Extracted text (via tesseract_tsv)
23561 characters
Maricopa County
Animal Care and Control
2500 South 27th Avenue
Phoenix, AZ 85009
(602) 506-7387 Tele.
(602) 506-2739 Fax
KENNEL PERMIT K15-000032
APPLICATION
ONew & Renewal _
Name: SUE NIX Kennel Name: NIX KENNELS
Mailing Address: 2505 E LOUISE DR Kennel Address: SAME AS MAILING
City: PHOENIX State: AZ Zip:85032 City: PHOENIX Zip: 85032
County Supervisorial District: 3
Phone: 602-482-6975 Kennel Phone: 602-482-6975
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.
Yo PLEASE ANSWER THE FOLLOWING QUESTIONS AND INITIAL EACH RESPONSE
&
e assume complete responsibility for the kennel at the premises for which I/we are making
ion 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).
e certify that I/We have LF dogs and that the kennel meets the definition in statute.
e certify that I/We have not been convicted of a violation of A.R.S. §§ 13-2910 (cruelty to animals)
.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).
e certify that all dogs over the age of three (3) months that are kept, harbored or maintained on the
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.
certify that [We are submitting a valid copy of the rabies vaccination certificate for each
application.
understand that a dog remaining within the kennel is not required to be licensed individually under
. § 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 thjs section.
e 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.
SA7
understand that a person who knowingly fails to obtain a kennel permit within thirty days after
eee
ritten notification from the county enforcement agent is guilty of a class 2 misdemeanor..
Ar
undersigned understand that that the kennel permit does not authorize the operation of any type
8. i The
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.
‘Appian Oo at et ¢ 2 - 7--/ ¢
hi
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" Avenue
Phoenix, AZ 85009
Phone: (602) 506-7387
pets.maricopa.gov
KENNEL PERMIT K16-000032
PREMISE INSPECTION
Number of Dogs: 13
Name: SUE NIX Kennel Name: NIX KENNELS
Mailing Address: 2505 ELOUISE DR_ Kennel Address: 2505 E LOUISE DR
City: PHOENIX State: AZ Zip:85032 City: PHOENIX Zip: 85032
County Supervisorial District: #3
Phone: 602-482-6975 Kennel Phone: 602-482-6975
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: 12/21/15
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: R15-281619 Receipt Date: 12/20/2015
Person ID: P1152886
Phone: 602 4826975
NIX KENNELS 12/20/2015 10:28:53Al ne.
2505 E LOUISE DR
PHOENIX, AZ 85032
item: Animal ID: Reference No: Price: Each: Amount:
KEN PERMIT AT777777 K16-000032 $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
5 1 14 3 1 2 486 1770 62 32 94.058495 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
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Number Number
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Tag Z | aun ent vets _(e0a-4489-1175 | blac AZ
2 pi HALAL - Tag _
Rabies Telephone (003-489 : No.) Rabies Telephone RAZ. No.}
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| State {License | ate (License
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M.I. Breed: ' u # ZISe Tempe, MI. Breed: ‘ #
Leah
CERTIFICATE . x CERTIFICATE
5 Predominant Veterinarian’s: [Da . Predominant Veterinarian’s:
type Name: (Signature) Address: type Name:
or Cheeni or Proenz p
#51 pen 3; 1 O [7] .| #51 pen iL 1 O |
Form S13 : lbs. : Ibs.
point Ibs. . Form point S Ibs. Ibs. 22.
First City 20 Under 50 Actual_—Z_Ibs, - 20 Under Actual
VACCINATION NASPHV ball &f}20-50tbs. T VACCINATION ball First 20-s0tbs. 50 T
* Size: Over NASPHV Size: Over
use - | c ra Other no. use Dr | c
C1 Lic/Vace. Lic/Vace. d2US71 - (1 ur *|
Print Age-chsic p (lot) Print mo ol p Fis
5 1 145 1 1 3 1965 1048 63 91 12.683887 Fae
5 1 145 1 1 4 1969 706 62 82 47.963718 CO
5 1 145 1 1 5 1951 557 93 96 35.053528 Teor
5 1 145 1 1 6 1956 220 75 334 34.113113 Lhe!
