FRIENDS FOR LIFE RESCUE - KENNEL PERMIT.PDF
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33990 characters
Maricopa County Animal Care and Control
2500 S. 27th Avenue
Phoenix, AZ 85009-6797
(602) 506-7387
hitp://pets.maricopa.gov
Receipt Number: R16-133979 Receipt Date: 06/08/2016
Person ID: P1279029
Phone: 480 4978296
FRIENDS FOR LIFE RESCUE
6/8/2016 1:47:11PM
143 W VAUGHN AVE
GILBERT, AZ 85233
Item: . Animal ID: Reference No: Price: Each: Amount:
KEN PERMIT A7777777 K17-000010 $328.00 1 $328.00
Total Fees Due: $328.00
Payments: Cash: $0.00
Check: $0.00
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 hitp://pets.maricopa.gov and click on Balance Due: $0.00
Contact
5 1 13 3 1 2 474 1779 60 30 60.866234 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
APODACAP EBUSOFF
Maricopa County
Animal Care and Control
2500 South 27th Avenue
Phoenix, AZ 85009
(602) 506-7387 Tele.
(602) 506-2739 Fax
KENNEL PERMIT K17-000010
APPLICATION
Name: Friends for Life Kennel Name: Friends for Life
Mailing Address: 143 W Vaughn Ave Kennel Address: 143 W Vaughn Ave
City: Gilbert State: AZ Zip: 85233 City: Gilbert Zip: AZ
County Supervisorial District: 2
Phone:480-497-8296 Kennel Phone: 480-215-6018
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
A —_——
Le \
1. |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).
eal
5 1 3 1 1 2 385 413 82 31 37.781467 I/We
5 1 3 1 1 3 481 412 108 40 94.672089 certify
5 1 3 1 1 4 603 412 68 31 96.820740 that
5 1 3 1 1 5 687 411 83 31 73.598984 I/We
5 1 3 1 1 6 785 411 87 30 96.956161 have
5 1 3 1 1 7 1004 358 55 88 47.897598 q
5 1 3 1 1 8 1176 410 87 39 95.508171 dogs
5 1 3 1 1 9 1278 409 65 31 96.366608 and
5 1 3 1 1 10 1359 409 68 31 96.288612 that
5 1 3 1 1 11 1440 409 56 31 96.288612 the
5 1 3 1 1 12 1512 409 117 31 94.077377 kennel
5 1 3 1 1 13 1647 410 108 30 96.550491 meets
5 1 3 1 1 14 1770 408 54 31 96.849831 the
5 1 3 1 1 15 1839 408 163 30 95.957642 definition
5 1 3 1 1 16 2020 408 26 30 96.641129 in
5 1 3 1 1 17 2063 408 131 30 96.837685 statute.
2 1 4 0 0 0 209 473 2041 171 -1
3 1 4 1 0 0 209 473 2041 171 -1
4 1 4 1 1 0 210 473 2040 79 -1
5 1 4 1 1 1 210 473 168 79 26.111641 aati
5 1 4 1 1 2 385 508 82 31 21.732956 I/We
5 1 4 1 1 3 482 508 108 40 94.534096 certify
5 1 4 1 1 4 604 508 68 31 96.950661 that
5 1 4 1 1 5 688 507 83 31 76.929237 I/We
5 1 4 1 1 6 787 507 86 30 96.345261 have
5 1 4 1 1 7 889 508 55 29 96.614601 not
5 1 4 1 1 8 960 507 86 30 96.519592 been
5 1 4 1 1 9 1063 506 172 31 96.297104 convicted
5 1 4 1 1 10 1251 505 35 31 96.556259 of
5 1 4 1 1 11 1298 514 19 22 96.825737 a
5 1 4 1 1 12 1332 505 149 31 96.272453 violation
5 1 4 1 1 13 1498 505 34 31 93.277374 of
5 1 4 1 1 14 1543 505 116 31 89.010910 A.R.S.
5 1 4 1 1 15 1678 505 42 38 89.010910 §§
5 1 4 1 1 16 1739 504 145 32 96.038658 13-2910
5 1 4 1 1 17 1900 504 134 39 96.459526 (cruelty
5 1 4 1 1 18 2049 505 32 30 96.345711 to
5 1 4 1 1 19 2096 504 154 38 96.660072 animals)
4 1 4 1 2 0 209 552 2040 44 -1
5 1 4 1 2 1 209 564 36 23 90.952255 or
5 1 4 1 2 2 265 557 199 31 90.952255 13-2910.01
5 1 4 1 2 3 489 557 78 39 96.492447 (dog
5 1 4 1 2 4 586 556 157 40 96.492447 fighting),
5 1 4 1 2 5 765 562 36 24 97.006241 or
5 1 4 1 2 6 819 555 119 30 96.804901 similar
5 1 4 1 2 7 955 555 170 30 96.686264 violations
5 1 4 1 2 8 1144 555 35 30 96.496201 of
5 1 4 1 2 9 1195 562 64 32 96.766266 any
5 1 4 1 2 10 1278 555 94 30 96.272980 other
5 1 4 1 2 11 1389 555 96 35 96.653755 state,
5 1 4 1 2 12 1507 555 120 38 96.436630 county
5 1 4 1 2 13 1646 562 36 23 96.149040 or
5 1 4 1 2 14 1701 553 170 40 96.608292 municipal
5 1 4 1 2 15 1890 553 120 31 96.069466 animal
5 1 4 1 2 16 2029 552 133 32 95.815300 welfare
5 1 4 1 2 17 2182 552 67 30 96.765930 law.
4 1 4 1 3 0 210 603 975 41 -1
5 1 4 1 3 1 210 604 190 40 96.680511 (Violations
5 1 4 1 3 2 415 605 35 31 96.680511 of
5 1 4 1 3 3 463 605 124 31 96.356903 license
5 1 4 1 3 4 603 604 65 31 96.581619 and
5 1 4 1 3 5 685 603 95 32 96.452034 leash
5 1 4 1 3 6 798 603 80 30 96.320892 laws
5 1 4 1 3 7 894 603 57 30 95.891190 DO
5 1 4 1 3 8 969 603 84 30 96.540871 NOT
5 1 4 1 3 9 1066 603 119 39 93.874931 apply).
