BURTNERS 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 / ---
New -6 Renewal Permit COPOT) 3 (.9
Name: CkTIQR - Kennel Name: auf-t-neKi 1/1-21e. nO 3
rst ‘Qu Ann I Ai
Mailing Address: \ t>C1r 1- Kennel Location: 1 5 c)ct
Cy '3o IC)KI2Me,AZ ZIP is County Supervisorial Distil
Kenne6hone:Ga Lit 4:6 (0 a a9,
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 "operating a kennel" must obtain a permit issued
by the Board of Supervisors where the kennel is located except if each individual dog is licensed. A.R.S. § 11-
1009 and MC Ordinance No. 13, Sec. 4. define a "kennel" 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 require individual licensing of each dog under the provisions of ARS
11-1008.
PLEASE ANSWER THE FOLLOWING QUESTIONS
Initial Each
1. INVe assume complete responsibility for the kennel at the premises for which Ilwe are making
app tion for a permit and understand that "kenner means an enclosed, controlled area, inaccessible-la\ .
other animals, in which a person keeps, harbors or maintains five or more dogs under controlled conditions
(ARS 11-1001).
2. INVe certify that the kennel has been approved by the local zoning authority (if applicable) at the
pre S for which I/vve are making application for a permit.
3. \ WINe certify that INVe havei4 i 1ogiand that the kennel meets the definition in statute.
4. I/We certify that I/We have not been convicted of a violation of A.R.S. §§ 13-2910 (cruelty to animals)
or "I 0.01 (dog fighting), or any other state, county or municipal animal welfare law. (Violations of license
and ash laws DO NOT apply.)
5' 1 Me certify that all dogs over the age of three (3) months that are kept, harbored of maintained on the
pre es of the above named kennel have been properly vaccinated against rabies by a veterinarian licensed to
practie in the state of Arizona and that a current vaccination certificate signed by a licensed veterinarian is
maintained on the premises for each dog.

I/We understand that a dog remaining within the kennel is not required to be licensed individually under
A . fir -1008. l/we also understand that a dog leaving the controlled kennel conditions shall be licensed under
A 11-1008 except if the dog is only being transported to another kennel which has a permit issued under this
section_
8. I/We understand that a person who fails to obtain a kennel permit under ARS 11-1009 is subject to a
pen of twenty-five dollars in addition to the annual fee.
I /We certify that I/We are submitting a valid copy of the rabies vaccination certificate for each
do. h this application.
9. OM /We understand that a person who knowingly fails to obtain a kennel permit within thirty days after written
notifit i ion from the county enforcement agent is guilty of a class 2 misdemeanor.
19..1/..is this kennel permit being obtained for the purposes of operating a business including bulaot limited to
brerWi's, groomers or boarding establishments? (Please check one) YES WNO
If the answer is "YES", you will need to provide proof of lawful presence in the United States in order to obtain a
kennel permit for the purposes of operating a business. The forms of identification accepted for this purpose
are listed below.
A.R.S. § 41-1080(A) provides:
After September 30, 2008, an agency or political subdivision of this state shall not issue a license to an
individual if the individual does not present any of the following documents to the agency or political
subdivision indicating that the individual's presence in the United States is authorized under federal law:
1. An Arizona driver license issued after 1996 or an Arizona non-operating identification
license.
2. A driver license issued by a state that verifies lawful presence in the United States.
3. A birth certificate or delayed birth certificate issued in any state, territory or
possession of the United States.
4. A United State certificate of birth abroad.
6. A United States passport.
6. A foreign passport with a United States visa.
7. An i-94 form with a photograph.
8. A United States citizenship and immigration services employment authorization
document or refugee travel document.
9. A United States certificate of naturalization.
10. A United States certificate of citizenship.
11. A tribal certificate of Indian blood.
12. A tribal or bureau of Indian affairs affidavit of birth.
Please submit a photocopy of both the front and back of your identification with your completed
application. Please also be prepared to present your identification at the time of inspection by the field
services officer.
If the answer to question 10. above is "NO" please answer question 11.
11 k e certify that the kennel permit is being used solely for the purpose of licensing my own multiple
F.,nion dogs in my household.