5 1 145 1 1 7 1959 123 81 4 34.756409 |
2 1 146 0 0 0 2034 486 53 1325 -1
3 1 146 1 0 0 2034 486 53 1325 -1
4 1 146 1 1 0 2034 486 53 1325 -1
5 1 146 1 1 1 2034 1720 27 91 77.536774 Month
5 1 146 1 1 2 2035 1634 32 57 94.276390 Day
5 1 146 1 1 3 2035 1525 26 67 87.404716 Year
5 1 146 1 1 4 2050 1328 32 34 78.470055 (14
5 1 146 1 1 5 2062 1255 25 32 86.881920 yr
5 1 146 1 1 6 2055 1093 27 148 24.104252 Lio./Vace.
5 1 146 1 1 7 2038 711 26 119 11.678410 (ignature)
5 1 146 1 1 8 2034 661 8 15 55.185051 7
5 1 146 1 1 9 2041 486 5 5 17.727022 .
2 1 147 0 0 0 2084 234 87 1128 -1
3 1 147 1 0 0 2084 234 87 1128 -1
4 1 147 1 1 0 2084 234 87 1128 -1
5 1 147 1 1 1 2094 1328 48 34 47.713737 Ml
5 1 147 1 1 2 2105 1299 25 17 94.292412 3
5 1 147 1 1 3 2111 1255 27 32 87.715134 yr.
5 1 147 1 1 4 2105 1095 27 146 50.518608 Lic/Vace.
5 1 147 1 1 5 2084 732 67 99 0.000000 accross:
5 1 147 1 1 6 2103 576 68 110 34.919468 395
5 1 147 1 1 7 2106 477 57 69 87.922478 E.
5 1 147 1 1 8 2096 334 67 112 29.414930 ISth
5 1 147 1 1 9 2102 234 58 84 44.982765 4).
2 1 148 0 0 0 2154 1098 27 83 -1
3 1 148 1 0 0 2154 1098 27 83 -1
4 1 148 1 1 0 2154 1098 27 83 -1
5 1 148 1 1 1 2154 1098 27 83 96.611168 Other
2 1 149 0 0 0 2193 130 108 1660 -1
3 1 149 1 0 0 2193 130 108 1660 -1
4 1 149 1 1 0 2193 130 108 1660 -1
5 1 149 1 1 1 2196 1744 63 46 69.779190 A
5 1 149 1 1 2 2207 1512 64 197 10.917416 jai
5 1 149 1 1 3 2192 1386 96 56 26.092800 |_
5 1 149 1 1 4 2210 1062 72 308 0.000000 293us7|
5 1 149 1 1 5 2210 492 91 198 62.597775 Tempe,
5 1 149 1 1 6 2210 372 52 81 82.992142 AZ
5 1 149 1 1 7 2193 165 69 177 60.017254 B58!
5 1 149 1 1 8 2202 130 27 2 95.736351 |
2 1 150 0 0 0 2265 1102 42 709 -1
3 1 150 1 0 0 2265 1102 42 709 -1
4 1 150 1 1 0 2265 1102 42 709 -1
5 1 150 1 1 1 2273 1720 25 91 94.268326 Month
5 1 150 1 1 2 2273 1633 31 56 93.943306 Day
5 1 150 1 1 3 2273 1525 25 67 90.657791 Year
5 1 150 1 1 4 2274 1329 26 81 91.644127 Vacc.
5 1 150 1 1 5 2274 1236 27 81 92.030350 Serial
5 1 150 1 1 6 2274 1171 33 52 84.430725 (lot}
5 1 150 1 1 7 2265 1102 36 58 70.883797 no.
