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Maricopa County
Animal Care And Control
2500 South 27th Avenue
Phoenix, AZ 85009
(602) 506-7387 Tele.
(602) 506-2739 Fax
KENNEL PERMIT APPLICATION
0 New lg Renewal Permit # 000023
Name: MARILYN DOMHOFF Kennel Name: SHANTE AFGHANS KENNELS
Mailing Address: 6824W KAREN LEE LN Kennel Location: : 6824 W KAREN LEE LANE
City: GLENDALE ARIZONA ZIP: 85382 County Supervisorial District: DISTRICT #4
Home Phone: 623-412-9739 Kennel Phone: 623-412-9739
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. INVe assume complete responsibility for the kennel at the premises for which I/we are making
application for a permit and understand that "kennel" means an enclosed, controlled area, inaccessible to
other animals, in which a person keeps, harbors or maintains five or more dogs under controlled conditions
(ARS 11-1001).
2. /40 1NVe certify that I/VVe have 8 dogs and that the kennel meets the definition in statute.
3. MO INVe 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).
4.14(V, IANe 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. I /We certify that I/We are submitting a valid copy of the rabies vaccination certificate for each
dog this application.
6. 14/ IANe understand that a dog remaining within the kennel is not required to be licensed individually under
A.R.S. \4_11-1008. . Ilwe 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. PIO INVe 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. tkV INVe understand that a person who knowingly fails to obtain a kennel permit within thirty days after
written notification from the county enforcement agent is guilty of a class 2 misdemeanor..
9. The undersigned understand that that the kennel permit does not authorize the operation of arytype
of busin -ss and is solely used for the purpose of licensing multiple dogs,
1/We certify that an of the information I/We have provided is true and accurate under penalty of law.
a V,,,,Xv.v
Applicant Signature Date:
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
Date: August 31, 2015
Lt Timothy Rummel
Enforcement Division Lieutenant
2630 W. Rio Salado Parkway
Mesa, AZ 85201
(602) 506-6274
trummel@mail.maricopa.gov
Kennel Permit # 2014000023
Number of Dogs— 8
KENNEL PERMIT INSPECTION
Shante Afghans Kennels
6824 West Karen Lee Lane
Peoria AZ 85382
623-412-9739
Count District #4
• Are all dogs over the age of 3 months properly vaccinated for rabies and in possession of a valid rabies
vaccination certificate? ("Properly Vaccinated" means, by a licensed veterinarian or Maricopa County Animal
Care and Control)
YES
• Is the kennel an enclosed, controlled area, inaccessible to other animals, in which a person keeps, harbors or
maintains 5 or more dogs under controlled conditions?
YES
• CORRECTIVE ACTION REQUIRED FOR COMPLIANCE - NONE
Lt Timothy Rummel
Maricopa County Animal Cale,and Control
Maricopa County Animal Care and Control
2500 S. 27th Avenue
Phoenix, AZ 85009-6797
(602) 506-7387
http://pets.maricopa.gov
Receipt Number: R15-198986 Receipt Date: 08/30/2015
Person ID: P1224832
Phone: 623 4129739
SHANTE AFGHANS KENNELS
6824 W KAREN LEE LN 8/30/2015 10:18:40AM
PEORIA, AZ 85382
Item: Animal ID: Reference No: Price: Each: Amount:
KEN PERMIT A7777777 K16-000023 $328.00 1 $328.00
Total Fees Due: $328.00
Payments: Cash: $0.00
Check: $328.00
Credit Card: $0.00
Total Payments Received: $328.00
Thank You!
Would you like to share your experience with our service to you? Change: $0.00
Please visit our website at http://pets.maricopa.gov and click on Balance Due: $0.00
"Contact Us" to email your comments for our review.
Animal Information;
A7777777 KENNEL PERM - BORN 9/14/1999, SPAYED, UNKNOWN/MIX, TRICOLOR DOG
License Information:
Tag Number: License Expires: Aninnal# Vacc Date: Vacc Expires:
Please retain this receipt with your pet's records
APODA CAP EBUSOFF
Month Month I DATE (Specify) Other Cat Dog SPECIES: ( NO. Owner's VAC0410001 Month - Month DATE (Specify) Other Cat Dog SPECIES:, NO. PRINT Owner's
VACCINATION 0 0 frk. ' AA' PRI±A-T.T.LAST '''''' 3 VACCINATION 0 0 1 .4";>-4;' ,•,.. .
