EVANZ KENNELS.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
LII New Renewal Permit # K1,6-000040
Name: Marilyn Pauley Kennel Name: Evanz Kennels
Mailing Address: 16853 N 39 th Drive Kennel Location: 16853 N 39"h Dr, Phoenix
City: Phoenix ZIP: 85053 County Supervisorial District: District #4
Phone: 602-843-0219 Kennel Phone: 602-843-0219
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
2 INVe assume complete responsibility for the kennel at the premises for which I/we are making
applie tion 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. I/VVe certify that I/We have 718 dogs and that the kennel meets the definition in statute.
3. INVe certify that I/We have not been convicted of a violation of A.R.S. §§ 13-2910 (cruelty to animals)
or 13 910.01 (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. P1)4) INVe certify that all dogs over the age of three (3) months that are kept, harbored or maintained on the
premes 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. Y 4--"' I /We certify that 1/We are submitting a valid copy of the rabies vaccination certificate for each
dog with this application.
6. NVe 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. IANe understand that a person wile fails to obtain a kennel permit under A.R.S.§11-1009 is subject to a
penal of twenty-five dollars in addition to the annual fee.
8. ef 1NVe understand that a person who knowingly fails to obtain a kennel permit within thirty days after
writte notification from the county enforcement agent is guilty of a class 2 misdemeanor..
9. ritirThe 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.
IliNe certify that all of the information I/We have provided is true and accurate under penalty of law.
Applicant Signature ate 1 J$
Applicant Signature Date:
For Official Use Only:
Copies of Valid Rabies Vaccination Certificates for each dog attached_y_e,_5
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 27th Avenue
Phoenix, AZ 85009
Phone: (602) 506-7387
pets.maricopa.gov
KENNEL PERMIT PREMISE INSPECTION
Name: Marilyn Pauley Kennel Name: Evanz Kennels
Mailing Address: 16835 N 39th Dr Kennel Location: 16835 N 39th Dr
City: Phoenix ZIP: 85053 County Supervisorial District: 4
Home Phone: 602-843-0219 Kennel Phone: 602-843-0219
I. Are all dogs over the age of three months properly vaccinated for rabies and in possession of a
valid rabies vaccination certificate?
YES
NOTE: Copies of each rabies vaccination certificate must be attached to the Kennel Permit
Premise Inspection form.
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?
YES
CORRECTIVE ACTION NEEDED FOR COMPLIANCE AND 3icele DAYS GIVEN
BEFORE REINSPECTION. (Note: There will be $49 re-inspect fee pa able to the Inspector by
check upon each return visit )
Deputy Enforcement Agent

Maricopa County Animal Care and Control
2500 S. 27th Avenue
Phoenix, AZ 85009-6797
(602) 506-7387
http://pets.maricopa.gov
Receipt Number: R15-218104 Receipt Date: 09/2412015
Person ID: P0999788
Phone: 602 8430219
EVANZ KENNELS 9/24/2015 10:28:28AM
16853 N 39TH DR
PHOENIX, AZ 85053
Item: Animal ID: Reference No: Price: Each: Amount:
KEN PERMIT A7777777 K16-000040 $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 911411999, 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
saucedos WBUSOFF

VETERINARIAN'S COPY RABIES VACCINATION CERTIFICATE
NASPHV Form #51 Rabies Tag Number
/ —
Owner's Name and Addrik Print - use ball point pen or type
First Telephone.
tew -si393- 0,a)
No. Street City ,,-)L 1 State
1 Lp
Species: Sex: Age: Size: Predominant Breed: • Colors: I
Dog male 3 mo to 12 mo 0 Under 20 lbs.
Cat 0 Female 0 12 ma or oider 20 - 50 lbs. 0 Prtsd e
Other: 0 Neutered 0 Actual Age Over 50 lbs. 0
(Specify) Actual H lbs. Name:
irn‘-ai' I n
DATE VACCINATED: Producer: Veterinarian's: # IVg.ci
—7 r?-g )3 (First 3 letters)
Month Day Year (SigiaLfttire)
0 1 yr. Uc./Vacc.
p' 3 yr. Lie./Vacc. Address:
VACCINATION EXPIRED: Other a;)'5
7 (-_21 iL0 .1,6;13
-Temy,
Month Day Year Vacc. Serial (lot) no.
RABIES VAGG1NATiuN Util I 1 r Maki = Rabies Tag Number
OWNER'S COPY
NASPHV Form #51
Owner's Name and Address Print - use ball point pen or type M.1. Telephone
First
PRINT -Aast crxXC 01/4C.-e_A- re.z... t tit,) 53
nOriteC ity .
N Street 3 CV-V/r‘' .1) t-- cell,*
Predominant reed: Colors:
Species: „Sex: Age: Size: 61'frer
TIr Male 0 3 mo to 12 rrto CI Under 20 lbs. C2° i`e
Dog IST4-'12 mo or old rr .-. _ 50 lbs. 0 .
Cat 0 Female t 9%. n Over 501 s . 0
Other: 0 Neutered 0 Actual Aged I Name:
(specify) Actual lbs.
AzPO,
-2... 0 f... Veterinarian's # (License No.)
DATE VACCINATED: Producer: / /
15 (First 0 letters) ' ( , .1—dirrarikA:A .
-- --91, (Signature) .
Month Day Year 0 i y r. Lie.! eacc. V Address:
irryr. Lic./Vacc.
VACCINATION EXPIRED: iiiq,7 Other ,7 5 , 3a5 . E /5-”' 51"
N 5
GI. Ck, $3:28°1
Month Day. Year Vacc. Serial (lot) no. • */1,02e A
' ._,