2 1 5 0 0 0 207 676 2045 208 -1
3 1 5 1 0 0 207 676 2045 208 -1
4 1 5 1 1 0 207 676 2044 69 -1
5 1 5 1 1 1 207 691 60 40 44.044220 a
5 1 5 1 1 2 268 676 83 69 32.129868 “—~
5 1 5 1 1 3 390 700 74 31 6.591949 We
5 1 5 1 1 4 480 699 104 39 96.546013 certify
5 1 5 1 1 5 599 700 67 31 96.108200 that
5 1 5 1 1 6 681 699 37 30 96.108200 all
5 1 5 1 1 7 735 699 87 38 96.584915 dogs
5 1 5 1 1 8 838 706 79 23 96.690155 over
5 1 5 1 1 9 931 697 55 31 96.883835 the
5 1 5 1 1 10 1002 706 65 31 95.485344 age
5 1 5 1 1 11 1083 697 35 32 95.485344 of
5 1 5 1 1 12 1130 697 90 32 96.892380 three
5 1 5 1 1 13 1237 697 44 40 96.673889 (3)
5 1 5 1 1 14 1300 697 130 31 96.496910 months
5 1 5 1 1 15 1446 697 66 31 96.728638 that
5 1 5 1 1 16 1527 705 57 23 96.759178 are
5 1 5 1 1 17 1600 697 82 39 96.041473 kept,
5 1 5 1 1 18 1702 696 156 32 96.959908 harbored
5 1 5 1 1 19 1876 704 35 22 96.574448 or
5 1 5 1 1 20 1927 696 194 30 96.683632 maintained
5 1 5 1 1 21 2139 703 41 23 96.302841 on
5 1 5 1 1 22 2197 696 54 30 96.556190 the
4 1 5 1 2 0 210 744 2042 44 -1
5 1 5 1 2 1 210 748 160 40 96.569168 premises
5 1 5 1 2 2 387 748 33 31 96.669319 of
5 1 5 1 2 3 433 748 55 31 96.436333 the
5 1 5 1 2 4 504 748 107 31 96.830467 above
5 1 5 1 2 5 628 747 121 32 95.638313 named
5 1 5 1 2 6 767 747 117 30 96.031815 kennel
5 1 5 1 2 7 901 747 85 30 95.957016 have
5 1 5 1 2 8 1003 746 85 32 95.957016 been
5 1 5 1 2 9 1107 746 143 39 96.527252 properly
5 1 5 1 2 10 1264 745 191 32 96.656136 vaccinated
5 1 5 1 2 11 1473 745 129 40 96.691078 against
5 1 5 1 2 12 1618 745 107 31 96.732391 rabies
5 1 5 1 2 13 1741 745 40 40 96.659813 by
5 1 5 1 2 14 1797 753 20 23 96.969383 a
5 1 5 1 2 15 1833 744 207 32 96.790329 veterinarian
5 1 5 1 2 16 2059 744 144 30 96.040634 licensed
5 1 5 1 2 17 2220 745 32 29 97.014862 to
4 1 5 1 3 0 210 792 2041 44 -1
5 1 5 1 3 1 210 796 137 40 96.294922 practice
5 1 5 1 3 2 370 796 26 31 96.862076 in
5 1 5 1 3 3 418 796 55 31 96.882431 the
5 1 5 1 3 4 494 797 85 30 96.746765 state
5 1 5 1 3 5 601 796 34 31 96.963799 of
5 1 5 1 3 6 652 796 136 31 96.726212 Arizona
5 1 5 1 3 7 811 795 64 30 96.637093 and
5 1 5 1 3 8 898 795 67 30 96.637093 that
5 1 5 1 3 9 986 802 19 23 94.365463 a
5 1 5 1 3 10 1027 795 125 30 94.365463 current
5 1 5 1 3 11 1171 794 199 31 96.465103 vaccination
5 1 5 1 3 12 1393 793 170 32 96.472252 certificate
5 1 5 1 3 13 1585 793 115 40 96.837166 signed
5 1 5 1 3 14 1724 793 39 40 96.325661 by
5 1 5 1 3 15 1784 801 20 23 95.920189 a
5 1 5 1 3 16 1827 792 143 32 95.920189 licensed
5 1 5 1 3 17 1993 792 208 31 95.854553 veterinarian
5 1 5 1 3 18 2226 792 25 30 96.576775 is
4 1 5 1 4 0 209 843 738 41 -1
5 1 5 1 4 1 209 844 193 31 96.519745 maintained
5 1 5 1 4 2 417 852 41 23 96.941406 on
5 1 5 1 4 3 472 844 54 31 96.332481 the
5 1 5 1 4 4 541 844 161 40 96.332573 premises
5 1 5 1 4 5 715 843 47 31 96.987923 for
5 1 5 1 4 6 774 843 84 30 96.495674 each
5 1 5 1 4 7 874 843 73 39 93.339615 dog.
2 1 6 0 0 0 207 899 197 71 -1
3 1 6 1 0 0 207 899 197 71 -1
4 1 6 1 1 0 207 899 197 71 -1
5 1 6 1 1 1 207 899 197 71 44.540100 pn)
2 1 7 0 0 0 207 936 2042 95 -1
3 1 7 1 0 0 207 936 2042 90 -1
4 1 7 1 1 0 391 936 1858 42 -1
5 1 7 1 1 1 391 940 4 31 96.447998 |
5 1 7 1 1 2 415 940 73 31 82.298691 ‘We
5 1 7 1 1 3 507 939 107 39 96.556679 certify
5 1 7 1 1 4 632 939 69 31 96.961998 that
5 1 7 1 1 5 720 939 83 30 51.974102 We
5 1 7 1 1 6 822 946 57 23 95.942917 are
5 1 7 1 1 7 897 938 186 39 95.823593 submitting
5 1 7 1 1 8 1103 946 19 22 96.921059 a
5 1 7 1 1 9 1141 937 82 31 96.103638 valid
5 1 7 1 1 10 1243 945 94 32 96.363670 copy
5 1 7 1 1 11 1356 937 39 31 96.842354 of
5 1 7 1 1 12 1410 937 61 31 96.785591 the
5 1 7 1 1 13 1491 937 117 31 96.321251 rabies
5 1 7 1 1 14 1627 937 226 31 96.070229 vaccination
5 1 7 1 1 15 1873 936 194 31 96.294342 certificate
5 1 7 1 1 16 2085 936 56 30 96.120728 for
5 1 7 1 1 17 2158 936 91 30 96.120728 each
4 1 7 1 2 0 207 936 497 95 -1
5 1 7 1 2 1 207 940 68 86 16.669674 aan
5 1 7 1 2 2 305 936 73 95 31.282749 wi
5 1 7 1 2 3 295 987 80 31 96.701828 with
5 1 7 1 2 4 390 987 71 30 96.755653 this
5 1 7 1 2 5 476 987 228 39 96.608406 application.
