Extracted text (via tesseract_tsv)
30899 characters
Maricopa County
Animal Care and Control
2500 South 27th Avenue
Phoenix, AZ 85009
(602) 506-7387 Tele.
(602) 506-2739 Fax
KENNEL PERMIT APPLICATION
Ilo
L] New i] Renewal Permit # K>S-000024
Name: Nancy Chapman Kennel Name: Chapman Kennels
Mailing Address: 4201 W. Tierra Buena Ln Kennel Location: 4201 W. Tierra Buena Ln, Phoenix
City: Phoenix ZIP: 85053 County Supervisorial District: District # 4
:Phone: 602-896-4019 Kennel Phone: 602-896-4019
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 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. 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
1. NC _|/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).
Ree /. L
2. I/We certify that I/We have dogs and that the kennel meets the definition in statute.
3. NC__-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).
A. 7 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.
5. yC—1 We certify that We are submitting a valid copy of the rabies vaccination certificate for each
dog with this application.
6. ee 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. 1 We understand that a person whi 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. Y\2— 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. Tethe 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 [MWe have provided is true and accurate under penalty of law.
Applicant Signature Thos, ACen. Date: Lof22 L Pa of 5
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
_
2 of 2
Maricopa County
Animal Care & Control
2500 South 27" Avenue
Phoenix, AZ 85009
Phone: (602) 506-7387
pets.maricopa.gov
KENNEL PERMIT K16-000024
PREMISE INSPECTION
Number of Dogs: 12
Name: Nancy Chapman Kennel Name: Chapman Kenhels
Mailing Address: 4201 W Tierra Buena Kennel Address: 4201 w Tierra Buena
City: Phoenix State: AZ Zip: 85053 City: Phoenix Zip: 85053
County Supervisorial District: #4
Phone: 602-896-4019 Kennel Phone: 602-896-4019
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
person keeps, harbors or maintains five or more dogs under controlled conditions?
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: 11/12/2015
October 2015
HO ARO
Maricopa County Animal Care and Control
2500 S. 27th Avenue
Phoenix, AZ 85009-6797
(602) 506-7387
http://pets. maricopa.gov
Receipt Number: R15-247873 Receipt Date: 10/30/2015
Person ID: P1246031
Phone: 602 8964019
CHAPMAN KENNELS
10/30/2015 12:43:21PI
4201 W TIERRA BUENALN
PHOENIX, AZ 85053
Item: Animal iD: Reference No: Price: Each: Amount:
KEN PERMIT Al777777 K16-000024 $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 15 3 1 2 481 1791 62 32 96.611923 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
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 - First M.I. |
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some 6994 Yo) 7
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Species: ,| Sex: Age: Size: Predominant Breed: Col
Dog Male of 3 mo to 12 mo C1,| Under 20 Ibs. cf bth ly, fin
ic
Cat [1]|Female C1] 12moor older 20-50 lbs. (| 26s Q EP
Other: C] Neutered" Actual Ae yy Over 50 Ibs.
Specity) Actual lbs. Name:
DATE VACCINATED: Veterinarian’s: # 2-) / o G
Producer: 2I re) a ™
(First 3 letters)
IL,
Month Day Year (Signature)
has r Ue. —— 328 E. ) 5 th JK
VACCINATION EXPIRED:
Other
| Tenge, A 2+F5 08)
joy ASITSS IA
Month Day Year _ | Vace. Serial (lot) no.
OWNER’S COPY RABIES VACCINATION CERTIFICATE Rabies Tag Number
oO
Print - use ball point pen or type
<i eee
First
Lats (- Hy)§
= ES) Zip |
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NO Wwe Terre. Baers
W390) rfant U Colors: .
Size: Predom Breed:
Speci pecies: Sex: : Age: 4 g 1c
Male 1) 3 moto 12 mo san 5, ‘ A 7h lass
Dog Y4J| nen '
Cat [| Female 42 mo or olde
Actual age. Yr Over 50 Ibgx CI
Other: C1 | Neutered kinrne:
(Specify) Actual Ibs.
Veterinarian’s: #
DATE VACCINATED: Producer: ZL O €|
(First
5 1 63 1 1 5 1026 2359 8 43 72.722717 3
5 1 63 1 1 6 1044 2368 79 30 88.760269 letters)
5 1 63 1 1 7 1431 2384 32 11 36.343037 ey,
5 1 63 1 1 8 1587 2365 72 30 55.468559 GEES
5 1 63 1 1 9 1685 2340 25 50 10.652361 ).