VETERINAMAN'S COPY RABIES VACCINATION CERTIFICATE
NASPHV Form #51 Rabies Tag Number
Owner's Name and Addre I Print - use ball point pen or type Q
PRINT - Last --_--- First ' .1. Telephone
" r) (Akitie i 14 rilf-----LitAn ‘ Upol '
No. Steet I City l‘, 1 - StatA . Zip
1' _
Species: Sex: ,..e Age: Size: Predominant Breed: Colors:
Dog g Male IX 3 ma to 12 no 0 cinder 20 lbs. -.)1 rkitf
Cat Iii Female 0 12 mo or older IA to- 50 lbs. 0
Other: 0 Neutered 0 Actual Age Over 60 lbs. 0
(specify) Actual_S_Ibs. Name: IA,
tici r OM ‘.4 ,
DATE VACCINATED: p r Veterinarian's: # 14(ieri 042
Producer: pcens4 IstE51.
. — (First 3 letters) i .v ,g1•'" . ) ' t1;12:/e-W
/Month Day Year 0 1 yr. Lic./Vacc. (Signature)
Address:
9-3 yr. Lio./Vacc.
VACCINATION EXPIRED: Other 7 2p.=, \ 5 E. ......„- --
Month Day Year VacC: Serial (lot) no. I
OWNER'S COPY RABIES VACCINATION ERTIF
NASPHV Form #51 Rabies Tag Number
Owner's Name and Address Print -use ball point pen or type
PRINT - LAt First M.I. Tplenh"--
-C-InPer. Mq . CISNe* - —
NI tow/Street to 31...vve , loc State i P3P53
.-V- NrCe 0 4- fV —Z—
Species: ..4 Sex: Age: Size: Predominant Breed: Col rs:
Dog MI Male 0 3 mo to 12 mo DI Under 20 lbs. Nt
W)0C\Ve-,
Cat CI Female Me. 12 mo or older NI/ -20 - 50 lbs. 0
Other: D Neutered n Actual Age Over 50 lbs. 0
(Specify) Actual_7_lbs. Name: •
k, keit\ '\
DATE-VACCINATED: Producer: 2_ 0 V.... Veterinarian's: # (License No
a _a s (First a letters) // Zail
its& 111 -.....aLel , i
Month Day Year El -.1,..yr. Lic./Vacc. {Signet re)
Address:
V3 yr. Lie./ Vacc.
VACCINATION EXPIRED: Other
SO5 E 15-1( 3-\--
3 41M94 7i-#pre,
Mo th Da Year Vacc. Serial (lot) no. 4"2) 3-59 5
)

vUllralINARIAN'S COPY RABI ES VACCINATIO N CERTIFICATE
Rabies Tag Number
NASPHV Form #51
Owner's Name and Addr(T') Print - use ball point pen or type .
PRINT - Last „, First M.I. Telephone
Paw 1-e rilay- i it, I
No. -, - ...... Strefek.t3 City p Staten
I 24, t Dr - )4- )14--
Species: Sex: Age: Size: Predominant Breed: Cvjors:
Dog c.1( Male p 3 ma to 12 mo I=1 1', Under 20 lbs. p 5, , yo-e,ve •
Cat, El Female 0 12 ma or older CA I 20 -. 50 lbs. 0, P/y/A ...._ -1 l l e
Other: 0 Neutered CI Actual Age .A‘1,!,_ Over 50 lbs. 0
Name:
Actuali„..C...lbs
F;1•C--,‹ 1 rie-t-ri f>ri
rimi Veterinarian's: i 1 V -4-6: I. , (1'7 ' t..,-
DATE DATE VACCINATED: Producer: p (Lleinise 04 ,,,., 47/1
'''..2)C1 1.6 (First 3 letters)
Month Day Year El 1 yr. Lic./Vacc. (Signature)
Address:
4:.,3 yr. Lic./Vacc. E_
VACCINATION EXPIRED: Other
- <-) J
2 \\LP -?-.7) 1.--i 1 I kW e A l '2‘L e-541) 1
Month Day Year . Vacc. Serial (lot) no.
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 - LaA First M.I./ Telephone 43 oatc
\,t,
Nis, treat City State 4
a
Species: „,Sex: Age: Size: Predominant Breed: Colors:
Dog Iiir Male 0 3 ma to 12 mo 0 Under 20 lbs. tl.: n \.-Q, 9\\Per
Cat 0 Female g 12 mo or older gr. 20 - 50 lbs. 0 V C
Other: Li Neutered 0 Actual Age4 Over 50 lbs. 0
isixacifyi Actual 1 [los Name: \ •
DATE VACCINATED: Producer: kl... 0 -..... Veterinarian's: # (license No.)
/
R G\ 15 (First 3 letters) I/ '' adiftli '” ..441•Ailid.4 , •
Month Day Year • n 1 yr. Lic./Vacc. (signature)
Address:
• &I'llyr. Lic./Vacc.
VACCINATION EXPIRED: Other
3 a5
- G\ ---V% 3 L4 11-19 if 913 Tnere 42'1 g528)
Mo th Day Year Vacc. Serial (lot) no.

•
VETERINARIAN'S COPY RABIES VACCINATION CERTIFICATE
NASPHV Form #51 Rabies Tag Number
Owner's Name and Add '' ) - use bail point pen or type ..
PAINT - Last . ---\,-.._-, First „ .1. Telephone
.., -e_LA rn Ott i I If) vc4 -z;Li 3 -6a- 161
No. reet alp. , •k st n7 t_t9,
_ 2 N.)?-1: eL" Ov' • .01 i•y:
Species: Sex: Age: Sizr: Predominant Breed: . Cad:sit:-
. .. ...
Dog tX Male• VI 3 me to 12 mo 0 Utler 20 lbs. 5it () ....I.
Cat 0 Female Cl 12 mo or older - tg 20- 50 lbs. 0 ti.2)0C 1 J 1,t)h)
Other: 0 Neutered 0 Actual Age Over 50 lbs. 0
(Specify} Actual Name .,...„. ..,
DATE VACCINATED: Producer: te". Veterinarian's: # I 1 (Z 4)::'
7/ D4; \ 1 • . (FIrst 3 letters)
Month Day Year Cl 1 yr. Lic./Vaco. (Sig ult)
5i, 3 yr. Lic./Vacc. Address:
VACCINATION ID<PIRED: Other 33 1.c&'-' S-I
Tèm 01.
Month Day Year Vacc. Serial (lot) no.
VETERINARIAN'S COPY RABIES VACCINATION CERTIFICATE Rabies Tag Number
NASPHV Form #51
Owner's Name and Addrel- ) Print - use ball point pen or type wi.I.- Telephone
First
PRINT - Last , 41 '
A>.
)(
Predominant Breed: Colors: .
Species: Sex: Age: Size:
Male 0 3 rno to 12 mo Under 20 lbs. 141/--4
Dog i.,51?
Cat 1:1 Female X 12 moor older 20 50 lbs.
Other: 0 Neutered LI Actual Age_ 'Actual Over 50 lbs. 0 Name:
(Specity) ti,) lbs.
fPtial
Veterinarian's: # en 'do CI Y
DATE VACCINATED: Producer:
(First 0 letters) 4 ‘,.
.(Signature)
Month Day . Year Cl 1 yr. Lic./Vacc. Address:
A 3 yr. Uc./Vacc. )41t-9-
VACCINATION EXPIRED: Other
\ I C
;
Month Day Year Vac°. Serial (lot) no.