IIWe certify that alj-cf the inform** lilke have provided is true and accurate under pena ty 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

Maricopa County Animal Care & Control
Date: August 9, 2015
Lt Timothy Rummel
Enforcement Division Lieutenant
2630 W. Rio Salado Parkway
Mesa, AZ 85201
(602) 506-6274
trummel@mail.maricopa.gov
Kennel Permit # 2016-000036
Number of Dogs —47
KENNEL PERMIT INSPECTION
Burtner Kennels
1509 N 194th Ave
Buckeye AZ 85396 (County District # 5)
602-295-3386
• 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
httb://pets.maricoba.cov
Receipt Number: R15-183638 Receipt Date: 08/07/2015
Person ID: P1875830
Phone: 602 2953386
BURTNER KENNELS
1509 N 194TH AVE 8/7/2015 1:03:26PM
BUCKEYE, AZ 85396
Item: Animal ID: Reference No: Price: Each: Amount:
KEN PERMIT A7777777 K16-000036 $325.00 1 $325.00
Total Fees Due: $325.00
Payments: Cash: $0.00
Check: $325.00
Credit Card: $0.00
Total Payments Received: $325.00
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: Animal# Vacc Date: Vacc Expires:
Please retain this receipt with your pet's records
holguins WBUSOFF

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 y First M.I. Telephone
VI_ \e- e-i-w., eAs , ele 69) - IND diR
No. 1 5 cf,i Striejt \CAL\ , c \,si e., . ..s, i ,0 c y iviate . tit-131 . 10
Species: >1.tex: ...,,Age: Size: Predominant Breed: Colors:
Dog ...- Male Err 3 mo to 12 mol=1 Under 20 lbs......-0 ,
Cat El Female 0 12 mo or older V 20 - 50 lbs. E ceNvi,
Other: 0 Neutered 0 Actual Age 1 I Over 50 lbs. E
(Specify) Actual_ lbs. Name: . 1
t-XIS i 1
DATE VACCINATED: P roducer: 7 0 Vtinar eerian's: Az ,,,nseie, I I 9(31
Lo \u, :),(16 (First 3 letters)
V
Month Day Year IA 1 yr. Lic./Vacc. (Signature)
Address:
24yr. Lic./Vacc.
VACCINATION EXPIRED: Other
--S 6 g 1 5.4) 54-
.,
Ae_ Ito ,90\S C L-11 4-‘ 1 la A-
Month Day Year Vacc. Serial (lot) no. ) e ape.
•
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
U F-1-n e c-_,,. V,e,ofNe \s W.-LIE& )etZ
No Street ,9tiy ,) State
1509 A; ty, ,i1 frk
e
Species: Sex: Age: Size: ,,, Pr dominant Breed: Colors:
Dog tia'Male ' 3 mo to 12 mo 0 Under 20 lbs ig
Cat 0 Female 0 12 moor older 1e20 -50 lbs. • El eb B 'SI3A "VcN:lei Zi\'‘ ')Q
Other: IE Neutered 0 Actual Age ii kl Over 50 lbs. El
(Specify) . Actual _lbs. Name:
DATE VACCINATED: Producer: 2. . 0 c Veterinarian's: id.-7...A.,
L, SG NO.)
(f) I (0 ‘',? co (First 3 letters)
Month Day Year (Signature)
0 1 yr. Lic./Vacc.
Address:
g-Tyr. Lic./Vacc. i \r‘
VACCINATION EXPIRED: Other 3;15 F.. 1 5
JO_ 1 .10 dOI 8 9-k Vek 18 U A Tempe, ec 21 S59,M
Month Day Year Vacc. Serial (lot) no.

TE 44 \ 1 _ _ . No)
Rabies Telephonl 59 No.) Loh Rabiei Telept- be) Z—ji.6 e 47
I State 1, 110 State fi Linen
„ \ ._St ' (License 1)-1-4--/i Ml, Breed: # ç
M.I. Breed: .rfI # E vcIes-
. clic‘ CERTIFICATE 4-7- CsCI Veterinarian's: 3)5 iefive
CERTIFICATE 42 Predominant OCIN Veterinarian's: 3,25 /ep-pe type Predominant p C Name: , (Signature) Address: „—
type Name: 1nOke' (Signature) Address: —,--- or e ' ‘
#51 or ev-P lbs.n " #5/ pen El" 0 E lbs.
pen k / E 0 Form point lbs. lbs.