Day Day 2 VACCINATED: Name Day 1 Day VACCINATED: " , Ye? LAST-,-; Name
EXPIRES: IPS Altered Female Male SEX: 4/ STREET ) &Address EXPIRES: Altered Female Male SEX: ST in &Address
Year Year — e)mr. ir), Year (-: Year tEETa
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Lic.Nacc. Lic.Nacc. Mo. Mo. , LicJVcc a. Lic.Nacc. Mo. Mo. 4-4,..--
or to pt-€4',. RABIES or to RABIES
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lbs. lbs. rY Pen lbs. lbs. , pen
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Address Signature :- C\ NAME: Fl j.„) tYPe 51 CERTIFICATE Address Signature r NAME: A-11 --"IF-'6;ricz,/,-- type 51 CERTIFICATE
Veterinarian's Veternarian's i 1 PAEFLIANT Veterinarian's Veterinarian' PREDOMINANT
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LEPTOSPIROSIS LEPTOSPIROSIS
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CHLAMYDIA CALICIVIRUS RHINOTRACHEITIS PANLEUKOPENIA BORDETELLA CORONAVIRUS PARVOVERUS ADENOVIRUS PARAINFLUENZA DISTEMPER RECORD CHLAMYDIA CALICIVIRUS RHINOTRACHEITIS PANLEUKOPENEA BORDETELLA CORONAVIRUS ADENOVIRUS PARAINFLUENZA DISTEMPER RECORD
IMMUNODEFICIENCY IMMUNODEFICIENCY VIRUS
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RABIES VACCINATION CERTIFICATE Tag fee $: VACCINATION RECORD
Name
ADAPTED NASPHV FORM 51 Tag #:
Owner's Name &Address PRINT - use ball point pen or type Cert. Serial 4: LI RABIES
PRINT LAsy,, . IIRST (44 TELEPHONE D LYME DISEASE
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NO. STREET/ CITY j STAT,E, ZIP 0 CANINE PARAINFLUENZA
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SPECIES: SEX: AGE: I SIZE: PREDOMINANT BRE COLORS: CANINE PARVOVIRUS
Dog A- Male Li 3 Mo. to 12 Mo. LD Under 20 lbs. p CANINE CORONAVIRUS
Cat 0 Female g- 12 Mo. or older i20 - 59 lbs Li c 0 CANINE BORDETELLA
Other 0 Altered 0 Over 50 lbs. 0 NAME: "1‘ evil / pa
0 LEPTOSPIROSIS
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DATE VACCINATED: PRODUCER: E FELINE PANLEUKOPENIA
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Month Day Year (First 3 Letters) , 0 FELINE CALICI VIRUS
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Month Day Year
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RABIES VACCINATION CERTIFICATE Tag fee $: VACCINATION RECORD
Name
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PRINT LI% , Ci_FIRST , 4 MI/./.7L TELEPHONE IT! LYME DISEASE
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VACCINATION RECORD
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Name
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0 LYME DISEASE
PRINT ,-) FIRST MI TELEPHONE
0 CANINE DISTEMPER
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SPECIES: SEX: AGE: SIZE: PREDOMINANT BREED: COLORS: 0 CANINE PARVO VIRUS
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Month Day Year (First 3 Letters) 0 FELINE CALICIVIRUS
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VIRUS
Month Day Year la Ic\t1/43—
Vac. Serial (Lot) No. (7---I Bo ehringer
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RABIES VACCINATION CERTIFICATE Tag fee S:
ADAPTED NASPHV FOF?M 51 Tag 4:
Owner's Name & Address PRINT - use ball point pen or type Cert. Serial t
PRINT LAST i FIRST MI TELEPHONE
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NO. STREET i STATE- ZIP
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_ SPECIES: SEX: AGE: SIZE: PREDOMINANT BREED: COLO
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Cat 0 Female k 12 Mo. or older X. 20- 50 lbs _.. ir
Other 0 Alterecintp Over 50 lbs. El NAME:
(Specify)
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DATE yACCINATED: PRODUCER: :3 8 , -/ I
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Month Day Year (First 3 Letters)
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1 yr. Lic.Nace. 0
VACCINATION EXPIRES: Signature ,
3 yr. Lic.Nacc. Address
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Month Day Year ( 71
ace. Serial (Lot) No.
VAC0410001
Arrow Animal Hospital, PLC
5144 West Thunderbird Road
Glendale, AZ 85306
(602) 938-2707
Rabies Certificate
Client ID: 27926 Patient ID: 34998
Client Name: Marilyn Domhoff Patient Name: Beau
Client Address: 6824 W. Karen Lee Lane, Species: Canine
Peoria, AZ 86382 Breed: Afgan Hound
Sex: Male
Phone: (623) 412-9739 Color: Tan
Markings:
Birthday: 1/13/2014
Weight: 63.4
Tag Number: 2015 Vaccination Date: 4/16/2015
Serial Number: S411411
Expiration Dpte: 4/1212016
Producer: Zoetis
Virus type: Killed
Staff: Dr. Stuart Sherrell DVM
License Number: 1620/199
CERTIFICATE OF VACCINATION
Date of Vaccination: 04-09-14 Certificate No. 0
Next Vaccination ant - 04-08-17 Previous Vaccination:
VETERINARY CLINIC OWNER OF ANIMAL
Sunburst Animal Hospital Marilyn Domhoff
5032 W. Thunderbird Road 6824 W. Karen Lee Ln.
Glendale, AZ 85306 Peoria, AZ 86382
602-938-1860 (623) 412-9739
This is to certify...
THAT I HAVE VACCINATED THE ANIMAL DESCRIBED BELOW AGAINST RABIES.
Patient information...
PATIENT: Fancy TAG NO:
SPECIES: Canine BREED: Afghan Hound
SEX: Female AGE: 7 years
WEIGHT: 0.00 lbs COLOR: BLU
MICROCHIP:
MFG BY PR, SERIAL: 05798D, EXPIRES: 12/23/14, ADMIN: SQ
Signed:
Vanessa Rucker, DVIVI License: 6257
Other Vaccinations...
Vaccinated By Vaccination Next due
04-09-14 VRR Rabies Vaccination & Exam (none)