OWNER'S COPY RABIES VACCINATION CERTIFICATE Rabies Tag Number
NASPHV Form #51
Owner's Name and Address Print .. - use ball point pen or type Telephone
First M,1.
PRINT - 09
tr,03
,tre5 t j i 2 ,i 4-h City / Stakz
' No. 1 I 1.
Size: Predominan Breed: • Colors:
Species: Sex: Age:
Dog Elate 0 3 mo to 12 ma 0 Under 20 lbs. Ce_ ) 13 14 1-t
Cat 0 Female ffirA 12 ma or old,rg 20 - 50 lbs. p
Other: 0 Neutered 0 Actual Age I ta-, Over 50 I s. 0 ,.
(Specify) 1 Actual lbs.
ri t 0
4_2- V ‘09
DATE VACCINATED: Producer: 0 Veterinarian's: # (license No.)
rersa:
(First 3 letters) at 4
1,5 (Signature)
Month Day Year 0 I /r. Lic./Vacc. Address:
EXPIRED: DI yr. LiciVacc, 3a.5 ei i Sill- .6i-
VACCINATION Other
Li i Li q q9 6 .
C'3 t c3 3 .—ThirnPe. kil 39 81
Month Day Year Vacc, Serial (lot) no.
11/ADICO Viitrkfliveti it.fix v....o..IFI I ii Rabies Tag Number
OWNER'S GOFY Form #51
r. NASPHV Print- use ball point pen or type Telephone
Owner's Name and Address First r . M.1.
PRINT -1„ast . mar ore
Cxper tate
log reet jv 39 c ap t heenOc
Predominant Breed: Color :
Species: Sex: Age: Size: Under 20 lbs. flP-. Ens_iii ie
E1Aale. 0 3 rno to 12 mo 0
Dog N-4 12 mo or older M".- 20 - 50 ibs. D
•Oat 0 Female 0 Actual Age JO y Over 50 elbs. 0 Name: .
Other: 0 Neutered Actual La lbs.
(sp ecify) /5revVeA) I4)
, Veterinarian's: # j ,,,,,, ,..
-2_ 0 can e No.)
DATE VACCINATED: Producer:
(First 3 letters)
(Signature)
4 Mon h DaSr 1 ear 0 1 yr. Lic./Vacc. Address:
Reg yr. Lic./Vacc. 3 „5 E I 6'"44 s*.
VACCINATION EXPIRED: Other
3_ 9 A ,i5 Lilt/7 1i 4113
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 - Last First .. M.1. Telephone
Poulet,i Man Icin 110)-34-0-0)19
Th..to 7 s, /:4 z__,?k,or:23 •
Species: Sex: Age: Size: Predominant Breed: Colors:
Dog liet Male 0 3 ma to 12 mo CI Under 20 lbs. KI ' , , Wh i- ie
Cat CI Female ix 12 mo or older KI 30 1 - 50 lips. CI r nood,t f
Other: CI Neutered CI Actual Age I ye aver 50 lbs. El
(Specify) Actual IQ lbs Name:
DATE VACCINATED: Producer: -a E Veterinarian's: # ii'89 A2
(license ( cense No.
S 1 4 , (First 3 letters)
ati>rNa:
Month Day Year (Signalers)
0 1 yr. Lic./Vacc.
g 3 yr. Lic./Vacc. Address:
VACCINATION EXPIRED: 3D,5 5 it:11---5.1
Other
f3 14 1-7 S3 G CY-Itp --F:e_rree fit 35a7 I
Month Day Year Vacc. Serial (lot) no.
OWNER'S COPY RABIES VACCINATION CERTIFICATE Rabies Tag Number
NASPHV Form #51
Owner's Name and Address Print - use ball point pen or tIfFie
First I M.1. Telephone
PRINT - Last
rila-ri \Lin togOr -?4-1.5--r89119
LI Cityik Stallaz
IP' I.' Alti."
Species: Sex: Age: Size: Predominant Breed: Colors:
Dog Male 0 3 mo to 12 mo 0 Under 24 lbs. 50 Pcoci e
Cat Ei .Female 12 mo or older 0 20 - 50 lbs. CI
Other: CI Neutered CI Actual Age tyr Over 50 lbs. CI
(Specify) Actual 1 .0 lbs
I ffl ifli
Veterinarian's: if 1 I c 61-
DATE VACCINATED: VACCINATED: Producer: (License No.)
(First 3 letters) 724.,
6 ILI
Month Day Year CI 1 yr. Lic./Vacc.
Address:
[N 3 yr. Lic./Vacc.
VACCINATION EXPIRED: Other e-
B._ 14 17 6-61 (54(40 Tcxnpe 117-
Month Day Year Vacc. Serial (lot) no.

(L111111' I0111"' RABIES VACCINATION CERTIFICATE
1111:1. 111.1.1HritHrr
NASPHV Form #51
HHHHH ITHurin HIIIIHH Print - use bail point pen or type
PRINT - Last First M.I. Telephone
9C\ o.1,-eNi fr\ekr 170M343
&H_itfte .
No. Street
PO ‘3 +V\
»HH HHH HIIHrintrHH1111 Colors:
11(H NA' IHH irinHH HHILH ...1.111H1
Cat (A Female 12 mo or older er. 20 - lbs. 0
Other: 0 Neutered D Actual Age3 Over 60 lbs. Cl
Name:
(specify) Actual Albs.
•i-
Veterinarian's: # -4 -z.irgc1
DATE VACCINATED: VACCINATED: Producer: (license Noi
2- 0,
a
(First 3 letters) •
0\ f7
(Signature)
Mon {h Day Year 0 1 yr. Lic./Vacc.
Vlyr. Lic./Vacc.
VACCINATION EXPIRED: Other -vh s+
3915 e, /5
CA 43\ H\LS LktttLketB
Month Day Year Vacc. Serial ( at) no. 774"-pe- 42) g:508
OWNER'S COPY RABIES VACCINATION CERTIFICATE
NASPHV Form #51 Rabies Tag NOmber
Owner's Name and Address Print - use ball point pen or type
PRINT - La First M.I. Telephone
Fel )4 L6 , / , /77arY4/„ti 0 3 -o..1),
No. Street ../ City Starr-jct....Zip
/ iy--5-3 Ax 37 d Or.. ,,5
Species: Sex: Age: Size: PredominKnt Breed: olors:
Dog Male 0,3 ma to 12 ma CI Under 20 lbs. •
Cat Female 47K 12 ma or older ' 20 - 50 lbs. 0 ii,Z _ ire
Other: CI Neutered CI Actual Age_..,44- Over 51bisi/' 0
iSflecIfY) Actual /rnia bs Nm . e57L)
)-. , .11
DATE VACCINATED: VACCINATED: Producer: 2 Veterinarian's: # i
o -E- (License NcL)
r.---_, f
is./ (First 3 letters) OA. X.)-(7:. i'ea.,,I
Month Day Year (Signature)
El 1.yr. Lic./Vacc. 224- E-v /5/ s-,-,_.
')1°3 yr. Lic./Vacc. Address:
VACCINATION EXPIRED: . Other
7.M724 A2- Vol-tY.)
CI'..2-) 1, 4e,P12 oi,i‘
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 - w, .t First M.I. Telephone _
• II
No. k keg qtrat% kl ,.,; 9 A, Irl telt State
Oe 0 trI, -I-
Species: Sex: Age: Size: Predominant Breed: Colors:
Dog V" Male El 3 mo to 12 mo LI Under 20 lbs. Ila--- 3;1 ye r
Cat CI Female Cr 12 mo or older 1E' 20 - 50 lbs. D e 610Cik .
Other: 0 Neutered El Actual Age 7 y Over 50 lb 0
(spoolfy) Actual t,2 lbs. Name:
DATE VACCINATED: 2. 0 E, Veterinarian's: # AZ I ) 37
Producer: (License No.)
01. )6 (First 3 letters)
CA 0
Month Day Year CI 1 yr. Lic./Vacc. (Signature)
Address: 5+
6 \fr. Lic./Vacc. .kh
VACCINATION EXPIRED: Other
°I Ck _II 5 H 11 1 H 1 5 _____, M f-.5•51
Month Day Year Vacc. Serial (l ot) no. fe541
OWNER'S COPY RABIES VACCINATION CERTIFICATE Rabies Tag Number
• NASPHV Form #51 r
Owner's Name and Address Print - use ball point pen or type
First , M .1 . ie I e Rho rkt3 019
PRINT r-Iast
vw,) kVA ,vc\00". k 161 COd ZiP
NQst. (.0 et City A 8s083
Ci‘ -\-1" k"Dc ‘Ro-en:)(
Species: ex: Age: Size: Predominant Breed: Colors:
Dog Male 0 I3 mo to 12 mo 0 Under 20 lbs. [IV' V008 )..e < V "e r
Cat E Female 2Tl 2 mo or older LIX 20 - 50 lbs. 0
Other: CI Neutered C1 Actual Age,. c ) 1 Over 50 lbs. 0
(Specify) Actualia_lbs Name:
5 k 4 f)1
0 t... Veterinarian's: # A -Z, AN 89
DATE VACCINATED: VACCINATED: Producer: 2. License No.)
/
CI‘ 1 5 (First 3 letters) 41 767(nri
Month Day Year 0 1 yr. Lic./Vacc. (Sign re
Address:
Ni-3-yr. Lic./Vacc.
VACCINATION EXPIRED: Other 5
Month Day Year Vacc. Serial (lot) no. "'W/rY‘ pc -P\ -2.-