Form point , 1 a 20 lbs. lbs. Firpt Ettk 20 lbs. 50 _
First ,6eitlY1)61s ity C C 50 50 Actual_lbs. VACCINATION NASPHV ball Size: Under 50 - Over Actual A
VACCINATION NASPHV ball e Size: Under - Over use Keil/n-1th 20 letters
use letters) i\ - 0 11".. 3 Lic./Vacc. Lic./Vacc. Other Ste no.
- , k E er-112"--20 L.0 (First 3 Lic./Vacc. Lic./Vacc. Other no. Print ite mo older Lki Z (First (lot)
Print 44-e, mo (lot) 12 or Age yr. 5t-iiiqlk Serial
12 ol or Age y 9-tti-t15tQ Serial RABIES to Producer: 0 1 --f giyr.
RABIES /41 to mo Producer: -1 0 qifth mo 3 12,mo Actual Vacc.
Li Age: mo 3 12 Actual Vac°. Address i il Nr E 0
Address i El D 25 nees A) Sex:,.Age: t5 EXPIRED:
Sur-l-ners EXPIRED: COPY and i fi Street Female Neutered Year Year
COPY and Street tti Female Neutered 0 _d Year )01g Year Male VACCINATED: lasis
Name Sex: Male VACCINATED: OWNER'S Name N ast 501 T' 0 0 . ay Day
OWNER'S Last 0 D )(12 Day ILO Day - No.' VACCINATION
- 66 VACCINATION Owner's PRINT i Species: Dog Cat Other: (Specify) DATE Le Month Month
Owner's PRINT No 1 Species: Dog Cat Other: (Specify) DATE 6, Month (L2 Month
Lnuovg —el quoini 7-1– DIVO ()Speeds) ueLgo leo 5oa :sepeds INIEld s,JeuirtA0
Number gi „scsai Ata 1 NOI1VNIOOYA ABa 0 0 „Ixt c/51.oN cl.) - s,unNmo
WiMpi;241X Colors: VC1Wn h 9 411 :GBI.VNIOOVA eitiAl :xas 0 lsv-1 aweN
Tag a• 41 / No.)„,./.4/ + JteA Jee,k paJalnaN eitwej (Y.„s6 --\-3 Put Acii00
Rabies Telephone i i //', "--- 4- $10-r :031:11dX3 clof
t j5 , E 'CS, E ssaiPPV
n- (4? jicerise t: d I. 3 e :e5v 1 c..90
M.I. Breed: # 'oaep, ii, 0 I. .JeonpoJ itrilov ow ow . b
fei..ies ! '.Iiic - ebv JO 0; I/ S3101V1:1
CERTIFICATE Predominant Veterinarian's: 01...,- re) 325 . (loi) h I iOn e ' Me -*PP ow MA- tupd
type l., "r-1 Name: Address: ---7--e •.., 8 ! JeLiTo -00u/1/91-1.2 '00RA i A 0 -
or c)kodie {Sig (s.....,,.„) 0 N ° asn
#51 pen D 0 lbs. -1k4 rilOV JeAo - Jepun :ezis --?'M)C Al Reg AFIcISVN
L lbs. lbs. It Og OC Isaij NOIIVNIOOVA
Form point City 20 lbs. 50 sql— .sql .sql OZ Al! kik)1-/ lulod Lli-l°g
ball First \(Nei\YoAs 50 e. .sgl
VACCINATION NASPHV N-Py-e_ Size: Under - 20 Over Actual. letters) A ID 0 1 SI uad Lg#
use - E % 0 3 Vacc. Vacc. Other no. :ssalpov (eantruDs) :BLUEN Z.) - .10
Print kAr‘ mo '\J ,First Lic./ Lic./ (lot) 5tc, .v07 :s,utueupeleA \KA-C4nnAi - N 4utuiwopeicl c)-j"\olyp( ad&
older 31VOIA111130
Lk 12 or Age ly.,C. Sillq/84, Serial •011,41-a/ -
RABIES C\ to mo mo Actual Producer: Li ilgriyr. Vacc. --4 vg :paaiii3 A T
\ Age: 12 ':..C.,- esueon) 7 Vt1,0\_ s
Address 1V3 0 0 6 L–k 1 Ocf em. 09
Q EXPIRED: jaig 51 ( ON VA — euoudelei seigtu
COPY and boi--\--T\-e-s Street Female Neutered ;C) Year Year l 5ei
Name Last CI Sex: I Male VACCINATED: (f, 1G tqc5-s "7'77 ‘PY‘,(r) :sloioo 107
OWNER'S E E ) Day VACCINATION Day AttccZz JeqwnN
Owner's PRINT' ‘a Species: Other: (Specify) DATE La Month . 1_ Month Sar
No. Dog Cat

ci', 11
Number , 5+ Number 061) . . -1-
. Colors; gha__ Colors: 5 85def
Tag Yali 5'-'-‘rN- Tag LOIS i <ALA .- 4L4 1'n
Rabies Telephone ' No.) ,p-jZ,14,vQ_JWI Rabies Telephone 1j 0 o.
