E CHARLES SHABAZZ.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
/ ]- 06066 ‘Le
MM New (CI Renewal Permit #
Name: Cnarle 5 N\alyaez Kennel Name:_=
ay
Malling Address: a) 2 ia { £ : CULV El ay. Kennel Location: 25 LZ 4 3 : CULVT . St «
~
Y Wo INS ZIP FF DO A District Wins é OPQ D sf ss
City ) County Supervisorial ]
Home Phone: \O()Z . 220 ‘ ASL 4 Kennel Phone: (OZ . 220. 152. 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 Boarad’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
A. f )_ 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).
A
2. ¢. -)__ We certify that I/We have Z | dogs and that the kennel meets the definition in statute.
<i C 5 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).
C )
4, We 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.
A
5. 1 AWe certify that We are submitting a valid copy of the rabies vaccination certificate for each
dog with this application.
6. e = We 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. Q We understand that a person who fails to obtain a kennel permit under A.R.S.§11-1009 is subject to a
2
penalty of twenty-five dollars in addition to the annual fee.
8. S MWe 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..
. rot
9. FS 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 [We have provided is true and accurate under penalty of law.
zz/h
Applicant Signature Date: ei (2
EMG Date: Aa. ~lb
Applicant Signature edict,
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 (\ L | > lL
BOS Approval Date Term of Permit.
2 of 2

Maricopa County
Animal Care & Control
2500 South 27" Avenue-
Phoenix, AZ 85009
Phone: (602) 506-7387
pets.maricopa.gov
KENNEL PERMIT K16-000062
PREMISE INSPECTION
Number of Dogs: 29
Name: Charles “E” Shabazz Kennel Name: None
Mailing Address: 2529 E Culver Street Kennel Address: Same
City: Phoenix State: AZ Zip: 85008 City: Phoenix Zip: 85008
County Supervisorial District: #5
Phone: 602-220-9523 Kennel Phone: 602-220-9523
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?
a
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: 11/05/2015
October 2015

Maricopa County Animal Care and Control
2500 S. 27th Avenue
Phoenix, AZ 85009-6797
(602) 506-7387
http://pets.maricopa.gov
Receipt Number: R16-057595 Receipt Date: 03/12/2016
Person ID: P2054053
Phone: 602 2209523 .
CHARLES SHABAZZ
3/12/2016 1:13:55PM aa.
2529 E CULVER ST
PHOENIX, AZ 85008
Item: Animal ID: Reference No: Price: Each: Amount:
KEN PERMIT AT777777 K17-000062 $328.00 s| $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
5	1	14	3	1	2	493	1778	63	31	96.275352	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 FOR MARICOPA COUNTY, ARIZONA
DATE VACCINATED VACCINATION EXPIRES RABIES TAG NUMBER
02/12/2016
awn
NAME: E Shabazz PET: BIk Top Male
2529 E Culver St
Phoenix, AZ 85008 TELEPHONE: 220-9523 (602)
.
SPECIES SEX AGE WEIGHT
Canine M 02/01/2013 6 lbs 0 ozs
BREED COLOR
Chinese Crested Black
Producer: PFi
Serial Number: $516082C
Vaccine Type: Killed
Duration: 1095
| hereby certify that | have vaccinated this animal in accordance with the company's recommendation
for the vaccine used on the above date.
Catalina Animal Hospital
9023 N 35th Ave
Phoenix, AZ 85051
A,
Mae
: A
Sighature Oflicensed veterijariax admMipt¢ting vaccine.
NeilFarrington, D.V.M.
Hospitay#1656

RABIES VACCINATION CERTIFICATE FOR MARICOPA COUNTY, ARIZONA
DATE VACCINATED VACCINATION EXPIRES RABIES TAG NUMBER
02/12/2016
AWA
NAME: E Shabazz PET: Curly
2529 E Culver St
Phoenix, AZ 85008 TELEPHONE: 220-9523 (602)
SPECIES SEX AGE WEIGHT
Canine M 02/01/2013 5 lbs 0 ozs
BREED COLOR
Chinese Crested Black
Producer: PFI
Serial Number: S516082C
Vaccine Type: Killed
Duration: 1095
| hereby certify that | have vaccinated this animal in accordance with the company's recommendation
for the vaccine used on the above date.
Catalina Animal Hospital
9023 N 35th Ave
Phoenix, AZ 85051
Sigh#tlire icensed veterinari fh irri ff vaccine.
x
NeilFary