2 1 8 0 0 0 205 1068 2047 190 -1
3 1 8 1 0 0 205 1068 2047 190 -1
4 1 8 1 1 0 207 1068 2045 53 -1
5 1 8 1 1 1 207 1068 254 45 7.397842 6.<~—We
5 1 8 1 1 2 477 1081 198 32 96.893799 understand
5 1 8 1 1 3 691 1081 67 32 96.690269 that
5 1 8 1 1 4 772 1089 20 23 96.752663 a
5 1 8 1 1 5 808 1081 65 40 96.921867 dog
5 1 8 1 1 6 891 1081 173 38 96.452835 remaining
5 1 8 1 1 7 1080 1080 99 32 96.488205 within
5 1 8 1 1 8 1195 1080 55 31 96.488205 the
5 1 8 1 1 9 1267 1080 115 30 96.881378 kennel
5 1 8 1 1 10 1400 1080 25 30 96.961975 is
5 1 8 1 1 11 1443 1081 53 29 96.998787 not
5 1 8 1 1 12 1512 1080 143 39 96.445305 required
5 1 8 1 1 13 1671 1080 32 30 96.627144 to
5 1 8 1 1 14 1720 1080 41 30 96.992188 be
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5 1 8 1 1 16 1939 1078 194 40 96.515427 individually
5 1 8 1 1 17 2151 1078 101 31 96.350296 under
4 1 8 1 2 0 205 1127 2044 43 -1
5 1 8 1 2 1 205 1131 113 31 65.121101 A.R.S.
5 1 8 1 2 2 340 1131 20 39 92.789398 §
5 1 8 1 2 3 384 1131 150 36 93.616859 11-1008.
5 1 8 1 2 4 577 1131 70 30 90.791931 I/we
5 1 8 1 2 5 667 1131 73 31 96.125977 also
5 1 8 1 2 6 762 1129 198 33 96.755836 understand
5 1 8 1 2 7 982 1129 65 31 96.720444 that
5 1 8 1 2 8 1066 1137 20 23 96.081070 a
5 1 8 1 2 9 1107 1129 63 40 96.081070 dog
5 1 8 1 2 10 1192 1129 123 39 96.563026 leaving
5 1 8 1 2 11 1336 1129 55 31 96.043358 the
5 1 8 1 2 12 1411 1128 171 32 96.085297 controlled
5 1 8 1 2 13 1605 1128 115 31 96.388573 kennel
5 1 8 1 2 14 1740 1128 179 30 95.388756 conditions
5 1 8 1 2 15 1940 1127 79 31 96.658600 shall
5 1 8 1 2 16 2041 1128 42 30 96.973778 be
5 1 8 1 2 17 2104 1127 145 31 96.446587 licensed
4 1 8 1 3 0 208 1175 2040 43 -1
5 1 8 1 3 1 208 1179 101 32 93.271576 under
5 1 8 1 3 2 324 1179 111 31 89.797226 A.R.S.
5 1 8 1 3 3 456 1179 18 39 92.824936 §
5 1 8 1 3 4 495 1179 143 30 96.645393 11-1008
5 1 8 1 3 5 655 1180 119 38 96.602791 except
5 1 8 1 3 6 791 1178 19 31 96.705734 if
5 1 8 1 3 7 823 1179 56 30 96.732277 the
5 1 8 1 3 8 895 1178 64 39 96.732277 dog
5 1 8 1 3 9 979 1178 25 30 96.975685 is
5 1 8 1 3 10 1021 1177 71 40 96.529503 only
5 1 8 1 3 11 1110 1177 93 40 96.327957 being
5 1 8 1 3 12 1221 1177 201 39 96.444290 transported
5 1 8 1 3 13 1440 1177 32 31 96.605553 to
5 1 8 1 3 14 1489 1177 136 31 96.660553 another
5 1 8 1 3 15 1642 1176 113 32 96.126350 kennel
5 1 8 1 3 16 1771 1176 101 30 96.662689 which
5 1 8 1 3 17 1891 1176 62 30 96.847191 has
5 1 8 1 3 18 1971 1183 20 23 96.766258 a
5 1 8 1 3 19 2010 1175 110 39 95.490646 permit
5 1 8 1 3 20 2137 1175 111 31 96.787376 issued
4 1 8 1 4 0 207 1227 320 31 -1
5 1 8 1 4 1 207 1227 102 31 96.881096 under
5 1 8 1 4 2 321 1227 59 31 96.568245 this
5 1 8 1 4 3 394 1227 133 30 96.721802 section.
2 1 9 0 0 0 205 1305 2044 105 -1
3 1 9 1 0 0 205 1305 2044 105 -1
4 1 9 1 1 0 205 1305 2044 56 -1
5 1 9 1 1 1 205 1305 254 48 0.000000 7.—-—“We
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. © |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. L/ The 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.
We certify that all of the information I/We have provided is true and accurate under penalty of law.
CO)
Applicant Signature Date:
_ ok
Val
bs A Shift 9,
Applicant Signature Bate. Dihinn 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 & Contro
2500 South 27" Avenue
Phoenix, AZ 85009
Phone: (602) 506-7387
pets.maricopa.gov
KENNEL PERMIT K17-000010
PREMISE INSPECTION
Number of Dogs: 9
Name: Friends for Life Kennel Name: Same
Mailing Address: 143 W Vaughn Ave Kennel Address: Same
City: Gilbert State: AZ Zip: 85233 City: Gilbert Zip: 85233
County Supervisorial District: #2
Phone: 480-497-8296 Kennel Phone: 480-215-6018
1. Are all dogs over the age of three months properly vaccinated for rabies and in
of a valid rabies vaccination certificate?