bOa State AZAill State 15 ilizi
(License /172-,, (1..icense
M.I. Breed: 4 # ia. ' M.J. pri Breed: # ......7 7j E
, , 7r( r
Predominant 80 Veterinarian's: _X . ill CERTIFICATE redominant 6 i Veterinarian's: 41- 'Tilde-
type 'A`e\i't Name: (agnature) Address: 395 —7- type .--ed Name: (Signature) Address: .3,2S
or or
#51 pen F'... E 0 #51 pen 0 C lbs:
Form pint t lbs. lbs. lbs.' Form point , Vix\s lbs. lbs. lbs.
ballo First City 20 50 Actual_lbs. ball First 20 50 50 fI
NASPHV use Pie- Size: Under -50 Over VACCINATION NASPHV use - Size: Under - Over Actual letters)
- 0 620 0 3 letters) Other no. - V5e AVe CE(-20 0 3 Other no.
Print A?\`‘ mo older (First Lic./Vacc. Lic./Vacc. (lot) Print mo 5 1 (First Lic./Vacc. Lic./Vacc. _1412915__LO__ (lot)
12 2_ \'‘ 12 older
c\'4 to Age yr. yr. Serial RABIES 'A to or Age 0;yr. 3 yr. Serial
\ mo moor Actual Producer: 0 1 ' S14 mo mo Actual Producer: .Ur r, Vacc.
Age: 3 12 Vacc. ..kge: 3 12
Address' k) E TSr 0 Address ‘ Vffr i El 0 06
and CA5 EXPIRED: 0\11 COPY and Street k) ,A EXPIRED: .101S
Street x: Male Female Neutered Year Year Sex: Male Female Neutered Year Year
Name Last VACCINATED: 4co 4) OWNER'S Name Last i".# VACCINATED: —AO Day itv
- 5 E E 1 Day 1 Day - 5ock E El VACCINATION e Day
Owner's PRINT ‘ No. Species: Dog Cat Other: (specify) DATE 6 Month VACCINATION Vp. Month Owner's PRINT No. 1 Species: Dog Cat Other: (Specify) DATE IP— Month • 1. Month
aCi)g i 1-‘2` 4 / I "3/6 li
..9a Number .
Number ,iec LI---4.) Colors: 21... ,5--)- 5:598 Colors: -3CZ04-\ g..5,2F1
1486 i . "NO-el .... Tag 6-44,5+
Tag , 4LI, .6•A4' Rabies 1;17)one ': No.)
Rabies Telephone 1P0a \c6°1 No e.7 e
State ease 42 nfate 'cense
i\--2- - iZ-A ' APN1444, E . M.I. Breed: E
M.I. Breed: - ., #-• -
cN q
.; Sid,5 i-)or CERTIFICATE Predominant e: Veterinarian's: Z27 .3-5 -7?-i,
type -q-e Predominant - Veterinarian's: 40014e (Signature) tvfle Nam-NA (Signature) Address:
1 Name: ,---, Address: --7- or Qlse
#51 pen or 0 IEI #51 nen ),:', lbs. Z 0 IE
Form \ vy,x, , lbs. lbs. lbs. Form nnint . ( 20 lbs. lbs.
p 'C't City 20 lbs. 50 First r-PK •\Di 50 50 Actual_lbs
NASPHV ball all First i- Under - 50 Actual Pi VACCINATION NASPHV htII -NeJN)le\4.) Size: Under - letters) A
use C Size: 20 Over letters) iie 20 Over 0 3 Other ID no.
- . Po-e- 0 lEr. c 3 Lic./Vacc. Vacc. Other no. - El 12' (First Lic./Vacc. Lic./Vacc. (lot)
Print . mo (First Lic./ (lot) Por mo older AgeA4.
k\-' 12 older Age • yr. yr. 5,-11%-\\S Serial Aor, to 12 or Eiyyr. yr. 5419IS Serial
to moor Producer: E 1 RABIES • mo mo Producer: 1N:3 Vacc.