5 1 63 1 1 10 1723 2361 12 38 0.000000 au
5 1 63 1 1 11 1745 2350 2 3 7.462187 -
5 1 63 1 1 12 1758 2336 95 46 18.183479 Ak.
5 1 63 1 1 13 1863 2353 73 35 10.315561 wise
4 1 63 1 2 0 1339 2410 112 26 -1
5 1 63 1 2 1 1339 2410 112 26 96.824402 (Signature)
4 1 63 1 3 0 811 2386 1116 131 -1
5 1 63 1 3 1 811 2444 35 32 45.452251 (11
5 1 63 1 3 2 886 2452 32 27 92.881943 yr.
5 1 63 1 3 3 931 2442 148 28 79.188606 Lic./Vacc.
5 1 63 1 3 4 1340 2461 16 21 73.062447 A
5 1 63 1 3 5 1356 2412 82 73 32.651196 sleet
5 1 63 1 3 6 1470 2397 71 120 86.060188 32
5 1 63 1 3 7 1503 2386 82 106 18.182726 it
5 1 63 1 3 8 1610 2392 62 105 0.000000 e
5 1 63 1 3 9 1704 2436 63 57 50.347542 IS
5 1 63 1 3 10 1777 2440 28 39 7.064180 $
5 1 63 1 3 11 1803 2418 33 66 59.275509 J
5 1 63 1 3 12 1855 2427 72 53 87.289368 Sk
2 1 64 0 0 0 859 2491 221 37 -1
3 1 64 1 0 0 859 2491 221 37 -1
4 1 64 1 1 0 859 2491 221 37 -1
5 1 64 1 1 1 859 2497 17 25 86.267639 3
5 1 64 1 1 2 887 2502 33 26 93.291718 yr.
5 1 64 1 1 3 933 2491 147 28 72.688271 Lic./Vacc.
2 1 65 0 0 0 363 2493 1628 111 -1
3 1 65 1 0 0 363 2493 1628 111 -1
4 1 65 1 1 0 363 2493 1628 111 -1
5 1 65 1 1 1 363 2538 216 32 92.488724 VACCINATION
5 1 65 1 1 2 591 2532 144 30 96.967003 EXPIRED:
5 1 65 1 1 3 995 2540 84 27 95.417191 Other
5 1 65 1 1 4 1472 2498 191 106 19.798584 Jepe,
5 1 65 1 1 5 1689 2493 55 75 95.721436 A
5 1 65 1 1 6 1755 2507 78 75 15.378513 rf
5 1 65 1 1 7 1857 2507 38 75 63.155350 5.
5 1 65 1 1 8 1892 2512 85 71 43.296410 Tr
5 1 65 1 1 9 1966 2520 25 82 87.400337 )
2 1 66 0 0 0 355 2568 777 204 -1
3 1 66 1 0 0 355 2568 777 204 -1
4 1 66 1 1 0 362 2568 770 141 -1
5 1 66 1 1 1 362 2594 87 115 27.522898 1g
5 1 66 1 1 2 486 2594 49 115 38.481140 J
5 1 66 1 1 3 611 2594 116 115 3.734550 Ne
5 1 66 1 1 4 796 2568 164 98 0.000000 dSI2
5 1 66 1 1 5 972 2575 160 67 0.000000 SSB
4 1 66 1 2 0 369 2660 695 48 -1
5 1 66 1 2 1 369 2682 64 25 96.657471 Month
5 1 66 1 2 2 489 2677 57 31 81.689217 Day
5 1 66 1 2 3 589 2673 65 25 81.689217 Year
5 1 66 1 2 4 770 2668 80 25 90.428162 Vacc.
5 1 66 1 2 5 863 2662 81 29 96.645645 Serial
5 1 66 1 2 6 956 2660 52 33 95.816498 (lot)
5 1 66 1 2 7 1021 2665 43 20 96.818665 no.