=
2. Is the kennel an enclosed, controlled area, inaccessible to other animals, in which a
keeps, harbors or maintains five or more dogs under controlled conditions?
ae
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.)
Deputy Enforcement Agent & Badge #: Lt Timothy Rummel Date: 6/23/16
October 2015
RABIES VACCINATION CERTIFICATE Rabies Tag Number _
NASPAY Forrn 850
eae ames Reese 7 Print - use ball point pen or type
trends, for Eibe MEAS H42-52 ry p1CATE
U3
5 1 8 1 1 2 266 312 46 39 39.531593 Ww
5 1 8 1 1 3 355 284 106 88 39.224640 Vilu
5 1 8 1 1 4 483 288 88 70 30.947256 yin
5 1 8 1 1 5 629 295 126 63 3.996305 ne
5 1 8 1 1 6 788 283 253 85 30.629658 Gilbert
5 1 8 1 1 7 1285 294 82 66 49.586491 AL
5 1 8 1 1 8 1399 336 25 28 83.926010 |
5 1 8 1 1 9 1426 294 78 69 9.542084 SS
5 1 8 1 1 10 1524 290 110 82 9.216394 RR
5 1 8 1 1 11 1434 309 198 54 46.638206 SSRSY
5 1 8 1 1 12 1701 323 191 44 0.000000 =sPITAL
2 1 9 0 0 0 94 357 1644 145 -1
3 1 9 1 0 0 94 357 1644 142 -1
4 1 9 1 1 0 97 357 1420 43 -1
5 1 9 1 1 1 97 366 106 25 39.796482 Species:
5 1 9 1 1 2 278 362 4 31 62.811115 |
5 1 9 1 1 3 298 358 50 42 34.668564 Saux
5 1 9 1 1 4 752 369 60 20 59.468689 Sac:
5 1 9 1 1 5 1054 368 157 21 30.397081 Pradaminant
5 1 9 1 1 6 1222 357 80 31 38.189461 Brew,
5 1 9 1 1 7 1452 366 65 26 82.816986 Coke
4 1 9 1 2 0 96 358 1642 128 -1
5 1 9 1 2 1 96 403 48 50 86.106552 Dog
5 1 9 1 2 2 289 412 60 20 66.488564 Mae
5 1 9 1 2 3 401 404 29 28 47.840645 =O
5 1 9 1 2 4 469 362 79 74 32.584538 oa
5 1 9 1 2 5 567 415 20 21 85.209663 10
5 1 9 1 2 6 599 412 51 24 85.209663 12
5 1 9 1 2 7 656 418 23 18 14.300995 ee.
5 1 9 1 2 8 686 358 22 128 44.156349 2
5 1 9 1 2 9 837 411 79 25 16.184769 hs
5 1 9 1 2 10 954 403 28 32 85.977310 O
5 1 9 1 2 11 1171 425 95 6 28.276777 ae
5 1 9 1 2 12 1350 358 74 86 47.104851 lk
5 1 9 1 2 13 1386 379 84 80 73.409721 br
5 1 9 1 2 14 1493 370 112 70 47.793098 Ra
5 1 9 1 2 15 1699 389 39 36 50.858387 25
4 1 9 1 3 0 94 415 1452 87 -1
5 1 9 1 3 1 94 456 42 24 67.601242 ca
5 1 9 1 3 2 183 447 28 32 87.512825 O
5 1 9 1 3 3 284 445 97 54 94.094841 Female
5 1 9 1 3 4 392 425 106 77 22.040205 Yr)
5 1 9 1 3 5 490 458 23 21 65.354935 12
5 1 9 1 3 6 525 462 80 36 84.748596 mo.
5 1 9 1 3 7 585 445 25 57 72.359665 or
5 1 9 1 3 8 613 459 62 20 73.262016 cider
5 1 9 1 3 9 699 445 41 57 35.528145 U7}
5 1 9 1 3 10 751 455 72 27 74.086975 70.50
5 1 9 1 3 11 831 458 42 20 61.964603 ibs.
5 1 9 1 3 12 953 435 52 43 41.136536 a
5 1 9 1 3 13 1016 415 159 79 0.000000 LN
5 1 9 1 3 14 1204 426 54 62 52.065872 ji
5 1 9 1 3 15 1271 430 85 69 39.865894 Iv
5 1 9 1 3 16 1504 449 42 18 17.944374 a
2 1 10 0 0 0 749 492 232 31 -1
3 1 10 1 0 0 734 486 247 41 -1
4 1 10 1 1 0 749 492 232 31 -1
5 1 10 1 1 1 734 486 165 41 49.043430 lowarsats.