2 1 151 0 0 0 2135 1441 25 373 -1
3 1 151 1 0 0 2135 1441 25 373 -1
4 1 151 1 1 0 2135 1441 25 373 -1
5 1 151 1 1 1 2135 1598 25 216 95.343689 VACCINATION
5 1 151 1 1 2 2135 1441 25 143 96.351852 EXPIRED:
2 1 152 0 0 0 1227 125 1055 14 -1
3 1 152 1 0 0 1227 125 1055 14 -1
4 1 152 1 1 0 1227 125 1055 14 -1
5 1 152 1 1 1 1227 125 1055 14 95.000000
2 1 153 0 0 0 2256 958 7 452 -1
3 1 153 1 0 0 2256 958 7 452 -1
4 1 153 1 1 0 2256 958 7 452 -1
5 1 153 1 1 1 2256 958 7 452 95.000000
2 1 154 0 0 0 2261 1722 4 92 -1
3 1 154 1 0 0 2261 1722 4 92 -1
4 1 154 1 1 0 2261 1722 4 92 -1
5 1 154 1 1 1 2261 1722 4 92 95.000000
2 1 155 0 0 0 1540 840 820 10 -1
3 1 155 1 0 0 1540 840 820 10 -1
4 1 155 1 1 0 1540 840 820 10 -1
5 1 155 1 1 1 1540 840 820 10 95.000000
2 1 156 0 0 0 1224 1822 1139 12 -1
3 1 156 1 0 0 1224 1822 1139 12 -1
4 1 156 1 1 0 1224 1822 1139 12 -1
5 1 156 1 1 1 1224 1822 1139 12 95.000000
2 1 157 0 0 0 1539 1419 822 9 -1
3 1 157 1 0 0 1539 1419 822 9 -1
4 1 157 1 1 0 1539 1419 822 9 -1
5 1 157 1 1 1 1539 1419 822 9 95.000000
2 1 158 0 0 0 2356 885 7 944 -1
3 1 158 1 0 0 2356 885 7 944 -1
4 1 158 1 1 0 2356 885 7 944 -1
5 1 158 1 1 1 2356 885 7 944 95.000000
2 1 159 0 0 0 857 3300 303 0 -1
3 1 159 1 0 0 857 3300 303 0 -1
4 1 159 1 1 0 857 3300 303 0 -1
5 1 159 1 1 1 857 3300 303 0 95.000000
Dv” 12mo
moorolder yr. yr. Serial 12 Age
RABIES moto Producer: [4 Ql 3 2 RABIES ‘ Lowise to oF Producer:
Lief. Age: 12 Actual Vacc. Age: mo Actual
[/12mo
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Address ‘Ley [&)3 1} 1 Address [5/8 11
x
EXPIRED:
COPY and 1+ Nix Stree _E Female Neutered Year Ww Year COPY and N Tee Neutered
, Sex: VACCINATED: Sex: Male Female
OWNER'S Name Last | fZi|Male | te Day Day OWNER'S Name Last | | | VACCINATED:
- (| [1] VACCINATION - aes" [fl [| [1
PRINT Gly
Owner’s No. 'LAEOn Species: Dog Cat Other: Specity) DATE Month {AS Month Owner’s PRINT [No. Species: Other: (Specify) DATE
a Dog Cat
iL |
| i | | :
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 M.i. Telephone
iw % LI? (od-493-104
No. AS OS Street } \ xv” - Phoentx 8 a7 [Beal
= CULAR,
4
Species: Sex Age: Size: Predominant Breed: Colors:
Dog ps Male §<{| 3 mo to 12 mo 1 | Under 20 Ibs. Bd 4 :
Cat CA | Female [1 | 12 mo or older fid | 20 - 50 Ibs. Cl A
Other: [1 } Neutered [1 } Actual Age Over 50 Ibs. 4
(Specify) Actual_}O_Ibs. Name:
Lous der
DATE VACCINATED: Producer: Veterinarlan’s: # ya, AL
p a £ (License No.)
G je {3 (First 3 fetters) Lor. ee Myrel/
Month Day Year (71 yr. Lic./Vacc. {Signature)
M3 yr. Lic./Vacc. Address:
VACCINATION EXPIRED: BPD E VE Ss
Other
A 15 Iw 5984 2 ta Ya)
Month Day Year Vacc. Serial (lot} no.
Number Number -4@9-[4 rial AZ 3B08)
WZ eh Colors: an
Tag ‘ag
Rabies ine No,) ESS} Telephone ta i324 AZ
ne WRA Rabies ‘160 No}
(License State (Licensé
MI. Breed: # Zo MI. Breed: Tennpe
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CERTIFICATE Predominant Lieezle Veterinarian’s: CERTIFICATE Cacn
type Phenix Name: Lhe (Signature} Address: type Predominant Veterinarian’s: Ld, (Signature)
or Proeniv Name:
or
#57 pen Pub & [1 lbs. #57 pen UL 4 (1
Form point lbs. ibs. Form Ibs. Ibs.