4 1 66 1 3 0 355 2707 92 65 -1
5 1 66 1 3 1 355 2707 92 65 45.910789 _
2 1 67 0 0 0 1475 1724 541 21 -1
3 1 67 1 0 0 1475 1724 541 21 -1
4 1 67 1 1 0 1475 1724 541 21 -1
5 1 67 1 1 1 1475 1724 541 21 95.000000
2 1 68 0 0 0 1475 1725 541 22 -1
3 1 68 1 0 0 1475 1725 541 22 -1
4 1 68 1 1 0 1475 1725 541 22 -1
5 1 68 1 1 1 1475 1725 541 22 95.000000
2 1 69 0 0 0 958 1741 551 23 -1
3 1 69 1 0 0 958 1741 551 23 -1
4 1 69 1 1 0 958 1741 551 23 -1
5 1 69 1 1 1 958 1741 551 23 95.000000
2 1 70 0 0 0 340 1731 417 39 -1
3 1 70 1 0 0 340 1731 417 39 -1
4 1 70 1 1 0 340 1731 417 39 -1
5 1 70 1 1 1 340 1741 120 29 41.150124 Owner's
5 1 70 1 1 2 471 1740 88 26 96.295609 Name
5 1 70 1 1 3 570 1735 54 28 95.972031 and
5 1 70 1 1 4 634 1731 123 29 95.972031 Address
2 1 71 0 0 0 393 1762 600 21 -1
3 1 71 1 0 0 393 1762 600 21 -1
4 1 71 1 1 0 393 1762 600 21 -1
5 1 71 1 1 1 393 1762 600 21 95.000000
2 1 72 0 0 0 393 1762 600 21 -1
3 1 72 1 0 0 393 1762 600 21 -1
4 1 72 1 1 0 393 1762 600 21 -1
5 1 72 1 1 1 393 1762 600 21 95.000000
2 1 73 0 0 0 393 1763 600 21 -1
3 1 73 1 0 0 393 1763 600 21 -1
4 1 73 1 1 0 393 1763 600 21 -1
5 1 73 1 1 1 393 1763 600 21 95.000000
2 1 74 0 0 0 393 1763 600 22 -1
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4 1 74 1 1 0 393 1763 600 22 -1
5 1 74 1 1 1 393 1763 600 22 95.000000
2 1 75 0 0 0 323 1764 670 22 -1
3 1 75 1 0 0 323 1764 670 22 -1
4 1 75 1 1 0 323 1764 670 22 -1
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4 1 77 1 1 0 1801 1824 217 13 -1
5 1 77 1 1 1 1801 1824 217 13 95.000000
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3 1 78 1 0 0 975 1820 1043 45 -1
4 1 78 1 1 0 975 1820 1043 45 -1
5 1 78 1 1 1 975 1820 1043 45 95.000000
2 1 79 0 0 0 1420 1838 280 9 -1
3 1 79 1 0 0 1420 1838 280 9 -1
4 1 79 1 1 0 1420 1838 280 9 -1
5 1 79 1 1 1 1420 1838 280 9 95.000000
2 1 80 0 0 0 320 1637 10 263 -1
3 1 80 1 0 0 320 1637 10 263 -1
4 1 80 1 1 0 320 1637 10 263 -1
5 1 80 1 1 1 320 1637 10 263 95.000000
2 1 81 0 0 0 326 1787 399 168 -1
3 1 81 1 0 0 326 1787 399 168 -1
4 1 81 1 1 0 326 1787 399 168 -1
5 1 81 1 1 1 326 1787 399 168 95.000000
5 1 81 1 1 2 530 1887 195 68 95.000000
2 1 82 0 0 0 656 1817 1362 61 -1
3 1 82 1 0 0 656 1817 1362 61 -1
4 1 82 1 1 0 656 1817 1362 61 -1
5 1 82 1 1 1 656 1817 1362 61 95.000000
2 1 83 0 0 0 1542 1831 3 89 -1
3 1 83 1 0 0 1542 1831 3 89 -1
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5 1 83 1 1 1 1542 1831 3 89 95.000000
2 1 84 0 0 0 1807 1833 2 90 -1
3 1 84 1 0 0 1807 1833 2 90 -1
4 1 84 1 1 0 1807 1833 2 90 -1
5 1 84 1 1 1 1807 1833 2 90 95.000000
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3 1 85 1 0 0 1701 1905 154 8 -1
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5 1 85 1 1 1 1701 1905 154 8 95.000000
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2 1 130 0 0 0 756 2732 625 21 -1
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2 1 131 0 0 0 703 2732 678 25 -1
3 1 131 1 0 0 703 2732 678 25 -1
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2 1 132 0 0 0 2545 2194 4 435 -1
3 1 132 1 0 0 2545 2194 4 435 -1
4 1 132 1 1 0 2545 2194 4 435 -1
5 1 132 1 1 1 2545 2194 4 435 95.000000
| ne 5
OWNER’S COPY RABIES VACCINATION CERTIFICATE
NASPHV Form #51 Rabies Wad thanber
;
Owner’s Name and Address Print - use ball point pen or type
PRINT - Last First Telephone
Chapman, Merer vi
OF 96 - 10/9
© Hz.