5 1 10 1 1 2 953 492 28 31 25.065941 2
2 1 11 0 0 0 1002 357 10 182 -1
3 1 11 1 0 0 1002 357 10 182 -1
4 1 11 1 1 0 1002 357 10 182 -1
5 1 11 1 1 1 1002 357 10 182 95.000000
2 1 12 0 0 0 80 449 1542 174 -1
3 1 12 1 0 0 80 449 1542 174 -1
4 1 12 1 1 0 80 449 1542 174 -1
5 1 12 1 1 1 80 487 209 136 95.000000
5 1 12 1 1 2 675 487 74 51 95.000000
5 1 12 1 1 3 1364 449 258 70 95.000000
2 1 13 0 0 0 801 528 830 15 -1
3 1 13 1 0 0 801 528 830 15 -1
4 1 13 1 1 0 801 528 830 15 -1
5 1 13 1 1 1 801 528 830 15 95.000000
2 1 14 0 0 0 411 538 440 85 -1
3 1 14 1 0 0 411 538 440 85 -1
4 1 14 1 1 0 411 538 440 85 -1
5 1 14 1 1 1 411 548 73 75 95.000000
5 1 14 1 1 2 704 538 147 10 95.000000
2 1 15 0 0 0 555 548 296 75 -1
3 1 15 1 0 0 555 548 296 75 -1
4 1 15 1 1 0 555 548 296 32 -1
5 1 15 1 1 1 555 548 296 32 95.000000
4 1 15 1 2 0 558 580 107 43 -1
5 1 15 1 2 1 558 580 107 43 95.000000
2 1 16 0 0 0 93 559 318 80 -1
3 1 16 1 0 0 93 559 318 80 -1
4 1 16 1 1 0 93 559 318 80 -1
5 1 16 1 1 1 93 596 120 22 64.613785 Froduste:
5 1 16 1 1 2 233 559 118 80 53.897873 IAAI
5 1 16 1 1 3 388 618 20 4 53.897873 E
5 1 16 1 1 4 384 568 27 55 43.000969 we
2 1 17 0 0 0 678 660 951 17 -1
3 1 17 1 0 0 678 660 951 17 -1
4 1 17 1 1 0 678 660 951 17 -1
5 1 17 1 1 1 678 660 951 17 95.000000
2 1 18 0 0 0 524 672 654 346 -1
3 1 18 1 0 0 524 672 654 346 -1
4 1 18 1 1 0 787 672 375 41 -1
5 1 18 1 1 1 787 672 375 41 95.000000
4 1 18 1 2 0 538 713 624 63 -1
5 1 18 1 2 1 538 713 624 63 95.000000
4 1 18 1 3 0 538 776 640 71 -1
5 1 18 1 3 1 538 776 640 71 95.000000
4 1 18 1 4 0 524 847 564 171 -1
5 1 18 1 4 1 524 847 564 171 95.000000
2 1 19 0 0 0 91 806 413 9 -1
3 1 19 1 0 0 91 806 413 9 -1
4 1 19 1 1 0 91 806 413 9 -1
5 1 19 1 1 1 91 806 413 9 95.000000
2 1 20 0 0 0 174 879 329 11 -1
3 1 20 1 0 0 174 879 329 11 -1
4 1 20 1 1 0 174 879 329 11 -1
5 1 20 1 1 1 174 879 329 11 95.000000
2 1 21 0 0 0 664 961 310 9 -1
3 1 21 1 0 0 664 961 310 9 -1
4 1 21 1 1 0 664 961 310 9 -1
5 1 21 1 1 1 664 961 310 9 95.000000
2 1 22 0 0 0 1716 959 476 12 -1
3 1 22 1 0 0 1716 959 476 12 -1
4 1 22 1 1 0 1716 959 476 12 -1
5 1 22 1 1 1 1716 959 476 12 95.000000
2 1 23 0 0 0 78 1007 483 11 -1
3 1 23 1 0 0 78 1007 483 11 -1
4 1 23 1 1 0 78 1007 483 11 -1
5 1 23 1 1 1 78 1007 483 11 95.000000
2 1 24 0 0 0 766 1005 859 17 -1
3 1 24 1 0 0 766 1005 859 17 -1
4 1 24 1 1 0 766 1005 859 17 -1
5 1 24 1 1 1 766 1005 859 17 95.000000
2 1 25 0 0 0 1427 1150 685 16 -1
3 1 25 1 0 0 1427 1150 685 16 -1
4 1 25 1 1 0 1427 1150 685 16 -1
5 1 25 1 1 1 1427 1150 685 16 95.000000
2 1 26 0 0 0 536 1175 317 10 -1
3 1 26 1 0 0 536 1175 317 10 -1
4 1 26 1 1 0 536 1175 317 10 -1
5 1 26 1 1 1 536 1175 317 10 95.000000
2 1 27 0 0 0 329 1182 329 6 -1
3 1 27 1 0 0 329 1182 329 6 -1
4 1 27 1 1 0 329 1182 329 6 -1
5 1 27 1 1 1 329 1182 329 6 95.000000
2 1 28 0 0 0 253 1372 327 8 -1
3 1 28 1 0 0 253 1372 327 8 -1
4 1 28 1 1 0 253 1372 327 8 -1
5 1 28 1 1 1 253 1372 327 8 95.000000
2 1 29 0 0 0 85 615 2192 837 -1
3 1 29 1 0 0 88 615 2149 837 -1
4 1 29 1 1 0 88 615 1385 138 -1
5 1 29 1 1 1 88 615 340 125 0.000000 sscabasaporine
5 1 29 1 1 2 509 657 88 55 9.284849 ‘TOATE
5 1 29 1 1 3 615 657 180 55 0.000000 VADGINATED:
5 1 29 1 1 4 1012 692 215 27 0.000000 \vemrarers®
5 1 29 1 1 5 1314 721 159 32 45.427040 a
4 1 29 1 2 0 101 752 2136 78 -1
5 1 29 1 2 1 101 774 245 4 0.000000 aeniieeccmat
5 1 29 1 2 2 431 774 72 4 0.000000 emeetiacel
5 1 29 1 2 3 769 774 51 55 56.124363 Day
5 1 29 1 2 4 1170 812 6 2 4.738464 ,
5 1 29 1 2 5 1200 752 178 78 20.488609 Gake
5 1 29 1 2 6 1378 795 37 27 46.244370 7
5 1 29 1 2 7 1454 762 68 56 34.337013 ae
5 1 29 1 2 8 1545 778 24 40 22.201004 MN
5 1 29 1 2 9 1581 759 88 62 81.977737 lm
5 1 29 1 2 10 1726 778 87 5 0.000000 a
5 1 29 1 2 11 1918 768 42 55 28.933878 —
5 1 29 1 2 12 2132 769 105 4 1.709738 oo
4 1 29 1 3 0 85 822 1290 71 -1
5 1 29 1 3 1 85 841 74 52 31.210327 One:
5 1 29 1 3 2 529 859 187 24 0.000000 VACATION
5 1 29 1 3 3 725 862 127 21 95.489845 EXPIRES:
5 1 29 1 3 4 1257 822 118 30 28.001003 a
4 1 29 1 4 0 88 867 1766 98 -1
5 1 29 1 4 1 88 905 85 60 38.783550 came
5 1 29 1 4 2 200 898 35 65 0.000000 1
5 1 29 1 4 3 270 906 47 20 60.436420 add
5 1 29 1 4 4 336 898 31 27 28.273211 LO
5 1 29 1 4 5 1103 868 209 60 95.926949 Askew,
5 1 29 1 4 6 1339 868 140 52 94.122345 DVM
5 1 29 1 4 7 1499 867 215 89 25.708023 #1672,
5 1 29 1 4 8 1737 902 66 52 48.252068 34
5 1 29 1 4 9 1817 878 37 87 6.140165 L.
