B-Z-B CHIHUAHUA 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
16 ---
New 10 Renewal Permit * 000003
Name: SHIRLEY BANDERET Kennel Name: B-Z-B CHIHUAHUA KENNELS
Mailing Address: 4424 WEST TIERRA BUENA LANE Kennel Location: 4424 WEST TIERRA BUENA LANE
City: GLENDALE ARIZONA ZIP: 86306 County Supervisorial District: DISTRICT #4
Home Phone: 602-978-3076 Kennel Phone: 602-978-3076
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, 5A 6 INVe certify that INVe have dogs and that the kennel meets the definition in statute.
3. 114ô 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. 6 0) 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. '5N6 I /We certify that INVe are submitting a valid copy of the rabies vaccination certificate for each
dog with this application.
6. I/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. ,Alb 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. 27) 1/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. if4k) The undersigned understand that that the kennel permit does not authorize the operation of any type
of business and is solely used for the purpose of licensing multiple dogs.
INVe certify that all of the information I/We have provided is true and accurate under penalty of law.
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 30, 2015
Lt Timothy Rummel
Enforcement Division Lieutenant
2630 W. Rio Salado Parkway
Mesa, AZ 85201
(602) 506-6274
trummel@mail.maricopa.gov
Kennel Permit ft 2016000003
Number of Dogs —8
KENNEL PERMIT INSPECTION
B-Z-B Chihuahua Kennels
4424 West Tierra Buena Lane
Glendale AZ 85306
602-978-3076
County District II 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 Care and Control

Maricopa County Animal Care and Control
2500 S. 27th Avenue
Phoenix, AZ 85009-6797
(602) 506-7387
http://pets.maricopa.qov
Receipt Number: R15-198649 Receipt Date: 08/2812016
Person ID: P1212486
Phone: 602 9783076
B-Z-B CHIHUAHUA KENNELS 8/28/2015 2:32:30PM
4424 W TIERRA BUENA LN
GLENDALE, AZ 86306
Item: Animal ID: Reference No: Price: Each: Amount:
KEN PERMIT A7777777 K16-000003 $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: AnimaIlt 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
1.7-a First, M.I. Telephone
if) .1Y I, fr i.- -- Oodo3 1, CI' 4-s — goVe,
cii, St
No. Li q?citre i ffrrd 1,1, or) IA 6 Lold.flii t P.?
Species: i Sex: i Age: Size: ) j Pre minant Breed: r (-Colors:
Dog EMI Male 111 3 mo to 12 mo 0 nder 20 lbs. iff, hbt raiLlyi f
Cat 0 Female 0 12 ma or olci9r 20 - 50 lbs. 0
Other: 0 Neutered 0 ktual Age w Over 5191%. 0 [ii hilt
iSPecifY) Actual 1 lbs. Name. , • in) 4115
rikiv i
DATE VACCINATED: p T Veterinarian's: # 1 2 i WI
Producer: - (license No.)
ae,e/g
4 X t3 (First 3 letters) , 124 il 76714'
-Month Day Year 0 1 yr. Lic./Vacc. (S3gnatirre) 2,,c E.
V4-yr. Lic./Vacc. Addres.: 19 h 4
VACCINATION EXPIRED: Other
4 75 i (, 3 20 2:7-a Te tin pc / 4z- 05-26 1
Month Day Year Vacc. Serial (lot) no.
OWNERS COPY • RABIES VACCINATION CERTIFICATE
NASPHV Form #5/ Rabies Tag Number
Owner's Name and Address Print - use ball point pen or type
PR T - Las;., , First M.I. Telephone
2- D Keiwei g 191-0,91,3 ‘o.2-97?.36124
' ee 411. tY Sta-- 7 ,r7Zie
, L ii./..4 e/72 _. , 0
_ I
Species: ,Sex: Age: Size: Predominant Breed: Colors: .
Dog U Male 0 . 3 rno to 12 mo 0 Under 20 lbs.