paaP th. Bibel” Pad)
70
Species: || Sex: Size: Predominant Breed: Colors:
ann st ;
Dog Male mo 12 mo Under 20 bs P,
ae 6, /
Cat [1] Female 12 mo or 20-50lbs. O
Other: 1 | Neutered Actual Aged ¥r Over oO
sayy <a
epeny) Actual_Z/Z bs. | Name
DATE VACCINATED: | producer] Z| Veterinarian’s: # AiellE [§ t
Q|
(First 3 letters) |
CM's
Month Day Year (Signature)
(11 yr. Lic./Vace. c —
BX yr. Lic/Vacc. Ix
VACCINATION EXPIRED: es
Other
2 FSP)
A 313 O16
Month Day Year Vacc. Serial (lot) no.
Se ee
OWNER’S COPY RABIES VACCINATION CERTIFICATE
Rabies Tag Number
NASPHV Form #51
Owner’s Name and Address Print - use ball point pen or type
PRINT - Last First M.I. | Telephone
,,
C hopman
ancy bop 2-401
No. Street City 4 ate p
UIOL I ona Buena LY Phoen» PYZ 125063
Species: | Sex: Age: Size: Predominant Breed: Colors:
Dog [if] Male 11] 3 moto 12 mo O | Under 20 Ibs. ¢
Shin V2
Cat (1| Female 12 mo or older BJ | 20-50 lbs. C1 _
Biers J ,
Other: (1 | Neutered Actual Age_¢ Over Oo
a
(Specify) Actual Ibs.
DATE VACCINATED: | producer:| ie
Tt
(First 3 letters)
Month: Dey Voor
(11 yr. Lic./Vacc.
[AS yr. Lic./Vacc.
VACCINATION EXPIRED: ; ys Ee \doths-
ener
OB4S 1 Tempe AIZ_ 26590
5
fear Vacc. Serial (lot) no.
owwewscory RABIES VACCINATION CERTIFICATE
NASPHV Form #51 Rabies Tag Number
Owner’s Name and Address Print - use ball point pen or type
First M.I. | Telephone
Che Map b oF PF b-74979
Orage,
*
ag) pA Terre Bucs Ly Piven, Ars 5-568
a
Species: Age: Size: Predominant B ; Colors:
Dog ‘A Male [1] 3 mo to 12 mo [1] | Under 20 InsrAA, BL
LAY ; an _-
Cat ‘C1| Female 12 mo or olde} 20-50tbs. 1 “4
Other: (1 | Neutered Actual Age Pate Over 50 Ibs. [1
(Specify)
Actual{“7 Ibs.
aia:
OAT
DATE VACCINATED: Producer: Veterinarian’s: #
21 O i? a
;
Month Day Year : Signa =
111 yr. Lic./Vacc. 5 j
ia 325 5 tk A
=< yr. Lic./Vacc.
VACCINATION EXPIRED:
Other A
fen
ES p, M-F 998)
(7S§28
Month Day Year Vacc. Serial (lot) no.
owver'scory = 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.l. | Telephone
Chepman None14 Lol) RG YO)
e i q
Mom, US rerva LO Phoenix “Pp [nse
Pirana
Species: | Sex: Age: Size: Predominant Breed: Colors:
Dog W]Male [1/3 moto12mo 1} Under 20 Ibs.) ‘ “i
Chibuiahua
Cat ([l|Female [%| 12 moor older §¥|20-50lbs. O
Other: [1] | Neutered JM | Actual Age \y Over 50 Ibs. O
Bret) Actual Ibe, | Name:
DATE VACCINATED: Sreducer: Veterinarian’s: # \ 1a“ YZ
a i pi
(First 3 letters)
Mou Day seer
1 1 yr. Lic./Vacc.