1004 Age: mo Actual Vacc. Age: 3 12 Actual
3 12 kc‘LA
Address Er 0 E c-- , El IYr 0 7Z1.5
)1.)r-Vnt.r N) 4106 EXPIRED: ao'IS Street NI. Year EXPIRED: ,)01S Year
and Street Female Neutered :;CINATED: Year Year j_c-Vfle Sex: Male Female Neutered CCINATED:
---. ame ast C-i Sex: Male ay TION Iay Last )c : VQ> Day ATlON WP Day
/ ( : :

V
Numbe 153ci Colors: sk Numbe i Colors:
Tag . icta 650.151 Tag (A;gt6L)-t29,' . .6 / 51-
TeleEhone, . CI .) \v` Telephone - I k1 i575.;2
Rabies „.0 N ) Rabies .,,,..., 1 7) No.) 1,5'" -
State k '‘ (License 15 dz State I cense
4-
M.I. ---e___ Breed: A,_7 e M.I. r • Breed: #
f\ Oen ovA7er 5 eiac
type Predominant • Veterinarian's: 4044 (Signature) 32 le type Predominant e: Veterinarian's: 1 (Signature) 7-t":"°7
.r) r Name: . Address: ill 00 Na Address:
or e\i-e or *
#51 pen 2 r.' El El . #51 pen - e El E lbs.
Form point lbs. lbs. lbs. - • Form point lbs. ibs. lbs.
First Gt.Y:f 20 50 50 Actual_lbs First \S Cit 20 50 50 e
NASPHV ball Size: Under - Over E letters) A NASPHV ball fee Size: Under - Over Actual letters)
- use Vr?' 20 (3 3 Other ko no. - use Ern .. 0 3 Vacc. Other pt la no.
Print CI ')Ni' (First Lic./Vacc. Lic./Vacc. (lot) Print ets) , El First Lic./Vacc. (lot)
-PVTR mo older --z_ it-kOr mo older Age,D Lie./
• 1 12 or Age yr. yr. Serial \A.% 12 or 1„yr. yr. 94tgo Serial
‘‘,.. -1-4 mo to mo Actual Producer: 0 1 54 mo to mo Actual Producer: 0 !oast- Vacc.
, . Lk Age: 12 Vacc. , /Age: 3 12
Address ..... V I IN/13 ID 0 Address oek',.,5_ By El 0 5
ao6 EXPIRED: , ' EXPIRED: acitS
COPY and Street tI Female Neutered Year go\S Year COPY and Street Female Neutered -.901 Year Year
,..Sex: Male VACCINATED: i Sex: Male VACCINATED:
OWNER'S Name Last "IV 0 CI _1142 Day Day OWNER'S - Name Last boc3c 0 0 P . -lila Day ko Day
- SOC\ VACCINATION - , VACCINATION
Owner's PRINT No i Species: Dog Cat Other: (Specify) DATE 19_ Month Month Owner's PRINT No. Species: Dog Cat Other: (Specify) DATE jii— Month Jo Month
di:23 j i "/ ) gluon ui.uoinj CY 3.1V0 (knoeds) :Jek-I10 4E0 Boa :sepads 5-IN - INItIci s‘leum0
Number Colors: 4)1Vk "f -aS Auto NOLLVNIOOVA IT 0 E Q -
Tag 2cTi`QP saild< ii....4-41I4W q5 Aso :CEIVNIOOVA -- Wel eweN SLIJENMO
Rabies Telephone I S9 / . Ma), crOC paJelneN el2Wed elpiN C•4 4eaq,s 53-awkW pus AdOO
No. 4 - a, 4:131=11dX3
State 1 (License A El p ssalloPY
1.......a
M.I. i\---2 Breed: ,irAlb. E '00eA 'Eno)/ Z :e5y
of-Cy Jri 0 :;aonpoJd OW ow
ominant Veterinarian's:107- 4- japes .-u(s-n -JA 1- abv JO 01 S31131/1:1
RTIFi type Ctrl F-1 . 325 -Tempe (401) z JePio zt
or -,cv-i-e\te_ Pre 0 1 Name: (Signature) Address: 40 •03eAr0il .00eAran ;s.idi kr ow Illlid
C #51 ..., e 0 ...& 0 -
pen 1_4: Er CI E Ibs. IsJoi4Di .enc) 03 rezis asn
Form point , C ' lbs. lbs. lbs. -g ien15V 09 og - -sqlczJaPun O.J ;s-lid [led AHdSVN NOLIVNIOOVA
VACCINATION ball First 20 50 50 — -sell •seil A 1.u!od 0.g
NASPHV use . Size: Under 20 - Over Actual letters) Pi -Sq I Ej El r1 uad U./.4
- Mr€ El Rr 0 3 Lic./Vacc. Lic./Vacc. Other no. 1 ao_al ii, r-454.3.-k-nC\ Jo g# I
Print ma older al Fret s (lot) issaappir, (aJnietibis) ir reueN adAl.