RABIES VACCINATION CERTIFICATE FOR MARICOPA COUNTY, ARIZONA
DATE VACCINATED VACCINATION EXPIRES RABIES TAG NUMBER
02/12/2016
ahi
NAME: E Shabazz PET: Quick
2529 E Culver St
Phoenix, AZ 85008 TELEPHONE: 220-9523 (602)
SPECIES SEX AGE WEIGHT
Canine M 02/01/2011 5 Ibs 0 ozs
BREED COLOR
Mix, Pomeranian
Producer: PFI
Serial Number: S516082C
Vaccine Type: Killed
Duration: 1095
| hereby certify that | have vaccinated this anjmal in accordance with the company's recommendation
for the vaccine used on the above date.
Catalina Animal Hospital
9023 N 35th Ave
Phoenix, AZ 85051
Sibndidre Ht jilensed veterinarigh Administdyfhg vaccine.
NeilFarri n, D.V.M.
Hospital #7656

RABIES VACCINATION CERTIFICATE FOR MARICOPA COUNTY, ARIZONA
DATE VACCINATED VACCINATION EXPIRES RABIES TAG NUMBER
02/10/2016
ae WAY
NAME: E Shabazz PET: Coco
2529 E Culver St
Phoenix, AZ 85008 TELEPHONE: 220-9523 (602)
SPECIES SEX AGE WEIGHT
Canine F 02/01/2009 4 tbs 0 ozs
BREED COLOR
Powder Puff Lt Brn
Producer: PFI
Serial Number: S576082C
Vaccine Type: Killed
Duration: 1095
| hereby certify that | have vaccinated this animal in accordance with the company's recommendation
for the vaccine used on the above date.
Catalina Animal Hospital
9023 N 35th Ave
Phoenix, AZ 85051
YY
f
ig licensed veterinarfag adryfhigfgring vaccine.
ifFarGogton, D.V.M.
Hospitayv#1656

RABIES VACCINATION CERTIFICATE FOR MARICOPA COUNTY, ARIZONA
DATE VACCINATED VACCINATION EXPIRES RABIES TAG NUMBER
02/12/2016
QWN-AN\A
NAME: E Shabazz PET: Female
2529 E Culver St
Phoenix, AZ 85008 TELEPHONE: 220-9523 (602)
SPECIES SEX AGE WEIGHT
Canine F 0 tbs 0 ozs
BREED COLOR
Chinese Crested Black
Producer: PFI
Serial Number: S516082C
Vaccine Type: Killed
Duration: 1095
| hereby certify that | have vaccinated this animal in accordance with the company's recommendation
for the vaccine used on the above date
Catalina Animal Hospital
9023 N 35th Ave
Phoenix, AZ 85051
A Vi, Mf
Z, Wf,
offlicensed veteringfi vaccine.
See
ington, D.V.M. “use
Hospital #1656

RABIES VACCINATION CERTIFICATE FOR MARICOPA COUNTY, ARIZONA
DATE VACCINATED VACCINATION EXPIRES RABIES TAG NUMBER
02/12/2016
a\\- 1%
NAME: E Shabazz PET: Slick
2529 E Culver St
Phoenix, AZ 85008 TELEPHONE: 220-9523 (602)
SPECIES SEX AGE WEIGHT
Canine M . 02/01/2011 5 Ibs 0 ozs
BREED COLOR
Chinese Crested No Hair
Producer: PF]
Serial Number; S516082C
Vaccine Type: Killed
Duration: 1095
| hereby certify that | have vaccinated this animal in accordance with the company's recommendation
for the vaccine used on the above date.
Catalina Animal Hospital
9023 N 35th Ave
Phoenix, AZ 85051

RABIES VACCINATION CERTIFICATE FOR MARICOPA COUNTY, ARIZONA
DATE VACCINATED VACCINATION EXPIRES RABIES TAG NUMBER
02/12/2016
Q-\\- \A
NAME: E Shabazz PET: Suga
2529 E Culver St
Phoenix, AZ 85008 TELEPHONE: 220-9523 (602)
SPECIES SEX AGE WEIGHT
Canine F 02/01/2008 6 Ibs 0 ozs
BREED COLOR
Chinese Crested Black
Producer: PFI
Serial Number: $516082C
Vaccine Type: Killed
Duration: 1095
| hereby certify that | have vaccinated this animal in accordance with the company's recommendation
for the vaccine used on the above date.
Catalina Animal Hospital
9023 N 35th Ave
Phoenix, AZ 85051
wd,
a 1G vaccine.