OWNER'S COPY RABIES VACCINATION CERTIFICATE Rabies Tag Number
• ,, , NASPHV Form #51
Owner's Name and Address Print - use ball point pen or type Telephone-7:
First M.1.
PRINT - Iet I
rami i/Ctrigy/),-,, SZiP
City f)/ A ,
No, jTi m3y# )0 r..
,- Size: i Predominant Breed: . olors:
Species: Sex: Age: / / /
x Male ""id 3 mo to 12 mo O J Under 20 lbs_lieli , AL"- AI or _ -`
Dog 0 Female El 12 moor older. 50 lbs. 0 • titgi
Cat Other: CI Neutered 0 Actual Age Over 50p.,§. El Nam e:
(sPecItY) Actual /6 lbs ,
0
2 Veterrnarian's: #
DATE VACCINATED: Producer: 0 E
(First 3 letters) Vila K.ifi 4411111Ed
--ie Month 2-21 Day Year IV 0 1 yr. Lie.! Vacc. (S1gnatore) 03.1s- E-70, / li../437-, .
Address:
,X3 yr. Lic./Vacc.
VACCINATION EXPIRED: Other
3)3 0 9,<•
Month GP 'IL Day --ig V.acc. Serial (lot) no.
OWNER'S COPY RABIES VACCINATION CERTIFICATE
NASPHV Form #51 Rabies Tag Number
Owner8 Name and Address Print - use bail point pen or type
PAINT- Last First M.I. Telephone
_5_.,,9:_a_ OCOP'C ..... _)_) ,7.. ,. .,,, eci _j_44:2____ ,,,....
Species: x: Age: Size: -Predominant Breed: Colorq:
Dog Male ter 3 ,,,T10 . i` t 0 12 iti 0 0 Under 20.1bs, ni ",....) -- . Rea
Cat 0 Female El 12 mo or older ffr-20 - 50 lbs, CI v V .
Other: El Neutered El Actual Age Over 50 lbs. CI
(SPectrY) Actual I\ lbs. Name:
°COG e--V
. a 9
DATE VACCINATED: Producer: Z 0 Veterinarian's: # ($ l een No.)
---, / i
C\ ek i_5 (First 3 letters) .401 ri MEA -2 1.14.11141
Month Day Year 0 1 yr. Lic./Vacc. (Sig • •
Address:
ID/Syr. Lic./Vacc.
VACCINATION EXPIRED: Other 3 5 E ts-N-i-
c 1 c\ A53 541T-n. 85agi
i? i,-47p,e - -, 4 2- i
Month • Day Year Vacc, Serial (lot) no.