4 1 29 1 5 0 440 961 1128 51 -1
5 1 29 1 5 1 440 965 12 3 8.891172 :
5 1 29 1 5 2 1226 963 201 35 73.450424 Hameward
5 1 29 1 5 3 1443 961 125 51 96.427376 Bound
4 1 29 1 6 0 250 1078 1825 119 -1
5 1 29 1 6 1 250 1120 146 77 67.127960 142
5 1 29 1 6 2 483 1120 73 47 0.000000 WN.
5 1 29 1 6 3 618 1100 264 81 69.917046 Vaughn
5 1 29 1 6 4 900 1122 192 55 13.643980 ave
5 1 29 1 6 5 1197 1088 38 113 13.643980 _
5 1 29 1 6 6 1261 1099 3 67 45.362572 |
5 1 29 1 6 7 1297 1102 290 70 9.270554 Guilber
5 1 29 1 6 8 1655 1108 97 55 67.715828 AZ
5 1 29 1 6 9 1830 1092 138 56 61.389561 892
5 1 29 1 6 10 1985 1078 90 73 67.363892 a4
4 1 29 1 7 0 250 1163 1322 130 -1
5 1 29 1 7 1 250 1199 3 47 61.343685 |
5 1 29 1 7 2 267 1182 77 77 95.243881 Pets
5 1 29 1 7 3 355 1183 128 73 96.763939 Name:
5 1 29 1 7 4 1198 1163 22 130 0.000000 -
5 1 29 1 7 5 1241 1163 147 130 61.792526 [Bred
5 1 29 1 7 6 1403 1187 36 36 93.093460 &
5 1 29 1 7 7 1454 1183 118 40 96.815376 Color:
4 1 29 1 8 0 250 1248 2027 173 -1
5 1 29 1 8 1 250 1248 7 131 94.162979 |
5 1 29 1 8 2 346 1297 345 76 47.173706 Abigail
5 1 29 1 8 3 1267 1296 163 125 23.582607 eee
5 1 29 1 8 4 1473 1304 79 50 13.739538 A
5 1 29 1 8 5 1683 1299 210 55 44.736588 Cioiden
5 1 29 1 8 6 1931 1288 346 57 0.000000 breaindle.
4 1 29 1 9 0 253 1376 1056 76 -1
5 1 29 1 9 1 253 1380 97 61 22.702913 Sex:
5 1 29 1 9 2 1264 1376 45 76 59.586037 A
2 1 30 0 0 0 388 1389 1151 178 -1
3 1 30 1 0 0 388 1389 1151 178 -1
4 1 30 1 1 0 388 1389 1151 178 -1
5 1 30 1 1 1 388 1563 75 4 25.239153 —
5 1 30 1 1 2 548 1481 163 86 46.982479 fem
5 1 30 1 1 3 651 1501 191 60 42.304245 MGI
5 1 30 1 1 4 1247 1454 100 95 59.015766 i
5 1 30 1 1 5 1313 1389 226 156 30.206455 eva
2 1 31 0 0 0 525 1564 1133 139 -1
3 1 31 1 0 0 493 1564 1165 139 -1
4 1 31 1 1 0 525 1564 1133 139 -1
5 1 31 1 1 1 525 1609 180 94 8.174276 iu
5 1 31 1 1 2 702 1600 200 98 22.229242 UA
5 1 31 1 1 3 901 1592 165 95 24.973141 a
5 1 31 1 1 4 1321 1564 122 91 4.887495 “J~
5 1 31 1 1 5 1457 1572 125 89 2.998276 (fo)
5 1 31 1 1 6 1587 1584 71 68 2.998276 2.
2 1 32 0 0 0 1836 1527 323 7 -1
3 1 32 1 0 0 1836 1527 323 7 -1
4 1 32 1 1 0 1836 1527 323 7 -1
5 1 32 1 1 1 1836 1527 323 7 95.000000
2 1 33 0 0 0 1656 1527 503 12 -1
3 1 33 1 0 0 1656 1527 503 12 -1
4 1 33 1 1 0 1656 1527 503 12 -1
5 1 33 1 1 1 1656 1527 503 12 95.000000
2 1 34 0 0 0 259 1764 1945 154 -1
3 1 34 1 0 0 259 1764 1945 154 -1
4 1 34 1 1 0 367 1764 1837 88 -1
5 1 34 1 1 1 367 1770 56 82 81.054596 x
5 1 34 1 1 2 487 1800 14 39 88.440880 ]
5 1 34 1 1 3 525 1800 110 36 96.410431 have
5 1 34 1 1 4 649 1791 235 52 96.612206 surgically
5 1 34 1 1 5 902 1787 164 43 96.351021 altered
5 1 34 1 1 6 1084 1787 74 39 96.351021 the
5 1 34 1 1 7 1175 1777 387 46 94.673721 above-described
5 1 34 1 1 8 1582 1773 164 43 96.568680 animal
5 1 34 1 1 9 1764 1777 45 35 96.012810 to
5 1 34 1 1 10 1828 1773 53 38 96.491295 be
5 1 34 1 1 11 1900 1764 304 56 96.491295 permanently
4 1 34 1 2 0 259 1852 604 66 -1
5 1 34 1 2 1 259 1852 233 66 82.617737 incapable
5 1 34 1 2 2 508 1862 51 39 96.923004 of
5 1 34 1 2 3 573 1857 290 56 96.789345 procreation.
