),41-1 3 1 mo. mo.- AGE: yr. yr. PRODUCER: or 12 NES yr. yr. PRODUCER: or 12 ES Serial 6-72.:.? .,_ olde mo. I Serial 0 Lit. Lic. older mo. (Lot) 6 Lit/Vaccine Lic./Vaccine (first , ri • \ City )1 PRINT (Lot) SO /Vaccine /Vaccine First P El citY PRINT No. D . 3 Over 20 - I-i'-'?-n- - No. 3 F 20 - 0 letters 50 - Under SIZE: ---A use NASPHV VACCDNATON El letters Over - Under .,SIZE: use VACCINATION ) 50 lbs. 20 2._ 50 50 20 NASPHV lbs. lbs. First ballpoint Form lbs. lbs. lbs. First ballpoint L 1 Form Address': Signathre Veterinaria 0 51 Address: D V El/ 5 pen Signatite,-Th Veterin'arian'si#: pen I Veterinaria.1442 ' VETERINAPJAI NAME: oluk. or Veterinarian1442 VETERINARIAN NAME: or Pa., ii type . . 4 type rn-e..,,o, a 1-4,5k.1 EDOMINANT F=0, iA.,k REDOMINANT g4 flii CERTIFICATE nnf-.5cA CERTIFICATE ,.. ,A. 1....<I ...------s, (4, - Az_ 1 7.1)14.14.Z-4'i ''''."' d'i- : BREED: M.1 g ba)6x-i BREED: ML AL,Fs 4r.".1 \NO/ No. 2) Zip UNI z, 3 Telephone Rabies -. Z Telephone RabiesTag Z '74 1-'' CO Tag 7 --.7 .") I --') r •., 3614 -319- - , l COLORS: 3 -75 ORS: Number ' ; j i 5 Number Qs) . (WD 2:1 LI 36n L9 Month 3 Month DATE Please Other Cut Dog No.. ki. PRI Owner's Month 9. Month DATE Please Other Cat Dog SPECIES: No. MIN Owner's VACCINATION SPECIES: VT: VACCINATION i specify 0 E , Last specify Ej 0 Last Day La Day Sc Name Day Ot Day VACCINATED: Name ' VACCINATED: Female Male SEX: . ' Female Mate SEX: Stree0 Year a_ EXPIRES: Year Neutered &Address Year EXPIRES: Year Neutered I ,. arrAUGOOk &Address 0 V , 5 " / 12 3 AGE: RA 6 12 3 AGE: 545 RA Vaccine 3 I mo. mo.- Vaccine 0...10 3 1 PRODUCER: ma. too.- LidO yr. yr. PRODUCER...7) or 12 IES yr. yr. or 12 ES Serial Lit. olde mo. Pi 'S-erial F,,,,) Lit. Lit. older mo. (Lot) /Vaccine Lic./Vaccine First 1 .f_; City PRINT (Lot) 14 /Vaccine /Vaccine (First t 0 0/1 ,,, .Ave, City PRINT N. "-A0) E 3 c Over Under SIZE. ' - N. (-) 3 ----piri, Over - 20 Under SIZE: _____.—....z - use - letters 50 -50 1 use NASPHV VACCINATION je/ letters 50 50 10 NASPHV '1ACCONATION lbs. lbs. 20 0 ', First lbs. lbs. tbs. 20 me First ballpoint lbs, Ro ballpoint Form Form Addrss: Signature Veterinarian's Veterinarian's g , I=1 pen 51 Address: Signature Veterinarian's Veterinarian's D pen 1 S VETERINARIAN , or VETERINARIAN N Iii or 1442 - A #. NAME: pWr\ type 1442 , L.5/1" ' #: : Lt k type / nu5V......y PREDOMINANT PREDOMINANT State CERTIFICATE Meza I 1/-i. Star CERTIFICATE - AL ,,i, 'Th 1, be.--.. p\-z— i , IEDId SOIL X i.... License gti .6(,,,,,cp BREED: M.1. License i I BREED: NJ. j No. A-z-Z ( No. Lj ' 1 1.‘ 1 I • Rabies Rt & -4.5 Zi.p... Telephone Rabies Telephone 14-i 7475 iA) 55 Tag COLORS: 5 Tag COLORS: LS57-1 Number 2-1 5 yiti 5L1 Number lit* I- 0 ro LP ...-7 LIZ Month Month C.. DATE Please Other Other Cat Dog C) No, PRINT: Owner's 5 5 DATE Please Other Cat Dog 6 0 ' No. • ir- Month Month SPECIES: PRINT: Owner's VACCINATION 1 I specify 0 D SPECIESI;i/ ILPOZI cA,r(Al Last v-.4 VACCINATION j specify E Er 4 , . ' iIII7' F4Ckr Last Day Day VACCINATED: Name Day Day F4 Name ' Female Male SEX: 5 saeet VACCINATED: Female Male SEX: e Str Year EXPIRES: Neutered ,. uok &Address ' ' Neutered go 1 Year Year EXPIRES: Year ( ip &Address '41 lay 540 i cg D E 4 f‘ok " li 12 3 AGE: R 12 3 AGE: pt\ib Vaccine 3 I mo. mo.- RABIES Vaccine 7 1 3 I mo. ma- 1 RABIES yr. yr. RODUCER: or 12 Nif yr. yr. or 12 Serial 7) : Lit/ older mo. , Serial 11 Lic. older mo. _.-CIY (Lot) 96 Lit/Vaccine Vaccine First ? - ,Re ' civ_..., PRINT (Lot) '39 /Vaccine Lic./Vaccine First PRODUCER:NMI ‘0 PRINT 3 , 0 VACCO No. r Over - 20 Under SIZE: MO use - No, -----) 3 Over 20- Under SaZ e)eine, - letters) i 50 50 20 NASPHV letters 50 50 . use NASPHV VACCINATION V s. i !bs. lbs. p_np,--J-- First ballpoint ATION ) lbs. lbs. lbs. 20 Fi ballpoint 1NX Form t Form Addi: res Signature eterinari Veterinarian's isy , El pen 5i Signatur if Ei Si' V-1, !:.-----, ' VETERINARIANL NAME: 4-.1`i , v r\ or Address:1-4j Veterinaria4442 Veterinarian's VETERINARIAN . ' -ITI or pen ,..-: al442. 1)4i #: LA ..1 _ type MESCA, 154 #: : It•4 type riA.:,--=;a .._.) -7 l PREDOMINANT CERTIFICATE ---.) ..:4 , aa PREDOMINANT ,• CERTIFICATE b i 1 )'/- . Z. tate 1 i-A5Ky State “ ,,,...... i 44 24 0X, ( irk 1- License 44P) 4-41P4 c_11 BREED: I. . M irli b°64A7L4 License — BREED: ri.r. A 7 . 2— 42) 7-.- . Zip Rabies No. 6ilat ,.. Zip 4.76 25 Telephone S5 g535 Telephone Rabies Tag 76 Tag COLORS: .._...-39 '-----) -TaKi COLORS: S5'2Atp 354 Number 21Lp "-Rrk i 1-1 -59-31,125 Number V .. ,.... p