OWNERS COPY' RABIES VACCINATION CERTIFICATE
NASPHV Form #51 Rabies Tag Number
Owner's Name and Address Print - use ban point pen or type
PRINT - Last First M.I. Telephone
-••••
: , di .0 1010 — a o• ie. C
No. •
• , Street L.. Aik"IgilMILI nliMMIIIII • i MI 41.-0 AP,'
Species: Sex: Age: Size: Predominant Breed: Colors::
Dog EA Male 0 3 mo to 12 mo 0 Under 20 lbs. EiS] Id* . .e•11 I Vi•'&7::, '
Cat 0 Female MI 12 mo or older X 20 7 50 Hos. 0 °LI POCCii ‘.- -
Other: 0 Neutered 0 Actual Age 4 yr Over 50 lbs. 0
PPecirs+) 1 Actual 1 lbs. Name;
DATE VACCINATED: Producer: 2..... 0 E Veterinarian's: # Ite9 ea-
(License No
3 6 .11-1 . (First 3 letters) I01/ ,,, , /
0-11(..)1/4'
Month Day Year 0 1 y r. Lic./Vacc. (Signature)
g 3 yr. Lic./Vacc. Address:
VACCINATION EXPIRED: 1„16 6 146-1-1-S-1-
Other
'S H n Sa 1%0346 T.(f.apt az_ 35g I
Month Day Year Vacc. Serial (lot) no.
..
VETERINARIAN'S COPY RABIES VACCINATION CERTIFICATE Rabies Tag Number
n NASPHV Form #51
Owner's Name and Addre( ; Print - use ball point pen or type '
' ,..-- 4- First ( . _ "-Al Telephone . :
PRINT - L.,ast
(to 1-e,ti fittly 1 i L ,(-1 ,
Cityf.... i State • I 2Ip -
No. Street N.) - -2-rt.-kg- i . ae ...)r--.1) e rIA \A_ (..)_ -02
Species: Sex: Age: Size: Predominant Breed: Colors:
fe -
Dog „IR Male 0 3 mo to 12 ma 0 Under 20 lbs. IR Pift+d i-e
Cat it Female 12 ma dr older 20 - 60 lbs. 0
Other: D Neutered 0 Actual Age' I lt__ Over 60 lbs. 0
PpecitY) 'II / Actual A lbs Name:
i t VCA
Veterinarian's: # \ (--VI
DATE VACCINATED: Producer: f 2 r: r — 4- .:- gidense-tto.) .„- .
fil (First 3 letters) _. 1-. ic`I -
-ia- i g ature) ' .
Month Day Year 0 1 yr. Lic./Vacc. _.
.p.. 3 yr. Lic. /Vacc. Address: . - t .... ,
VACCINATION EXPIRED: Other --V-' ,,,, *.a ' t— -- )P,r1-5-T
-
,ro , pc
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 bail point pen or type
PRINT - Last ,. First . M,I. Telephone
rn ar j statetcri_ iPalig` fre,(57 Can
No1 t ;eet De-
(osg5_ 1\) . 4::14-1-. citYhouNoe
Species: Sex: Age: Size: Predominant Breed: Colors:
Dog igi Male 0 3 mo to 12 mo CI Under 20 lbs.
Cat 0 Female 1:Kl 12 moor older Z , 20 - 50 lbs. C1 f<
Other: 0 Neutered 0 Actual Age 3 (1Over 50 lbs. 0
(Speoify) Actual (0 lbs Name:,
NJ 1
DATE VACCINATED: Producer: 2, 0 E._ Veterinariali's: # 1 I 61 Pa.
(LIcanee Na,)
5 ( (First 3 lettere) i 1 • /
14 if 0 42. a
Month Day Year 0 1 yr. LiciVacc. (Signature)
Address:
x 3 yr . LiolVacc.
VACCINATION EXPIRED: Other
3 1 Li \ -7 -N - U—it_49 --relYlpe_ 62.- S5a2 I
Month Day Year '/550. 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 - Last First , M.I. Telephone
PaILA ki.1 • 'Mx- i kin 1eCg—N3 - OH
No.1 Street City stater)?
1 j)2 3 M ?CHI- 4-)r Phoef\ 1 x
Species: Sex: Age: Size: Predominant Breed: Colors:
Dog ' Ig. Male - 0 3 mo to 12 mo 0 Under 20 lbs. E1 _r_...
Cat 0 Female gl 12 mo or older K 20 - 50 lbs. 0 i Oil PrCY Ifr --
Other: 0 Neutered 0 Actual Age e Over 50113s. 0 /
(specify) Actuala_lbs. Name: 1. .
tor)) oci5
DATE VACCINATED: Producer Veterinarian's: # I 1 ±9A-2..
(License No.)
b )4 (First 3 tatters) T af4
Monti; Day Year 0 1 yr. Lic./Vacc. (Sna igr 4 .
Address:
g:i 3 yr, Lic./Vacc.
VACCINATION EXPIRED: Other
(8 il-4 n s-7-) 12;) 040 --RyyTe_ ici-2- gE)&i.
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
Telephone ,
No. eet
..
Species: Sex: Age: Size: Predominant Breed: Colors:
Dog male CI 3 me to 12 mo 0 Under 20 lbs.
Cat 0 Female 12 mo or older Z 20 - 50 lbs. El
Other: D Neutered D Actual Age Over 50 lbs. D
(Specify) Actual 5___Is b Name: ‘
DATE VACCINATED: Producer: E Veterinarian's: #
0 cense No.)
,
°k _15 (First 3 fetters) i f 4 6/
(RAW 'Ar—ri Li
Month Day Year (Signetturo)
0 1 yr. Lie./ Vacc.
. Rlyr.1_10./Vacc. Address:
VACCINATION EXPIRED: , Other . 3ps t
°I.- C\ Vi3 5 1 °A'' s3
Month Day Year Vacc. Serial (lot) no. ,--..— P .'a‘ 56k
\ .e. 11(\pe.,
OWNER'S COPY RABIES VACCINATION CERTIFICATE
Owner's Name and Address Print - NASPHV use ball Form #51 Rabies Tag Number
PRINT -14st point pen or type
First
7)iiAv X.,Nt ,14IG
M11 :\, 111
(kC3S tree: _
VCCOe Aate 15053
Species: Sex:
Dog Male rrnicc 1 II 1111:11r11111111.
11111)1112(
Cat 0 Female 1I 1:1:11 e 11- 1:: ODC /111_,J'IL
Other: El Neutered D Actual Age 31
(SPecifY)
Actual_lbs.
DATE VACCINATED:
Producer: Veterinarian's: #
°k Licrfnse No.)
-5 (First 3 letters)
Month Day Year
D 1 yr. Lic./Vacc. (Signature)
VACCINATION EXPIRED: rcioGr. Lic./Vacc. Address:
Other 3a5 e 16 441 5+
131 1 S 5 GYM 3
Mon h Day Year Vacc. Serial (lot) no. --refipe
z) 850781

VETERINARIAN'S COPY RABIES VACCINATION CERTIFICATE
NASPHV Form #51 Rabies Tag Number
Owner's Name and Addro I Print - use bail point pen or type
First Telephone
reec 1. IL in
_74 ()*x1
rov. City jah_crt
ri-
Species: Sex: Age: Size: Predominant Breed: Colors:
Dog §4 Male El 3 rno to 12 mo El Under 20 lbs. p,
Cat El Female 12 moor older 20 - 50 lbs. 0
Other: El Neutered CI Actual Age Over 50 lbs. 0
(Specify) Actual 71 lbs. Name:
{
DATE VACCINATED: Producer: Veterinarian's: # rl
(License
ac-1 (First 3 letters) } 724
Month Day Year 0 1 yr. Lic./Vacc. (Signature)
3 yr. Lic./Vacc. Address:
VACCINATION EXPIRED: Other
1
Month Day Year Vacc. Sena (lot) no.
RABIES VACCINATION CERTIFICATE _Rabies Tag Number
OWNER'S COPY
NASPHV Form #51
Owner's Name and Address Print - use ball point pen or type M.I. irlosSstilione
PRINT-Las First 4f/ HFLi-3 -0)9
Mar t
a11kL 1 City p hc7t11,_.)4 Stateoz
N -Street
llotabb Predominant Breed: Colors:
Age: Size: latxrifj ,
Species: ( Sex: El 3 mo to 12 mo El Under 20 lbs. cgi To9 Pocri le
Dog 'VI I Male 12 moor older Ziki 20 - 50 lbs. 0
Cat El Female 512 4-yr Over 50 lbs. 0
Other: CI Neutered LII Actual Age Name:
(specify) Actual _a_lbs.
1 1 '2)9 R2.
Veterinarian's: /cense # No.)
DATE VACCINATED: Producer: O
(First 3 letters)
6 1 14 {Signature)
Month Day Year CI 1 yr. LiciVacc. Address:
/RI 3 yr. Ijc./Vacc. 6.3-5 E
VACCINATION EXPIRED: Other 4g5a2
13_ 17 5 3 i (1—Os
Month 1.3a.y Year Va.= Serial (lot) no.