20 m\e) point lbs. Ibs. ated
ball First Br” 20-50lbs. 50 First 20 50
VACCINATION NASPHV Size: Under Over Actual letters) VACCINATION NASPHV ball Dr.” Size: Under 20-50 Over Actual TT |
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- : J ON . 3 (First Lic./Vace, Lic./Vace. no. - & Pip 3 Ve Lic./Vace. Other no.
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Louie. 12 or Age yr. yr. ___-dOther Serial 12 older Age yr. Lic./ yr. yr. ——_—.._. AIBC Serial
RABIES moto mo Producer: (1 & 3 RABIES Lovet to or mo Producer: [11 3
Age: 3 12 Actual Vacc. Age: mo 12 Actual $43 Vace.
| 3
Address M (] [1 Address Oo pr (1 |
COPY and Female Neutered 2 Year EXPIRED: lo Year COPY and Nix Py cSt Neutered {3 Year EXPIRED: \bo Year
hosx Ds Sex: Male VACCINATED: Sex: Male Female
OWNER’S Name Last YM CJ CI ite Day \S Day OWNER’S Name Last. | VACCINATED: |e Day Day
- Ao VACCINATION - Sp is 5 VACCINATION AAS
Owner's PRINT No. Species: Dog Cat Other: (Specify) DATE A Month A Month Owner's PRINT ) Species: Other: (Specify) DATE 4 Month Month
No. Dog Cat
|
OWNER'S COPY RAB 3IES VACCINATION CERTIFICATE
NASPHV Form #57 Rabies Tag Number
Owner's Name and Address Print - use ball point pen or type
PRINT - Last First MA.
TW Ve. . aul SF b975
“95 OS Street & LOUISe Vypsenix A pate BS 635A
#
Species Sex: Age: Size: Predominant Breed:
Dog Male. [1 } 3 mo to 12 mo [1] | Under 20 Ibs. 1]
Cat (i | Femate (4712 mo or alder G47 y 20 - 50 Ibs. | ef
Other: LI} N eutered (] | Actual Agedl sy. Over 50 Ibs. [1]
(Specify) Actual_£Q Ibs. Name:
‘Rec
DATE VACCINATED: Producer: Veterinarian’s: # AZ. UE
Cc. OQ Ee {License No.}
(First 3 letters) Laz Voom Lobe
(Signaftrey ~ F Lol
(1 yr. Lic./Vace. Address: BA
E43 yr. Lic./ Vace. 32, E- sf.
VACCINATION EXPIRED: Other %, A 2-FI2Y)
Avo \% oa fe,
Month Day Year Vacc. Serial (lot) no.
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Number |B Az YALIZD Aaivec
Colors: Ref 8B7E Number 2403
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Tag
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CERTIFICATE cr
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Form point Ibs. tbs. Ibs. Form point Ibs. Ibs.
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VACCINATION NASPHV ball Under 50 - ¥ ball Ci 50 50 LE
use Size: 20 Over Actual letters} VACCINATION NASPHV peo Size: Under 20 - Over letters}
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older Lic./ older
12 or Age ye. yr. Serial 12 age ye. yr. Serial
RABIES Loiee to mo mo [1 1 Lys RABIES Louise j moto moor (1) 1 CHS
Age: 3 12 Actual Vacc. Age: 12 Actual acc.
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Address 9 & C1 Address fa 1] |} LC
COPY and Rise . EXPIRED: 15 EXPIRED: 18
oe Neutered {% Year le Year COPY and Female Neutered Year Year
Name Sex: MiMale Ol|Female VACCINATED: iS eX: Male
OWNER’S Last - | | [1 ie Day 1S Day OWNER'S Name Last nix “I505°E. 10 \i2 Day Day
M260 VACCINATION - | [| VACCINATION jAI1O
Owner's PRINT Species: Dog Cat Other: (Specify) DATE “A Month A Month Owner’s PRINT Or Species: Other: (Specify) Month Month
Dog Cat
OWNER’S COPY “RABIES VACCINATION CERTIFIGATE
NASPHV Form #51 Rabies Tag Number
Owner’s Name and Address Print - use ball point pen or type
First ML. Telephone
SUC WA YUB8RXEGZ
M9 SO Streat. Levursé or.” Gity Phoen: = a ‘4 aoe
Gk. ¢
Species: Sex: Age: Size: Predominant Breed: Colors:
Dog Male 113 mo to 12 mo £1 | Under 20 Ibs. [HI] dach
Cat C\ Female [2/12 mo or older 21 20 - 50 Ibs. Cl
Other: [1 | Neutered [J | Actual Age ue Over 50 Ibs. O
B 3 ® 2. <= Actual #2 Ibs. Oe on gq
9
Veterinarian’s: # AZ (EG
DATE VACCINATED: Producer: C O- FE ce {License No}
}2 30.15 First 3 letters)
Month Day Year (11 yr. Lic./Vace. {Signature} +f
AS yr. Lic./Vacc. Address: ° SSPE,
VACCINATION EXPIRED: Other 325
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jA 1018 IO7TWY B “TS
Month Day Year ——+¥ Vacc. Serial (lot i no.