r \ \ 12 or Age 1_:w. yr. ti-i Serial --dita2L is :s,ueueupeleA 15CM lueu!LuopeJ 31V3IA1E130
RABIES A ma to ma Producer: E .TEef sLi
Age: 12 Actual Vacc. Itel,...c6/ # :paeAs 4.--
rCV-1 3 1g eleISV T
Address El IN'. 0 v ;I 4-
01.3 EXPIRED: (7 i-ry c1:77u--7arli/ .
CCJP'T and Street k) Female Neutered Year Year 51 VI? eubi4cleiej se!cieu
EHS Name Last . Sex: '"Male CCINATED: TION -',),C) TcS ,c Nh bei
CI ' 7 7 lay L2 lay oa i

I -lt A
Numb .. Colors: i-h514 ;q5 Number t t5-iL Colors: s gSaS
Tag Tag 1-64; 5‘fNc-, -1A-Ovr\ / 1 aiiik.4....1.
Telephone 45 GI IS--"N
Rabies No.) /5 Rabies Teleghone li...' CIL No.) --2,_-1
State be 1 nse - 4, State ir2-1\
M.I. Breed: -f- M.I. PCZ- Breed: (I_Jcense _ AV , 'E K,
#
/\----L. Veterinarian'de- 3,25. 7 , 0,5?1 5
type Predominant V'''''Footlie MOM (Signature) re/ CERTIFICATE Predominant Veterinarian's: 0 ---ct.,tY\
or -t, Name: A Address: type Name: Vp (Signature) Address: 3),
#51 ' or
pen , E E lbs. #51 pen 5 l'OC)e_'\i'e CI E
Form point lbs. lbs. lbs. . Form point lbs. lbs.
First. ‘3:-,' 20 50 50 e.... tO-CA Ck 20 lbs. lbs.
NASPHV ball Size: Under 20 - Over Actual letters) A- VACCINATION NASPHV ball First )3 . Under -50 50 Actual '.., A
- use R'.. 3 Other 19 no. use 12 lyrii Size: 20 Over letters) L2
vte... E y (First Lic./Vacc. Lic./Vacc. - El 521. 0 3 Vacc. Vacc. Other no.
Print mo older 4 Z (lot.) Print mo older L (First Lie.! Lic./ i (lot)
to 12 or Age yr. yr. 51-iVALI1, Serial 12 Age yr. yr. Li
mo ma Actual Producer: E 1 V3 RABIES CP‘tV. to moor ,1 3 t Serial
Age: 3 Vacc. Age: mo 12 Actual Producer.: 0 Q' 611 Vacc.
Address _ t3ii-k CI 212 0 (3
Address .;Arsle,c-.3 0 E '6
COPY and Street .N.I Female Neutered _AZ Year EXPIRED: Year COPY and Street t,.) . 2143 EXPIRED: IO
R'S s/Vx: e Male VACCINATED: „Sex: Male Female Neutered Year Year
WN Name Last v El E I ip Day :(0_113.aol Day OWNER'S Name Last C6O'c VACCINATED: \vi FLO
- No.15oci VACCINATION - IC)CC41 .I IL CI 1:1 Day \ Day
Owner's PRINT Species: Dog Cat Other: (Specify) DATE L, Month Month Owner's PRINT Species: Other: (Specify) DATE Month VACCINATION Month
No. Dog Cat -U'
Number Lig0Ca dcitZ (.0 i
Colors: BlAcK #ti....M___.-_-- Number
Tag 5520/ 639 Colors: ±B‘iPtd& . 3+ 61.58
Rabies Telephone 6L1)? No.) Tag tea-Ligi5)
Licen s e 42_, Rabies Telephone el •-l No.) --i'h ,
M.I. Breed: . ( State n-1-1 icense 4 -2
it Veterinarian's: E M.1. t2- Breed: . # 1_.