Address:
XJ 3 yr. Lic./Vace.
VACCINATION EXPIRED: Other 295 & \orn St
Son 2 ea tet] Az. C528 [
Tempe
Day Year
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 First M.l. Telephone
Chapman
Mlaney G22? (~4O/F
NO ¥
Mol el. Tere. B uae hot Phecosy, Ai. FIPS?
oe
Species: | Sex: Age: Size: Predominant Breéd: Colors:
Dog Male 11/3 moto 12 mo F] Under 20 Ibs:
“o A Charkes
Cat Female {| 12 mo or older | 20 - 50 Ibs. Kine
Other: CJ | Neutered (1 | Actual Age Over 50 Ibs. [J
—_—
(Specify)
Actual {7 _ Ibs. “|
DATE VACCINATED: Producer:
OF
(First 3 letters)
Month Day Year ne SE. rue f
[11 yr. Lic./Vace. 3
DX Lic./Vace. Address:
yr.
VACCINATION EXPIRED: Fenpe
Other A 2-528)
ASIDES IR
Month Day Year Vacc. Serial (lot) no.
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 - First Telephone
Chepmor’ May bor- Fb
4019
No. treet Af ity
yo) Wh Tierra ‘Buens Lal Pheer ae aX
}
Species: ,| Sex Age: Size Predominant pred:
Dog Male L,| 3 mo to 12 nord Under 20 Ib: ay
bape farles
Cat [| Female ral 12 mo or (| 20 - 50 Ibs. ;
i J
Other: [| Neutered [1 | Actual Age Over 50 Ibs. (1
See Actual Ibs, | Name:
DATE VACCINATED: es ed LG Veterinarian’s: # Feel ie
r
(First 3 letters)
ion
(Signature) oe
Day Year Yh
yr. Lic./Vacc. iast
Address:
3 yr. Lic./Vacc. fe
VACCINATION EXPIRED: 308
Other
Je-pe, A2652F)
SIPS SN
to 4a 1h |&
M ay Year Vacc. Serial (lot) no.
OWNER’S COPY RABIES VACCINATION CERTIFICATE : Number
Rabies Tag
NASPHV Form #51
Owner’s Name and Address Print - use ball point pen or type
First M.l. | Telephone
PRINT - Last
(a0 Tle 40
Chapman Vances
> “ tal i
| City PAROS
’ uy Paurarc Lyn Phoeni YZ
Ribyoy) Tere
Size: Predominant Breed:
Species: Sex: Age: dhe
fi 3 mo to 12 mo] Under 20 Ibs. mM sooth
Dog [i|Male
[|)Female O 42 mo or older wi 20 - 50 Ibs. O
Cat
Other: C1 | Neutered C1 Actual Age Over 50.lbgs. C1
‘| 9
(Specify) Actual Ibs.
qv
yea_AZ
Veterinarian’s: #
DATE VACCINATED: — | producer] > | A Wg
AN]
(First 3 letters) sorr()
WAL VS
Moran Day: “Year 011 yt. Lie/Vace. cone
IX 3 yr. Lic./Vace. 295 &
VACCINATION EXPIRED: —_—— lee
AZ Oo
Tempe
GIBUAT |
AN 19 Ww
ionth Day Year Vacc. Serial (lot) no.