2 1 35 0 0 0 261 1959 1995 146 -1
3 1 35 1 0 0 261 1959 1995 146 -1
4 1 35 1 1 0 490 1959 1766 75 -1
5 1 35 1 1 1 490 1994 18 40 66.193329 |
5 1 35 1 1 2 529 1993 109 37 96.119049 have
5 1 35 1 1 3 654 1985 229 44 96.591148 examined
5 1 35 1 1 4 901 1985 73 40 96.656799 the
5 1 35 1 1 5 991 1976 388 45 96.157913 above-described
5 1 35 1 1 6 1399 1971 163 44 96.188156 animal
5 1 35 1 1 7 1579 1969 88 42 95.933189 and
5 1 35 1 1 8 1688 1967 136 40 95.933189 found
5 1 35 1 1 9 1842 1963 191 51 96.253479 surgical
5 1 35 1 1 10 2052 1959 204 40 96.204384 evidence
4 1 35 1 2 0 261 2046 742 59 -1
5 1 35 1 2 1 257 2042 46 69 96.489830 of
5 1 35 1 2 2 324 2046 283 59 96.489830 sterilization
5 1 35 1 2 3 625 2056 116 40 96.746246 done
5 1 35 1 2 4 757 2051 246 41 93.671150 elsewhere.
2 1 36 0 0 0 336 2041 154 6 -1
3 1 36 1 0 0 336 2041 154 6 -1
4 1 36 1 1 0 336 2041 154 6 -1
5 1 36 1 1 1 336 2041 154 6 95.000000
2 1 37 0 0 0 802 2448 1485 36 -1
3 1 37 1 0 0 802 2448 1485 36 -1
4 1 37 1 1 0 802 2448 1485 36 -1
5 1 37 1 1 1 802 2448 1485 36 95.000000
2 1 38 0 0 0 269 2399 1434 94 -1
3 1 38 1 0 0 269 2399 1434 94 -1
4 1 38 1 1 0 269 2399 1434 94 -1
5 1 38 1 1 1 269 2446 281 41 93.106430 Veterinarian
5 1 38 1 1 2 568 2443 230 50 96.266518 Signature:
5 1 38 1 1 3 1049 2404 55 71 0.000000 ill
5 1 38 1 1 4 1126 2421 206 50 0.000000 Askew,
5 1 38 1 1 5 1359 2407 138 55 95.869232 DVM
5 1 38 1 1 6 1518 2403 65 56 95.495483 #1
5 1 38 1 1 7 1594 2399 109 55 96.012527 672
2 1 39 0 0 0 1894 3218 582 12 -1
3 1 39 1 0 0 1894 3218 582 12 -1
4 1 39 1 1 0 1894 3218 582 12 -1
5 1 39 1 1 1 1894 3218 582 12 95.000000
2 1 40 0 0 0 2544 2938 6 360 -1
3 1 40 1 0 0 2544 2938 6 360 -1
4 1 40 1 1 0 2544 2938 6 360 -1
5 1 40 1 1 1 2544 2938 6 360 95.000000
RABIES VACCINATION CERTIFICATE Alahiea Tay Nuri
NASPHV Fann #50
Gwosr's Mame & Acdres Print - use bal] polmt pan or type
= ror Tie 20S!
aces ns TE RICATR
bat
Rog | | Mile x Smo: te 12 ma. LD | Unter 20 Ibs. i : 225
Cat | Femeie O 12 mo. of alder | 2 ala hi dua EU
Name Sursobe
[MLe | we] EG see Vacs. Serial (lot) No.
Producer: 1 yr Lisaos
(Fired <1 testers] O 3yr tics Neco, Cathar
For Gestsing Agency Use | DATE VACCINATED: 7
_ Monts Dy Year
_ 7 oe
Jill AskewsbDVM #1672
Saar htesaintioneciPions:
Change Oo nad LD
Contra Ne. Hamoward Bound fa 4 lp
IAG E. Pusos He #4
Chandler AZ 85225
|
are W, Vaughn ‘Bas Gilber 4+ AZ 8S224
Pets Name: Breed & Color:
| Wecctor Chubahie Brown #wWhife
| Sex: “Age:
. 2 CUNS
Made ig Yeu
TLL i ee
Ea
\4__I have surgically altered the above-described animal to be permanently
incapable of procreation.
_i have examined the above-described animal and found surgical evidence
of steriliza tion done elsewhere.
Veterinarian Signature: Jit Askew, DVM #1672
JUL-O1-2016 FRI 03:00 PM P. 001
2 VIRUS
RECORD DISTEMPER PARAINFLUENZA ADENOVIRUS PARVOVIRUS CORONAVIRUS BORDETELLA RANLEUKOPENIA RHINCTRACHEMIS IMMUNODEFICIENCY
LEUKEMIA CALICMALS CHLAMYDIA
DISEASE Boehringer Ingelheim
OLEPTOSPIROSIS
VACCINATION Name CIRABIES CLYME- CICANINE CANINE OOCANINE OCANINE CANINE OCANINE FELINE FEUNE OFELINE OFELINE OFeuUNE OOFELINE VIRUS G@ all
C1 CO O OV
: :
_|}
fi]
yw
&:
§: Serial TELEPHONE “TH 4
20 #: COLORS:
Tag Tag Cart ZIP
‘| |
BAEED: . _ ay om
2p #
. Mi STATE a Hf
CERTIFICATE PREDOMINANT Veterinarian’s Pos
Ss NAME:
FORMS? hype
or 1] “|
pen point Ce et . Ibs, Ibs Ibs. a:
NASPHY ball 20 Under $0 50 Over No,
VACCINATION use pity city SIZE: - 20 {Lat}
- {_ Q gil Letters) yasai Serial
-AYOS ADAPTED PRINT e Mo. 3
es 12 alder (First Was.