OWNER'S COPY RABIES VACCINATION GERTIHUA I t
Rabies Tag Number
NASPHV Form #51
Owner's Name and Address Print - use ball point pen or type
PRI Ny..,z Last F:Lrst M.I. Telephone
813 Wig
sS \'‘e.4 3,14.1,1„. pCrityt Viv,iceo , N4 Atate
N\ Lp t 0053
Species: Sex: Age: Size: Predominant Breed: Colors:
Dog Male 0 3 mo to 12 mo 0 Under 20 lbs. EV" pact&
-One' X
Cat 0 Female 12 mo or older, 20 - 50 lbs. El.
Other: 0 Neutered LI Actual Age I' 62- Over 5C1 lbs. El
(Specify) Actual to bs. Name:
ol e.
5ere 0a
A , —7 , i
DATE VACCINATED: Producer: o E Veterinarian's: a.,.,/crrct, # (Lic o e No.)14,..egi •
(First 3 letters)
Month Day Year D 1 yr. Lic./Vacc. (Signature)
Address:
Mlyr. Lic./Vacc.
VACCINATION EXPIRED: Other r /501 6-1-
_v. ,5 Li /41 q qi3 ,3t .5
01 clt 7c5761e. /tZ i 852 8 /
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 - Last First M.I. Telephone
air illk Vb ' • ii -e...:
Nck \I:79A rest loc C State
* \r‘oevtc-F. A--a_, 115o53
Species: .,,$ex: Age: Size: Predominant Breed: Color :
Dog LW' Male IV3 ma to 12 mo 0 Under 20 lbs. ne ocA Vip,
Cat 0 Female Ei 12 rno or older Nt 20 - 50 lbs. 0 i) I k...* ..'
:\._
Other: 0 Neutered 0 Actual Age Over 50 lbs. El ,
(Specify) Name:
Actual...j_lbs.
DATE VACCINATED: Producer: Z., 0 E Veterinarian's: # evz \\V‘
icense No)
C\r 0‘ V-5 (First 3 letters) I:24 ift %DO J
Monti; Day Year Ei (Signature)
1 yr. Lic./Vacc.
Nie14;r. Lic./Vacc. Address:
VACCINATION EXPIRED:
Other S 6 ',v 1 5 -Vs"Si
CI. (3\, \I Tempc pr-z... \ 6.5981
Month Day Year Vacc. Serial (lot) no: .

OWNER'S COPY RABIES VACCINATION CERTIFICATE Rabies Tag Number
NASPHV Form #51
Owner's Name and Address Print - use ball point pen or type
First M.I. Telephone
PRINT - I q.g.t._ laa V P) la
V\0\e \ t\I
City State
Dr 010 1\4 /0-.. g'$41.53
No. t, tl3et 0 3`17th ,Predominant Breed: Colors:
Species: x Age: Size: zur 9 ex-eurN
Dog Male 0 ) mo to 12 mo LVUnder 20 lbs. Vt
Cat 0 Female ', ' r 12 MO or older 0 20 - 50 lbs. 0
Other: 0 Neutered El Actual Age141.01 Over 50,s. 0 C... 4 veguy)
Name:
(Specify) Actual , lbs
. c' OR IN) i,i ,.c.,\\ sc‘
DATE VACCINATED: Producer: e E Veterinarian's: # ones NO
Di 91 15 (First 3 letters)
(Signature)
Month Day Year rryr. Lic./Vacc. Address:
0 3 yr. Lic./Vacc.
VACCINATION EXPIRED: Other . 3,5 V:: -5 1...,0,5*'
ov ck vto /
42, 5DrA6 1
Month Day Year Vacc. Serial (lot) no. '7:-.erre—
OWNER'S COPY RABIES VACCINATION CERTIFICATE Rabies Tag Number
NASPHV Form #51
Owner's Name and Address Print - use ball point pen or type
First M.I. Telephone
PRINT - Last tioa 8'13 Ot2 15
•\L er\- q C.‘ . i 1 itl.
.111zg c) treet 0 30c" c KA,1 de fi 4 k5-453
0 Size: Predominant B eed: Colors:
Species: Sex: Age:
Dog Er 3 mo to 12 mo 'Under 20 lbs.13Y- akk
/
Cat . U Female 0 12 mo or older 0 20 - 50 lbs. 0
Other: 0 Neutered CI Actual Ageg_ika_. Over 50 lbs. 0 IACk 61 ,
(Specify) Actual bs
PP 0)
DATE VACCINATED: Producer z 0 Veterinarian's: # ense 7 NO.) t "11
99 i c; (First 3 letters)
i (Signature)
Month Day Year 1:q#11, Lic./Vacc.
Address:
0 3 yr. Lic./Vacc. 54-1 5+
VACCINATION EXPIRED: Other l%/5Eel- i
9 ±4 , . 6 4 N ° SP
la a 7five 4-2,3-Vgi
Day Year Vacc. Serial (lot) no.

RABIES VACCINATION C;t11 I irlwAt = Rabies Tag Number
OWNER'S COPY NASPHV Form #51
Address Print - use bail point pen or type Ml. Telephone
Owner's Name and First , 1 oi 009
PRINT - t , I
a oVe-\ iY)01(.-1 1 pv State 8„-6t45.3
City
treat ai-441 tc `V\rvoet I-‘., Colors:
‘kolg.5. 0 Size: i/edominan Breed:
Species: Sex: Age: . Under 20 lbs. WIli`
Male 3 mo to 12 mo 0
Dog n 12 mo or older M/20 - 50 lbs. 0
Gat (E3 Female Actual Age Over 50 lbs. 0
Other: CI Neutered 0 , . Actual te_lbs Name:
(Specify)
Veterinarian's: # icense No
DATE VACCINATED: Producer: ID .e, 771eKeote
(First 3 letters) 6"rri. .,
C:\ I (Signature)
-a-Day Year El 1 yr. Lic./Vacc. Address:
Neyr. Lie./Vacc,
3Z E 15 +1rN 6+
VACCINATION EXPIRED: . Other
5__Hanal_a_ ?)10e 421 K. 5f2g 1
°‘ C\ 7
Month Day Year Vacc. Serial (lot) no.
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 - ast First „ Mi. Telephone
iNnar t 1 \I Ai too-4/36oli
0...
treet i -„LVfl- h br Vho4ni )c
t r5 o g )0
Species: Sex: Age: Size: Predominant Breed: Colors:
Dog ResrMale ne3 mo to 12 mo 0 Under 20 lbs. v pooci It Si t re r
Cat El Female 0 12 mo or older ea - 50 lbs. ID •
Other: El Neutered El Actual AgeJ Over 50 13; '0
(Specify) Actual lbs. Name:
ii5 h-i--
V
7._ E Veterinarian's: # A 2-- ‘ kg 1
DATE VACCINATED: Producer: 0 License Na.) ,
(First 3 fetters) ,,00 .I ,iilai ,,,) z.c..„„LiA
Cti (S •nurej
Month' Day Year 0 1 yr. Lic./Vacc.
Address;
yr. Lic.•Vacc.
VACCINATION EXPIRED: Other 3,5 E
ck 'A \'' s i-il l--K\ L-to‘ 13
Month Day Year Vacc. Serial (lot) no. 12 YIIPt ‘I° 2 ) e,5'018)