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Number Number “WATS
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Tag HDS lawn
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Rabies iE rd, 28032 Telephone GA AZ
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Mi. BREED: D | ate __LL (License E
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CERTIFICATE
PREDOMINANT Pheer CERTIFICATE Habb
type Di za : Veterinarian’s: Lhe
or PHN NAM VETERINARIAN: VeterinafaanSigiatubs type Name: (Signature) Address:
51 pen DK or
Form “T] [j Address; #51 |
ballpoint First ibs. ibs. pen Sue : 1 ips.
VACCINATION NASPHV 20 tbs. 50 Form point lbs. |
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- | ui \) 3 Ph No. ball First 50 Actual_A\_ Cc
PRINT Dive [J al J (First /Vaccine (Lot) VACCINATION NASPHV Over letters)
Ahi use _
12me. Lic. / ic, Serial ~ Pic 3 /Vace. Other 1 no.
org) PRODUCER: yr. a Print First LeVace. (lot)
NABIES mo,- mo. | Vaccine Lie . |_SA8us4i
oe 12 - Sy a yt Serial
4 9%
EUS 58 [7 Pal @ RABIES producers 14 2
Address 7 Vacc.
| Year EXPIRES: Year |
& Y ys, ale Neutéred Address —_|
Name Ni | De ix Ie Day E.
5 1 121 3 1 3 1475 1190 35 184 32.607265 Lawist
5 1 121 3 1 4 1458 1062 52 81 79.062683 Dr.
5 1 121 3 1 5 1455 711 57 174 31.446072 Phoen:
5 1 121 3 1 6 1481 666 31 27 54.263123 x
5 1 121 3 1 7 1458 326 51 78 95.502930 AZ
5 1 121 3 1 8 1473 229 51 74 0.000000 Sa
5 1 121 3 1 9 1466 141 62 58 0.000000 Bo)
4 1 121 3 2 0 1530 208 55 1573 -1
5 1 121 3 2 1 1530 1656 55 125 96.815346 Species:
5 1 121 3 2 2 1530 1539 43 63 96.529381 Sex:
5 1 121 3 2 3 1531 1312 43 67 96.701996 Age:
5 1 121 3 2 4 1530 1008 43 69 95.674744 Size:
5 1 121 3 2 5 1536 609 27 189 96.094971 Predominant
5 1 121 3 2 6 1537 502 26 95 96.765526 Breed:
5 1 121 3 2 7 1531 208 43 103 87.098969 Colors:
2 1 122 0 0 0 1571 832 96 1028 -1
3 1 122 1 0 0 1571 832 96 1028 -1
4 1 122 1 1 0 1571 832 67 1028 -1
5 1 122 1 1 1 1571 1857 67 3 94.897415 |
5 1 122 1 1 2 1585 1722 32 57 94.438065 Dog
5 1 122 1 1 3 1572 1635 48 35 25.812635 KI
5 1 122 1 1 4 1568 1610 56 15 91.027016 |
5 1 122 1 1 5 1585 1530 26 71 78.431335 Mate
5 1 122 1 1 6 1581 1410 32 33 47.573814 [11
5 1 122 1 1 7 1574 1384 50 13 55.658363 |
5 1 122 1 1 8 1587 1360 24 17 86.366386 3
5 1 122 1 1 9 1593 1303 18 44 94.547226 mo
5 1 122 1 1 10 1587 1263 24 29 95.448669 to
5 1 122 1 1 11 1587 1216 24 34 95.881645 12
5 1 122 1 1 12 1592 1159 19 44 95.881645 mo
5 1 122 1 1 13 1581 1111 32 34 61.858574 [J
5 1 122 1 1 14 1574 1088 50 14 90.312531 |
5 1 122 1 1 15 1586 985 25 92 96.556664 Under
5 1 122 1 1 16 1587 940 24 37 96.771523 20
5 1 122 1 1 17 1578 832 36 95 95.733269 Ibs.