RABIES ta or acd eS
IAG FIRST ve : Ma. 12 PRODUCER: Lin
oO 1 yr
a:
Address STREET SEX: Male Female Altered
bsia— &
Name LAST SY
O OJ
Owner's PRINT NO, SPECIES: Dag cat Other WACO410001
Fax
RABIES VACCINATION CERTIFICATE
OWNER'S INFORMATION:
RESCUE FRIENDS FOR LIFE P1279029 (480 ) 4978296 SHELTEF
NAME FIRST NAME PERSON (D Bo TELEPHONE NUMBER EXT:
LAST
143. W VAUGHN AVE GILBERT AZ 85233
STREET ADDRESS: APT cry STATE 2iP CODE
ANIMAL INFORMATION
DOG SPAYED 9/30/2010 LARGE LABRADOR RETR MIX
ANIMAL TYPE AHIMAL SEX ANIMAL DATE OF BIRTH SIZE PRIMARY BREED SECONDARY BREED
BLACK WHITE
A3670948 WINDY
papa PRIMARY COLOR SECONDARY COLOR
ANIMAL NAME MICROCHIP NUMBER
VACCINATION INFORMATION
RABDOMUN 12 Months | 10/8/2015 | __toenoe | 6/5/16
VACCINE PRODUCER VACC. LENGTH DATE VACCINATED: VACCINATION EXPIRES | PRINT DATE
ee SOS a ym
Jr “ See os CS ‘
KILLED Maricopa County
Animal Care & Control
VAGGINE TYPE TETERIMARIAIES BIGRATORE 2500 S 27th Avenue, Phoenix, AZ 85009
(602) $06-7387
$516085
VACC. SERIAL NO. VETERINARIANS LICENSE NUMBER
sane Society of Yuma, Inc.
J SOUTH AVE 4 1/2E
JMA, AZ 85365
Phone: (928) 782-1621
| SAVE ONE UNTIL THERE ARE NONE
Vaccination Certificate
Vaccination infor
Vaccination ID HSOY
Vaccination Type RAB
Effective Date -
Expiration Date
Issued by NNE STACK DVM
Drug administered:
Manufacturer ZOETIS
Vaccine NOBIVAC 3 RABIES
Lot ID
Serial ID 110776
About this animal
Pet Name a Se. Sor License None on record
Species DOG ID#: 161167 Vacc ID HSOY
Primary Breed TERRIER Microchip None on record
Gender MALE/STERILIZED Registration None on record
Age ADULT | \- Ql 1%
Size MEDIUM Bites NO
| su | Vitra
gran
oe
ION
Veterinarian Signature A mua A
AL
\ | b
Veterinary License #
Federal Tax ID 86-6053617
Printed using Shelter Pro
aCe oe" NASPHY Form #50
Idregg—————— -— Print - use bell point pen or type
Lite. - paloma Me Pippo S 742
nis for
Chilbert Av °° [95234 TIFICATE
WwW Ave.
Sex: “Youghn Size: Precom ant Breed: | pons, ip (OY : SPITAL
Male “7 mo. to 12 mo. 4 | Under 20 tbs. CI ad ey 25
( |Female i? 42 mo. or older EX | 20-50 Ibs. Ly fi ial!
Over50ibs. OD] , 1G eres
e ofaned J No.
Vacc.
Producer: [- Z| O re a | wy Lic./Vacc. Ot} ne 5") 9023
(First 3 letters) (4 3 yr. Lic./Vace. Other :
For Licensing Agency Use DATE VACCINATED:
License No. Year , License No.
Month Day Year J
Signature
VACCINATI Homeward Bound
Other 1020 E. Pecos Rd. #1
Change DQ Add Chandler AZ 85225 * Fa SZC
Control No.
He. 6S23e
Galbert
Ave—
Vaughn
143_w_
Pets N Breed & Color
hfe Cattle Dog MU Tri lor
Sex: Age:
Femate Lear
”
po-lo-l4
_
Vaan
surgically altered the above-described animal to be permanently
incapable of procreation.
~ have examined the above-described animal and found surgical evidence
of sterilization done else where.
CAL halen) Dm.
Veterinarian Signature:
Jill Askew, DVM #1672
RABIES VACCINATION CERTIFICATE
Rabies Tag Number
NASPHV Form #50
Owner’s Name & Address Print - use ball point pen or type
PRINT - Last First
FEL Ml. | Telephone
WOT 7-S2%U
No. Street
I4Z . Ww: Vaughn ribet ity _. State om j
ave Az |8s234
Species: Sex: Age: Size: Predominant Breed:
Colors;
Dog pz Mate (4 |3mo.to12mo.( | Under 20 lbs. O Tot
cat O Female xh 12 mo. or older 20-50 ibs. 1 | oh er - nat MK
Name Over 50 Ibs.
| mM | eC | 2 | Vacc. Serial (lot) No.
Producer: vi] 1 yr. Lic.Vacc.
(First 3 letters) Os yr. Lic.Vacc. Other SY og O71 2
For Licensing Agency Use DATE VACCINATED:
License No. Year
Month Day
2
Other VACCINATION EXPIRES:
Change O add O Homeward Bound
Control No. 1020 E. Pecos Rd. #1
Chandler AZ 85225
mane of Yuma, Inc.
Society
/50 SOUTH AVE 4 1/2E
YUMA, AZ 85365
Phone: (928) 782-1621
|
| SAVE ONE UNTIL THERE ARE NONE
Certificate
‘Vaccination
Vaccination information:
Vaccination ID
Vaccination Type RABI
Effective Date
Expiration Date
Drug administered:
Manufacturer INTERVET
Vaccine RABVAC 3
Lot ID 1215411A
Serial ID
About this animal
License None on record
Pet Name DAISY Vacc ID
G ID#: 163748
Species Microchip 900074001800185
Primary Breed DACHSHUND None on record
Registration
FEMALE/STERILIZED
Gender
Age ADULT Bites NO
Size SMALL
Veterinarian Signature.
Veterinary License #
a RABIES VACCINATION
CERTIFICATE
NASPHV Form #50 Rabies Tag Number
Owner's Name & Address
PRINT - Last Print - use ball point pen or type
re L. First
Ml. | Tele
WUE
- £09 6
143 W"VauLgnn Tia
Ave™ Gilbert
Speci Age: 7 ‘Y5a3Y
Dog wi Predominant Breed:
3 mo. to 12 20 Ibs. OQ non
Cat ro
12 mo. or oldergXJ | 20-50 Ibs. Shep. MY Be wera
Na
PLA A | Over 50 Ibs. a
Producer: 1 yr. Lic.Vacc. Vacc. Serial (lot) No.
(First 3 letters) x 3 ke
For yr. Lic.Vace, Other d &f *, d- 8
Licensing Agency Use DATE VACCINATED:
License No. Year
£
—
License No.
Month Day Year
i?
Other
VACCINATION EXPIRES: i
Change O add O
Control No. | Askew, DVM #1672
fomeward Bound
1020 E. Pecos Rda-#1
Chandler AZ 85225