Cat 0 Female IC 12 mo or ol r 0 20 - 50 lbs. II/ 01,4 pia TR i
Other: 0 Neutered Actual Age yr Over 50 lbs. 0
(Specify) Actua6-1-769. Na e. c xi - e 7' 2411-C9
__B_Z_LARYI
DATE VACCINATED: Producer: Veterinarian's: 4i (License No.)
i
3o x13 (First 3 /otters)
Month Day Year 0 1yr. LIGIVacc. (Signature)
Address:
1 3 yr. Lic./Vacc.
VACCINATION EXPIRED: 32 5- g . /5 441 5+1
Other
c/ 30 aOff 5 3.-glic 7/ ......,.._
Month Day Year Vacc, Serial (lot) no. I ern pei fiz . gc.21

OWNER'S COPY RA. ES 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
Pe t ii5---0o3
No. Street ; City State Zip
Speciesi, Sex: Age: Size: Predominant Breed: Colors:
Dog 4 . Male 0 3 mo to 12 mo 0 Under 20 lbs.0 // . ilgt Li..et7,44-4) I
Cat 0 Female Ng 12 mo or older'' 20 -50 lbs. 0 (11
Other: I=1 Neutered 0 Actual Age Over 50 lbs. 0
(sPacily) I Actua --' tbs. Name. s
2
DATE VACCINATED: Producer: 0 r Veterinarian's: # (License Na.?).4
__ZZ .1) /1 V (First 3 letters)
Month Day Year 0 1 yr. LiciVacc. (Signature) 3 ),..s- E isr7/:.3-77-
Address:
,....).-3 yr. Lic./Vacc.
VACCINATION EXPIRED: Other 0 -pi /1 2- rs2,F)
/ i 21 /7 V 0 ‘ 57Z
Month Day Year Vacc. Serial (lot) no.
OWNER'S COPY FIABIES VACCINATION CERTIFICATE
NASPHV Form #51 Rabies Tag Number
Owner's Name and Address Print - use ball point pen or type
PWNT - Last , First M.1. Telephone
WeMn NW 3 W2--97g -10 74
to 0 -1.17)) ,N ei RI (-/-
Lia l-istr.0, I 1 erra 8 iiitnq2-4 C-IendaVe 192NDA
Species: Sex: Age: Size: Predo, inant reed: Colors:
Dog "K. Male 0 3 mo to 12 mo 0 Under 20 IlasV t 1 a 1 Fawn
Cat 0 Female wig 12 mo or o er 20 - 50 lbs. CI _AA it
Other: Li Neutered 0 Actual Ag 4. Over 59 lbs.— 0
pp.ify) Actual ii.5 lbs. NV: 1 7-3i-12,
U. I r) 11
DATE VACCINATED: Veterinarian's: # /I 2 — 1 V/9 _
Producer: .. .„......}..icenSe N.
9 30 9-06 (First 3 fetters)
Month Day Year (Signalize)
0 1 yr. Lic./Vacc.
Address:
X 3 yr. Lic./Vacc.
VACCINATION EXPIRED: Other 3abr- 1/4 15' St -
c/ 30 )016 3 ,w).s- 1-7)
Month Day Year Vacc. Serial (lot) no. 7-elfne f , i

OWNER'S COPY RA IES VACCINATION CERTIFICATE
Rabies Tag Number
NASPHV Form #51
Owner's Name and Address Print - use bail point pen or type
First , M.I, I Telephone
PRINT - Last
ZIO ‘G - 0 )000
4.1.A14 1: \7trjeet nerviin .9)k) y.:1 novi\\ Ste
Species: Sex: Age: Size: Predominant Breed: Colors:
Dog NI Male 0 3 mo to 12 mo 0 Under 20 lbs.Ne (h \'- fakiOn
Cat 0 Female 7 . 12 mo or older 0 20 - 50 lbs. 0
Other: 0 Neutered 01 Actual A ge I lit Over 50
(Specify) N Actual i-10" Ups. Name:
40\\RA
DATE VACCINATED: Producer 2 0 E Veterinarian's: # (Licenie No.)
-7, (First 3 letters)
Month Day' Year r 0 1 yr. yr. Lic./Vacc. (Signature)
Lic./Vacc. Address 316 E 164ch
VACCINATION EXPIRED: Other Terope. 25Z1
Month Day Year . Serial (lot) no.