OWWNER'S COPY RABIES VACCINATION CERTIFICATE
Rabies Tag Number
NASPHV Form #51
Owner's Name and Address Print - use ball point pen or type
PRINT - Last First M.l. | Telephone
()-Fllo- 4019
Want,
hapmown
aCi x State Zi
Boor 1 uy Terma Aire Phoeni AZ
5 1 79 2 1 7 1849 2145 193 60 36.714062 BeOS
4 1 79 2 2 0 381 2229 1570 43 -1
5 1 79 2 2 1 381 2238 126 32 92.106941 Species:
5 1 79 2 2 2 534 2233 15 42 96.006218 |
5 1 79 2 2 3 561 2237 64 25 96.006218 Sex:
5 1 79 2 2 4 784 2231 66 41 96.773926 Age:
5 1 79 2 2 5 1084 2229 70 41 96.494530 Size:
5 1 79 2 2 6 1362 2232 187 40 96.554199 Predominant
5 1 79 2 2 7 1561 2231 95 25 95.739304 Breed:
5 1 79 2 2 8 1847 2229 104 26 95.502609 Colors:
4 1 79 2 3 0 382 2256 1656 103 -1
5 1 79 2 3 1 382 2288 59 32 96.530884 Dog
5 1 79 2 3 2 487 2275 44 46 38.908028 P|
5 1 79 2 3 3 562 2286 71 26 93.745995 Male
5 1 79 2 3 4 715 2280 41 33 27.267427 Bg
5 1 79 2 3 5 763 2267 10 57 27.267427 |
5 1 79 2 3 6 784 2286 18 24 79.235413 3
5 1 79 2 3 7 814 2292 46 18 93.222588 mo
5 1 79 2 3 8 870 2286 30 24 96.665825 to
5 1 79 2 3 9 912 2284 34 26 96.316353 12
5 1 79 2 3 10 958 2290 47 20 94.645058 mo
5 1 79 2 3 11 1017 2278 35 32 38.303352 C1
5 1 79 2 3 12 1057 2267 15 57 86.021103 |
5 1 79 2 3 13 1085 2282 90 27 96.963066 Under
5 1 79 2 3 14 1185 2283 36 25 96.748184 20
5 1 79 2 3 15 1233 2271 95 49 92.361839 Ibs.
5 1 79 2 3 16 1295 2267 34 57 0.000000 f¥!
5 1 79 2 3 17 1380 2257 107 95 54.020695 King)
5 1 79 2 3 18 1504 2259 109 100 33.521542 ats
5 1 79 2 3 19 1629 2262 67 86 71.231667 KS
5 1 79 2 3 20 1789 2297 41 36 53.408031 Le
5 1 79 2 3 21 1853 2267 63 85 54.841896 Me
5 1 79 2 3 22 1947 2256 91 81 58.179787 fede.
4 1 79 2 4 0 381 2308 1653 56 -1
5 1 79 2 4 1 381 2337 52 26 89.562073 Cat
5 1 79 2 4 2 494 2333 174 31 8.394003 [1|Female
5 1 79 2 4 3 718 2332 35 30 59.067707 [1]
5 1 79 2 4 4 786 2335 34 26 52.544395 12
5 1 79 2 4 5 832 2340 88 21 46.754509 moor
5 1 79 2 4 6 929 2334 76 26 46.754509 older
5 1 79 2 4 7 1083 2332 169 26 84.690506 20-50lbs.
5 1 79 2 4 8 1294 2328 34 30 52.259407 OO
5 1 79 2 4 9 2025 2308 9 5 61.113518 :
4 1 79 2 5 0 381 2377 947 70 -1
5 1 79 2 5 1 381 2387 96 60 61.734978 one
5 1 79 2 5 2 494 2383 34 31 51.266731 [|
5 1 79 2 5 3 562 2386 133 26 94.306175 Neutered
5 1 79 2 5 4 718 2382 35 30 55.402946 (1
5 1 79 2 5 5 760 2378 12 45 94.699173 |
5 1 79 2 5 6 784 2385 92 26 96.152878 Actual
5 1 79 2 5 7 888 2385 59 32 93.416336 Age
5 1 79 2 5 8 1084 2383 72 26 92.450455 Over
5 1 79 2 5 9 1164 2382 99 26 4.517355 50,!bs.
5 1 79 2 5 10 1293 2377 35 31 52.859833 1
3 1 79 3 0 0 382 2423 938 165 -1
4 1 79 3 1 0 399 2423 921 49 -1
5 1 79 3 1 1 399 2423 45 49 39.064655 sat
5 1 79 3 1 2 1083 2428 93 40 96.819084 Actual
5 1 79 3 1 3 1271 2431 49 26 73.610168 Ibs.