RABIES VACCINATION CERTIFICATE FOR MARICOPA COUNTY, ARIZONA
DATE VACCINATED VACCINATION EXPIRES RABIES TAG NUMBER
02/12/2016
Aa-\\- IN
NAME: E Shabazz PET: Solo
2529 E Culver St
Phoenix, AZ 85008 TELEPHONE: 220-9523 (602)
SPECIES SEX AGE WEIGHT
Canine M 02/01/2011 4 lbs 0 ozs
BREED COLOR
Mix, Pomeranian White
Producer: PFI
Serial Number: S516082C
Vaccine Type: Killed
Duration: 1095
| hereby certify that | have vaccinated this animal in accordance with the company's recommendation
for the vaccine used on the above date.
Catalina Animal Hospital
9023 N 35th Ave
Phoenix, AZ 85051
Ms
dmigistdring vaccine.

RABIES VACCINATION CERTIFICATE FOR MARICOPA COUNTY, ARIZONA
DATE VACCINATED VACCINATION EXPIRES RABIES TAG NUMBER
02/12/2016 a \\~ AOVG
NAME: E Shabazz PET: Velvet
2529 E Culver St
Phoenix, AZ 85008 TELEPHONE: 220-9523 (602)
SPECIES SEX AGE WEIGHT
Canine F 02/01/2013 3 lbs 0 ozs
BREED COLOR
Mix, Pomeranian Red
Producer: PFI
Serial Number: S516082C
Vaccine Type: Killed
Duration: 1095
| hereby certify that | have vaccinated this animal in accordance with the company's recommendation
for the vaccine used on the above date,
Catalina Animal Hospital
9023 N 35th Ave
tie.
Sigrathird of licensed veteringfan administering vaccine.
NeilFarrington, D.V.M.
Hospitalj##1656

RABIES VACCINATION CERTIFICATE FOR MARICOPA COUNTY, ARIZONA
DATE VACCINATED VACCINATION EXPIRES RABIES TAG NUMBER
02/12/2016
ANWAAA
NAME: E Shabazz PET: Baldy
2529 E Culver St
Phoenix, AZ 85008 TELEPHONE: 220-9523 (602)
SPECIES SEX AGE WEIGHT
Canine M 02/01/2014 5 lbs 0 ozs
BREED COLOR
Chinese Crested No Hair
Producer: PFI
Serial Number. S516082C
Vaccine Type: Killed
Duration: 1095
| hereby certify that | have vaccinated this animal in accordance with the company's recommendation
for the vaccine used on the above date.
Catalina Animal Hospital
9023 N 35th Ave
Phoenix, AZ 85051

RABIES VACCINATION CERTIFICATE FOR MARICOPA COUNTY, ARIZONA
DATE VACCINATED VACCINATION EXPIRES RABIES TAG NUMBER
02/12/2016
BWIA
NAME: E Shabazz PET: Spike
2529 E Culver St
Phoenix, AZ 85008 TELEPHONE: 220-9523 (602)
SPECIES SEX AGE WEIGHT
Canine M 02/01/2014 4 tbs 0 ozs
BREED COLOR
Mix, Pomeranian White
Producer: PFI
Serial Number: $516082C
Vaccine Type: Killed
Duration: 1095
| hereby certify that | have vaccinated this animal in accordance with the company's recommendation
for the vaccine used on the above date.
Catalina Animal Hospital
9023 N 35th Ave
Phoenix, AZ 85051
J
Sighature diffcensed veterinarig inStéring vaccine.
NeilFarringtén, D.V.M.
Hospital #7656