OWNER'S COPY RA.HES VACCINATION CERTIFICATE
NASPHV F01777 #51 Rabies Tag Number
Owner's Name and Address Print - use ball point pen or type
PRINT - Last First I1.4.1. Telephone
137-g Keinne,1 K6-3O3 L0-02- 93r-30-167
Streetve, r ci gum 01, Ziyr1 State
44 214 60 6 i t n Mo ot e it
itO(ei
Species: Sex: Age: Size: Predominant Breed: Colors:
Dog VS Male 0 J 3 mo to 12 mo a Under 20 lbs.ISV
Cat 0 Female ini 12 moor older El 20 - 50 lbs. 0 Vakii tA
Other: 0 Neutered 0 Actual Age*ICI6 Over 50 lbs. 0 (AO\r‘kte,
(Specify) Actual 3 lbs. Name:
DATE VACCINATED: Producer: Z., Veterinarian 's: # A .2-- /i 4F1
0 E -0.1cerise NO
1> (First 3 letters) ki 0 Orntj'-4 a /
Month Day Year (Signature) go 15-...,,,
Fi<1 yr. LiolVacc. , „
0 3 yr. LiciVacc. Address:
VACCINATION EXPIRED: Other riejp-Si A 2--Tszy)
5S 3 It.,p SI7C518
Month Day Year Vacc. Serial (lot) no.

OWNER'S COPY 'A - IES VACCINATION CE 'TIFICATE
NASPHV Form #51 Rabies Tag Number
Owner's Name and Address Print - use ball point pen or type
PRI T - • First Mi. T ephone
AA _ •A # _ #1 * 0 * ir,
No. St
r . MENVilni 4 _
Species: i Sex: Age: Size: /Pres •minant Breed: Colors:
Dog Dilli Male 0 3 mo to 12 mo Cl nder 20 lbs. gr
Cat 0 Female [kii 12 rrro or otjlsr E 20 - 50 lbs. 0 i 1
(Specify) Other: 0 Neutered 0 Actual Age Over 5 lq. 0 id kill
C y j Actual lbs. "
00,e-A
,
DATE VACCINATED: Producer: p i Veterinarian's: #
(Lica t IV
11 X )3 (First 3 letters) / /
Month Day Year (Signature le 4 attik, ) Atiwitt,
0 ) yr. Lic./Vacc. g., (sit/7 . 5f.
PV3 yr. Lic./Vacc. Address: 32c
VACCINATION EXPIRED:
Other
4 25 _IL 2b;21.-OS Iftyipi, flo gszei
Month Day Year Vacc. Serial (lot) no.
OWNER'S COPY AiZ ES VACCJNAflON CERTIFICATE
Owner's Name and Address NASPHV Form #51 Rabies Tag Number
Print - use ball point pen or type
PRINT - Last First , M.I. Telephone
ele) art ne.,1 ‘L- 16- 000003 too2-cri-Nit
r2-1•7A r'ci-exycA Nfeicio LRY Citwdictigi ft- -tate
Species: Sex: Age: Size: Predominant Breed:
Dog Et Male 0 3 mo to 12 mo 0 Under 20 lbs.X f Colors:
Cat 0 Female p 12 ma or older 0 20 - 50 lbs. 0 \--' \c•-\\y\VO\NCA. Fat* h
(Specify) Other: 0 Neutered u Actual Age I 112 Over 50 ls. 0 6VMM
lg. Actual lbs. Name:
\ CA-Cjt
DATE VACCINATED: Producer: 7.. 0 a Veterinarian's: # Pi .--, L % - % 1 q
(Licens No. 9 ir
.• l_g_ la (First 3 letters)
Month Day Year 4... grv
El 1 yr. Lic./Vacc. (Signature)
>6 yr. Lic./Vacc. Address; .--7...6 -E , )b-t-y) a
VACCINATION EXPIRED: •
Other mve Tv i -A2 .657X I
3 la r6 141-0(
Month Day Year Serial (lot) no.