OWNER'S COPY RABIES VACCINATION CERTIFICATE
NASPHV Form 451 Rabies Tag Number
'Owner's Name and Address Print - use ball point pen or type
PRINT - Last,...\ First M.1. Telephone
FatA I-ea . Mori i (in • - - ' - 00119
N Street City 0 State Zi a
. 1 • Tak • am' 6 ilkiliCii 94- :in& .0116itrI
Species: Sex: Age: Size: Predominant Breed: Colors: . ,._.
Dog RI Male (S1 3 mo to 12 mo 0 Under 20 lbs. ES „,r D i t• & (V•CK '
Cat 0 Female 0 12 moor older [ZI 20 - 50 lbs. 0 1 04 I- 010C1 if
Other: 0 Neutered 0 Actual Age O'er 50 lbs. 0
(Specify) Actual (.0 lbs. Name: ..
DATE VACCINATED: Producer: 2 0 E Veterinarian's: 4 (License 1139 No.) . AL-2
i l 1L-1 (First 3 letters) 6-rhjj
Month Day Year 0 1 yr. Lic./Vacc. (Signature)
, tS 3 yr. LiciVacc. Address: -
VACCINATION EXPIRED: Other
95 . ILI )77 s3INCY-ttp . Tenge (12- ZSA I
Month Day Year Vacc. Serial (lot) no.
_ RABIES VACCINATION CERTIFICATE
OWNER'S COPY Rabies Tag Number
NASPHV Form #51
Owner's Name and Address Print - use ball point pen or type Telephone
, First M.I.
PRINT - Last qdre-, L
eeo r rocv
State
).t.reet4/ Phetr7)QC r 4 Z.— 1 5,5 i
3 * Dr
Size: . '- Predominan Breed: Colors:
Species: _St„x: Age: _ e
Dog LW-Male El 3 mo to 12 mo 0 Under 20 lbs.1-_ --- .
Cat CI Female ligI12 mo or older e'10 - 50 lbs. El
Other: 1:11 Neitered El Actual Age. Over 501bs. 0 Name:
(specifY) • Actual (.0 lbs. •
e-44/41;"e•
i Veterinarian's: # 4 2 /71?
DATE VACCINATED: Producer —2_ 0- License No.)
(First 3 letters) v %/9
----/ -15 '(-sigpature) ,
month Month Day Year CI 1 yr. Lic./Vacc. Address:
Zi#S1r. Lic./Vacc.
VACCINATION EXPIRED: Other 302,5 E
5 1-iiii9"-ig 0
4 cA __Xi et- 4Z
Mon h Day Year Vacc. Serial (lot) no.

OWNER'S COPY CI NATION E TIF E
NASPHV Form #51 Rabies Tag Number
Owner's Name and Address Print - use ball point pen or type
PRINT - Last • First M.I. Telephone ,
Vtk 0 Ve,•1 Mac&‘ \ i\J Ica 19-3 cal<
No‘, \44,65.iireet ta te
4E1256:3
Speciesex: Age: Size: Predominant Breed: • Colors:
Dog nkir Male 0 3 mo to 12 mo CI Under 20 ibs. R-iv...... , ,, ..... _.., 16 ‘ At, v.,
Cat 0 Female !Li' 12 mo or older V20 -50 lbs. CI . vtvotT le,,,t.
Other: 0 Neutered LI Actual Age Over 50 lbs. CI )liS\r\ 1 Ajt
{Specify) Actual 15 lbs. Nettie:
bgioee_
DATE VACCINATED: Producer: Z. c, Veterinarian's: #
.,..) cens No.)
CI . I,5 (First 3 letters) U ryn0 4 / / /
i.4::
Month Day Year 0 1 yr. Lic./Vacc. (Signattire)
?rryr. Lic./Vacc. Address:
VACCINATION EXPIRED:
Other
qi IC)\ \ 4g CI 4- 35 t, 15 6•N—
Month Day Year Vacc. Serial (lot) no.
'—VC-'er \ ip‘.. f\--1---1 OA 8 I

VETERINARIAN'S COPY
NASPHV Form #51 „-----, Rabies Tag Number
Owner's Name and Aiddr , _..../ • Print - use ball point pen or type ( '
PRINT - Last , Firs,y M.I. Telephone
t -L., V )
No. tree t bit y is‘ i St‘fite,
4 DY- 1-116-0\
C..--- '•
Species: Sex: . Age: Size: Predominant Breed: Colors:
Dog Male JR:i 3 mo to 12 mo ip Under 20 lbs. Wr. 0 _a
Cat Female • 12 ma or older 20 - 50 lbs. 0 "r CC( 1 '. (
—1
Other: CI Neutered 0 Actual Age Over 50 lbs. 0 •
(Specify) . Actual i.j) lb 's. N, ame:
rni-1-)irci.,)
DATE VACCINATED: Producer: Veterinarian's: #
(License o,) .
71 13 (First 3 Iettors) A ' /147r1 .), tA• '4* e _
Month Day Year El 1 yr, LIGIVacc. (Signkuns)
Address:
W3 yr. Lic./Vacc.
VACCINATION EXPIRED: Other --7 Z) e I -- .-)1.- - ' f
— ,
7 ,-_-,--?, 1 (1-,, c-C ,.._ )t--i -`-`77 I }-Q, A .Z.._ -(3 45,16 1
Month tiay'-' Year Vacc. Serial (lot) no.
OWNER'S COPY RABIES VACCINATION CERTIFICATE
N,4SPHV Form #51 Rabies Tag Number
Owner's Name and Address Print - use ball point pen or type
PRINT - Last First M.I. Telephone -
COOe g CfNC\ orxrA e
N7.6 q,a eetm 39 • br
Vioent' fit- 1riet52
Species: Sex: Age: Size: yredominant Breed: Colors:
Dog Male 0 3 mo to 12 ma CI Under 20 lbs. V it_ , S
Cat 0 Female' .NK-12 mo or older V20 - 50 lbs. CI PIDOCA
Other: 0 Neutered 0 Actual Age Over 5q lbs. CI
(Specify) Actual lbs Name:
surpr i 2-f.,
DATE VACCINATED: 0 Veterinarian's: # A 2 ' 1181
Producer: -7._ (License No.)
9 QI 6 (First 3 letters) /„ ) , ...,
Month Day Year 0 1 yr. Lic./Vacc. (Signature
Address:
Erl yr. Lic./Vacc.
VACCINATION EXPIRED: Other
35 E )5+,)6-1-
21_0\ A(1 p .,,-A \LielLic\ C5
Month Day Year Vacc. Serial (lot) no. 7 eisipe 4-zr 8981