RABIES VACCINATION CERTIFICATE FOR MARICOPA COUNTY, ARIZONA
DATE VACCINATED VACCINATION EXPIRES RABIES TAG NUMBER
02/12/2016
a-\\- \Q
NAME: E Shabazz PET: Kookie
2529 E Culver St
Phoenix, AZ 85008 TELEPHONE: 220-9523 (602)
SPECIES SEX AGE WEIGHT
Canine F 02/01/2011 0 lbs 0 ozs
BREED COLOR
Chinese Crested Black
Producer: PFI
Serial Number: S516082C
Vaccine Type: Killed
Duration: 1095
| hereby certify that | have vaccinated this animal in accordance with the company's recommendation
for the vaccine used on the above date.
Catalina Animal Hospital
9023 N 35th Ave
Lyi Phoenix, AZ 85051
fz
Signaturéffcensed veterinarian f vaccine.
ypistoning
NeilFarringjon, D.V.M.
Hospital #1656 /
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RABIES VACCINATION CERTIFICATE FOR MARICOPA COUNTY, ARIZONA
DATE VACCINATED VACCINATION EXPIRES RABIES TAG NUMBER
02/12/2016
2-\\- \\
NAME: E Shabazz PET: Sally
2529 E Culver St ;
Phoenix, AZ 85008 TELEPHONE: 220-9523 (602)
SPECIES SEX AGE WEIGHT
Canine F 02/01/2011 5 Ibs 0 ozs
BREED COLOR
Chinese Crested White
Producer: PF]
Serial Number: $516082C
Vaccine Type: Killed
Duration: 1095
| hereby certify that | have vaccinated this animal in accordance with the company's recommendation
for the vaccine used on the above date.
Catalina Animal Hospital
9023 N 35th Ave
Phoenix, AZ 85051
Peano
Sighatu igensed veterinarian vaccine.
Rear of V.M.
3°
Hospital #4

RABIES VACCINATION CERTIFICATE FOR MARICOPA COUNTY, ARIZONA
DATE VACCINATED VACCINATION EXPIRES RABIES TAG NUMBER
02/12/2016
Q-WAA
NAME: E Shabazz PET: Flopsi
2529 E Culver St
Phoenix, AZ 85008 TELEPHONE: 220-9523 (602)
SPECIES SEX AGE WEIGHT
Canine F 02/01/2013 6 lbs 0 ozs
BREED COLOR
Chinese Crested Black
Producer: PFI
Serial Number: S516082C
Vaccine Type: Killed
Duration: 1095
| hereby certify that | have vaccinated this anjmal in accordance with the company's recommendation
for the vaccine used on the above date.
Catalina Animal Hospital
9023 N 35th Ave
Phoenix, AZ 85051
dimihistéring vaccine.

RABIES VACCINATION CERTIFICATE FOR MARICOPA COUNTY, ARIZONA
DATE VACCINATED VACCINATION EXPIRES RABIES TAG NUMBER
02/12/2016 a-W- IA
NAME: E Shabazz PET: Blue
2529 E Culver St
Phoenix, AZ 85008 TELEPHONE: 220-9523 (602)
SPECIES SEX AGE WEIGHT
Canine M 09/29/2010 6 Ibs 2 ozs
BREED COLOR
Chinese Crested Bik-Wht
Producer: PFI
Serial Number: S$516082C
Vaccine Type: Killed
Duration: 1095
| hereby certify that | have vaccinated this animal in accordance with the company's recommendation
for the vaccine used on the above date.
Catalina Animal Hospital
9023 N 35th Ave
Phoenix, AZ 85051

RABIES VACCINATION CERTIFICATE FOR MARICOPA COUNTY, ARIZONA
DATE VACCINATED VACCINATION EXPIRES RABIES TAG NUMBER
02/12/2016
XWAA
NAME: E Shabazz PET: Hanna
2529 E Culver St
Phoenix, AZ 85008 TELEPHONE: 220-9523 (602)
SPECIES SEX AGE WEIGHT
Canine F 0 Ibs 0 ozs
BREED COLOR
Mix, Pomeranian White
Producer: PFI
Serial Number: S516082C
Vaccine Type: Killed
Duration: 1095
| hereby certify that | have vaccinated this animal in accordance with the company's recommendation
for the vaccine used on the above date.
Catalina Animal Hospital
9023 N 35th Ave
Phoenix, AZ 85051