5 1 122 1 1 18 1574 830 50 34 47.452625 Ki]
4 1 122 1 2 0 1624 832 43 1028 -1
5 1 122 1 2 1 1640 1858 15 2 70.615044 |
5 1 122 1 2 2 1636 1729 25 52 80.590004 |Cat
5 1 122 1 2 3 1632 1494 30 174 6.765461 (1|Female
5 1 122 1 2 4 1627 1410 38 33 17.678576 (€}
5 1 122 1 2 5 1636 1342 25 34 86.875366 12
5 1 122 1 2 6 1636 1158 26 171 81.576355 moorolder
5 1 122 1 2 7 1624 1110 43 35 39.975380 Ki
5 1 122 1 2 8 1636 972 26 105 0.000000 20-50
5 1 122 1 2 9 1636 909 26 50 0.000000 tbs.
5 1 122 1 2 10 1632 832 30 34 67.888573 ©
2 1 123 0 0 0 1667 88 96 1771 -1
3 1 123 1 0 0 1667 88 96 1771 -1
4 1 123 1 1 0 1667 97 77 1762 -1
5 1 123 1 1 1 1686 1855 35 4 85.559547 |
5 1 123 1 1 2 1677 1789 52 23 81.480927 |
5 1 123 1 1 3 1684 1690 41 91 96.117058 Other:
5 1 123 1 1 4 1681 1634 31 34 38.626465 [1
5 1 123 1 1 5 1677 1607 52 14 90.684723 |
5 1 123 1 1 6 1686 1467 26 134 96.866249 Neutered
5 1 123 1 1 7 1681 1410 32 33 25.266880 C1
5 1 123 1 1 8 1677 1390 52 10 94.634453 |
5 1 123 1 1 9 1686 1285 26 94 96.881798 Actual
5 1 123 1 1 10 1686 1216 33 58 80.622978 Age
5 1 123 1 1 11 1667 1104 77 91 33.639519 Say Expire: We
[7] specify COPY and tree 1 Year: Year
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3 1 74 1 0 0 1183 1967 296 58 -1
4 1 74 1 1 0 1183 1967 296 58 -1
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2 1 75 0 0 0 1224 1921 293 42 -1
3 1 75 1 0 0 1224 1921 293 42 -1
4 1 75 1 1 0 1224 1921 293 42 -1
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5 1 75 1 1 2 1252 1921 80 42 3.521643 (0)
5 1 75 1 1 3 1345 1927 80 26 44.003494 [eHeg
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2 1 76 0 0 0 1274 2253 6 104 -1
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4 1 76 1 1 0 1274 2253 6 104 -1
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2 1 77 0 0 0 1053 2219 303 343 -1
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owner's cory — RABIES VACCINATION
CERTIFICATE
Owner’s Name and Address NASPHV Form #51 Rabies Tag Number
PRINT Print - use ball point pen or type
- Last
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AiX | Telephone *
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Species: S: Sex: Age:
Dog IN} Male NI] Size: Predominant Breed: Colors:
3 mo to 12 mo O Under 20 Ibs.
Cat (1) Female [4] 12 moor older EL Bel é h (i 1 Tar
Si | 20-50 Ibs.
Other: Li | Neutered C1 | Actual Ageia}
| Over 50 Ibs. [J =
Specity)
Actual £€) Ibs, id i
| oe 7 d fs (
DATE VACCINATED:
Producer: 2 bole Veterinarian’s: i
iZ ] O 15
(First 3 letters} y
Month Day Year / f / hb A fy
C11 yr Lic./Vace. (Signature} °
Sy LioVaco. Aatess: ; ;
VACCINATION EXPIRED: 22 OE SSIL SK
Other
iA 10 18 | . ; (3 Ange, A 2ef52 #29) oa
4107414 Z e
Month Day Year Vacc. Serial
(lot) no.
|
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