OWNER'S COPY RABIES VACCINATION CERTIFICATE
NASPHV Form #51 Rabies Tag Number
Owner's Name and Address Print - use ball point pen or type
PRI Last -, First i M.I. Telephone
' Ck0 ke . -• 4.1-\06 101)Q_ 31-13090 ,
11,0k4 A ltreat Al 39.4,11 or Citwoef,,,;..)( fil
ZO,53
Species: Sex: Age: Size: Predominant Breed: Colors:
Dog Male El 3 ma to 12 ma El Under 20 lbs. M... (4. ../ ... fa.rjle,__Si /ver
Cat 0 Female ce.12 ma or older 20 - 50 lbs. I:11 .."/
Other: 0 Neutered 0 Actual Age i- Over 50 lbs. n S il yer
(speoify) Actual__Lvlbs. Name:
DATE VACCINATED: Producer: Veterinarian's: # 192 1187
Cr) (License No.)
9 9 i c (First 3 fetters)
Cfr(7.-/
Month Day Year 0 1 yr. Lic./Vacc. (Signature)
Address:
[: [: -;3r. -;3r. Yr. LicVacc. ./
VACCINATION EXPIRED: Other 3:915 E /5111 51-
• el 9 / g 5iii4/9z/VB ....„ 4-2, g.5:7281
Month Day Year Vacc. Serial (lot) no. 7e;v17
OWNEFI'S COPY RABIES VACCINATION CERTIFICATE
NASPHV Form #51 Rabies Tag Number
Owner's Name and Address Print - use ball point pen or type
PRINT - Las First
, " M.I. Telephone
adtkll Mtelr 1 il i n tto-nto-o4i,ci
No. Street City " State
KO .367-, M 3941— 0 r vive_nix
Species: Sex: Age: Size: Predominant Breed: 65; 1
Dog NI Male NI 3 ma to 12 me 0 Under 20 lbs. Oil --r- 0 i f,,,,. '1PL. Colors:
Cat 0 Female El 12 me or old r tlil ..20 -50 lbs. 0 4 CI ILCIOrnr— Lit° .L.-'k ,.
Other: 0 Neutered El Actual Age i /z Oyer 50 lbs. El (t)11.1.4t
(Specify) , .
Actual _lbs. Name:
Coofd-b
DATE VACCINATED: Producer: a Veterinarian's: # I 1C39 h2
E- (License No
S I 1 LI (First 3 fetters) j4,,,X) 7-3 f / - / / '
Month Day Year (Signature)
El 1 yr. Lic./Vacc.
RI 3 yr. Lic./Vacc. Address:
VACCINATION EXPIRED:
Other
6 ILI IT
Month Day Year 6 130Lko Tftinix. ii--7, 1
Vacc. Serial (lot) no. -

RABIES VACCINATION CERTIFICATE .,
VETERINARIAN'S COPY Rabies Tag Number
,-----, ' ISJASPHV Form #51
Owner's Name and Addre( Print - use ball point pen or type
_..-----'-„..-- First
PRINT - Last
9
City_
• Stree
_ Predominant Breed:
'Species: Sex: Age: Size: R.
Male 3 mo to 12 mo 0 Under 20 lbs.
Dog Female .0 12 rno or oider 20 - 50 lbs. 0
Cat 0
Neutered 0 Actual Age Over 50 lbs. 0
Other: 0 Name:
(Specify) aa
C.4
Veterinarian's: # (License No
DATE VACCINATED: Producer:
(First 3 letters ii
(Signa(ie)
Month Day Year 0 1 yr. Lb./Woo. Address:
5,3 yr. Lic./Vacc.
VACCINATION EXPIRED: Other
H51 1 kx\,-ipt
TT c-) -3
Month Day Year Vacc. Serial (lot) no.
OWNER'S COPY RABIES VACCINATION CERTIFICATE
NASP1-11/ Form #51 Rabies Tag Number
Owner's Name and Address Print - use ball point pen or type
P' ei ENT- First
U Mett";
grOst:e!, .
N .
Species: Sex: Age: .Size:
Dog ._.)Er Male 1111 3 mo to 12 mo. 0, Under Htt
Cat ri Female 0 12 rno or older)114:, 20 - 5('
Other: 0 Neutered 0 Actual Age Over 500r 1Ibbl nn
(Specify)
Actual A . irbb
DATE VACCINATED:
Producer: o
F {First 3 letters)
Month Day Year
0 1 yr. Lic./Vacc.
0 3 yr. Lic./Vacc. 31-Y isti ST-
VACCINATION EXPIRED:
Other
fai3
0V‘
Month Day Year Vaceterial (lot) no.

•
Owner's Name and Addre ) NASPHV Form #51 ) Rabies Tag Number
Print - use ball point pen or type
, PRINT- . Last First M.I. Telephone
1
No. ., , StreeT City ,
. State Zjp
t - rp?_J-1.
pecies: Sex: Age: I Size: IPLEcillumul.:1Lrnr:
,Dog Male 0 3 mo to 12 mo CI Under 20 lbs. Egl •
iCat Li Female X 12 mo or olderR1 ,--, 20 - 50 lbs. ED POC/i (Th
, ,Other: (Specify) CI Neutered 0 Actual Age Over 50 lbs. 0
Actuat ILO lbs Name:
DATE VACCINATED:
Producer: Veterinarian's: #
fucahs6 Nfei)
(F1r3t 3 lettore)
Month Day Year etr
0 1 yr. Lic./Vacc. ature)
;Z 3 yr. Lic./Vacc. Address:
ACCINATION EXPIRED:
Other
15-1-1'
-7 99: _ILL
ionth Day Year Vac. Serial (lot) no. riV"C 35;1-z
r
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
PctiAk Mori iqr) -0).49
N . Street City pk40 ,, State
1141.6 IQ -39-4-*' D r-
Species: Sex: Age: Size: Predominant Breed: _ Colors:
Dog IX Male CI 3 mo to 12 mo. CI Under 20 lbs. e ,...r..,. SI IVO'
Cat CI Female 1.;9 12 moor older 59 ''20 -50 lbs. El . tN.1 PC:Cia it
Other: 0 Neutered CI Actual Age are Over 50 lbs. CI -s4
ispeoliY) Actual 1 lbs. Name.. 1
PO in--11-tS6
DATE VACCINATED: Producer: -2.., 0 f Veterinarian's: # (Lfcense2etw 1 1 b9 PiZ
t )'3 14- (First 3 letters) 0/1.1.6)-40-r,
Month Day • Year (Signature)
0 1 yr. Lic./Vacc.
Address:
iN 3 yr. LiciVacc.
VACCINATION EXPIRED: Other 3
b 1 1-1 I i S 1 7D OHL 0 • Tun pc Az 35a8 1
Month Day Year Vacc. Serial (lot) no. .