4 1 79 3 2 0 382 2560 300 28 -1
5 1 79 3 2 1 382 2562 80 26 96.672462 DATE
5 1 79 3 2 2 472 2560 210 27 89.914970 VACCINATED:
3 1 79 4 0 0 786 2565 404 104 -1
4 1 79 4 1 0 786 2565 404 66 -1
5 1 79 4 1 1 786 2565 139 44 96.770805 Producer:
5 1 79 4 1 2 961 2571 40 60 54.081856 P
5 1 79 4 1 3 1050 2567 58 58 58.012878 a
5 1 79 4 1 4 1129 2571 61 50 84.365463 T
4 1 79 4 2 0 986 2643 159 26 -1
5 1 79 4 2 1 986 2644 56 25 95.773102 (First
5 1 79 4 2 2 1049 2644 14 19 96.262329 3
5 1 79 4 2 3 1071 2643 74 25 96.038399 letters)
2 1 80 0 0 0 1354 2317 700 407 -1
3 1 80 1 0 0 1354 2317 700 407 -1
4 1 80 1 1 0 1354 2317 700 407 -1
5 1 80 1 1 1 1354 2317 700 407 95.000000
2 1 81 0 0 0 1359 2672 155 93 -1
3 1 81 1 0 0 1359 2672 155 93 -1
4 1 81 1 1 0 1432 2672 82 13 -1
5 1 81 1 1 1 1432 2672 82 13 35.700539 er
4 1 81 1 2 0 1360 2693 119 26 -1
5 1 81 1 2 1 1360 2693 119 26 96.846725 (Signature)
4 1 81 1 3 0 1359 2744 99 21 -1
5 1 81 1 3 1 1359 2744 99 21 95.454918 Address:
2 1 82 0 0 0 784 2854 1214 111 -1
3 1 82 1 0 0 784 2854 1214 111 -1
4 1 82 1 1 0 784 2854 1214 111 -1
5 1 82 1 1 1 784 2854 1214 111 95.000000
2 1 83 0 0 0 2044 1879 26 1136 -1
3 1 83 1 0 0 2044 1879 26 1136 -1
4 1 83 1 1 0 2044 1879 26 1136 -1
5 1 83 1 1 1 2044 1879 26 1136 95.000000
2 1 84 0 0 0 364 3005 1695 24 -1
3 1 84 1 0 0 364 3005 1695 24 -1
4 1 84 1 1 0 364 3005 1695 24 -1
5 1 84 1 1 1 364 3005 1695 24 95.000000
2 1 85 0 0 0 2534 1991 16 841 -1
3 1 85 1 0 0 2534 1991 16 841 -1
4 1 85 1 1 0 2534 1991 16 841 -1
5 1 85 1 1 1 2534 1991 16 841 95.000000
Month Day Year
11 yr: Lic./Vacc.
13 yr. Lic./Vace.
VACCINATION EXPIRED:
Other
lab
Day Year
—
VACCINATION CERTIFICATE
OWNER’S COPY RABIES Rabies Tag Number
NASPHV Form #51
Print - use ball point pen or type
Owner’s Name and Address M.l. | Telephone
First
PRINT —~4oIF9
Che Nancy 4
ip
City fA
No. é JIVEIS hs
Cri
Predominant Breed: olors:
Size:
Species: Age: ped hub
3 mo to 12 mo C1 | Under 20 Ibs. x % Chor Les
Dog CI Lréeg : Chocks
42 mo or older 20-50 lbs.
Cat (| Female 1
Over 50 Ibs.
Other: C1| Neutered [1 | Actual Age A Oy,
Actual _} JF Ibs.
(Specify)
VACONATED:
sane VACCINATED: | roo] DL ol £|
DATE
(First 3 letters)
(Signature)
(11 yr. Lic./Vace. Address: EN
Bee
3 yr. Lic./Vacc.
Other fof,
5.06
S125
Year Vacc. Serial (lot) no.
Month Day
|
VACCINATION CERTIFICATE
OWNER'S COPY RABIES Rabies Tag Number
NASPHV Form #51
and Address Print - use ball point pen or type
Owner’s Name Ml. _ | Teleph
First / 10/9
PRINT - GOETH
Ch
© Phoem, f De oh c0 5 p
Tee Buchs
No.
ol Breed: Colors:
Size: Predominant
Species: || Sex: Age: C1 ‘ BLK te
3 mo to 12 mo (| Under 20 Ibs. / th aches of
Dog Male e ee kde C
42 mo or 20 - 50 Ibs.
Cat ‘LI | Female
Over 50 Ibs. 1
(| Neutered [1 | Actual Age
Other: Actual,)_}_ Ibs. Name:
Speci)
2 JE
Veterinarian's: #
VACCINATED: Le euiiaieial (License Noy, yy
DATE Producer: O
Yi
ga By
(First 3 letters)
(Signature St.
Month Day Year (11 Lic./Vace. 305 is std.
yr. Address:
XB yr. Lic./Vace.
VACCINATION EXPIRED: Other Jenpe, A 552E)