Predominant f'''.00„,,ccaie.., / .., vr E
CERTIF type Name: clieo piga Address: 3)5 77e.-. CERTIFICATE e Veterinarian's: eipi
' or i type Predominant glippecAt (Signature) 325 /
#51 pen 0 CI 1 Name: Address:
ION Form point pere_citp,oc.A.,..e lbs. lbs. lbs. #51 pen or ISLX-iq 2r E E
ball First 1\-YG 20 50 50 Actual_lbs Form point . lbs. lbs. lbs
NASPHV Size: Under - Over ft As Ci 20 lbs. 50
- use 1<) W20 3 letters) Vacc. Vacc. Other L-) no. VACCINATION NASPHV ball FirV Size: Under - 50 Over Actual A-
El (First use ,nof 20 letters)
Print rno older Age/1_ to' Lie./ Lie./ 46 (lot) - f PlAel- CI hid. b 3 Vacc. Vacc. Other no.
, 12 or yr. iii Serial Print V i mo older 1 ).. 7._ (First Lie./ :T.ic./ 1 (lot)
GILI mo to mo Actual Producer: E 1 4 .th 12 or Age yr. 1-1 Serial
Age: 12 ,5 Vacc. RABIES to 1 I
C-5 \ Mr3 i-i Age: mo ma Actual Producer: CI SLI Vacc.
Address t! 0 El 6 9 12 .
EXPIRED: Address 1 V3 E CI •S
and CA-NCA Streit) Female Neutered _,-._ Year Year EXPIRED:
Name Last Sex: Male VACCINATED: \\.,;10 COPY and A--oeT3 et 13 Neutered .." ja Year :L4C1A Year
- 0 5oci - Lid 0 0 lic.; Day INATION Day s ime Stre le5ex: Male Female 1:INATED: ON
r's r -1 as ) 1,i ist ;I ' Cl y ,t

Number =Al 8t31 Number 9C zip...3-3( /
Colors:. ..),a1 1-5tp Colors: tv'ef-
l' 4 64..,./--e
Tag i,n Tag
Rabies Telephone 6)) ' NO Rabies Telephone 140.1 5; ‘5C1 No.)
State ense o-fri-J: /is S/ cense
itZ-11 --470-0;
ATE M.I. PIZ— Breed: AT M.I. Breed: le #
a., '4" ant VO0C-C\ .
e, Pr/dominant • Veterinarian's: —Te-froe. Veterinarian's: 4
type Ii I Name: (Signature) Address: type ?WA Predom' Name: (Signature) Address:
or f or
#51 pen cv" 0 0 . #51 pen 0 0
- Form point k2()E lbs. lbs. . Form c7t-NrA‘e_A_D' OY lbs. lbs.
-- - 20 lbs. 50 Actual_lbs. p 20 ibs. 50 Actual_lbs
-- ball ,First b 50 e.... ball all First 50
-- NASPHV Size: Under 20 - Over letters) N NASPHV A-AN Size: Under - Over letters)
- - - use Ven11-CAS 0 0 3 Other no. - use 20 0 3 Other no.
- if 0 RI.4 . (First Lic./Vacc. Lic./Vacc. i%1P 0 Er. Al i (First Lic./Vacc.
-- Print mo older 31 —2_ (lot) Print mo. z yr.Lic./Vacc. ill (lot)
— -- , In' 12 or Age Lyn i4 Serial cii—k 12 older Age yr. Serial
— 1 to mo Producer: p Ilif-3'yr. ii-ii \ to moor Producer: 0 1 E I-1.- t-ii
-- - 'I_CILA Age: rno Actual Vacc. Age: mo Actual Vacc.
- e-C-5 3 ge12 3 IS/12 0
Address 0 0 Address 0
t ;ell EXPIRED: 0 _206 EXPIRED: )I06
COPY and , 1)- -t Female Neutered Year licAtAS Year COPY and Street Female Neutered Year Year
Name Last 0C; i ....Sex: Male VACCINATED: Name Last os_ .i,;Sex: Male VACCINATED: :--14 ay (0 ay
OWNER'S - 9) et El 0 Day VACCINATION Day OWNER'S - krr 0 D VACCINATION )
Owner's PRINT Nol_s Species: Dog Cat Other: (Specify) DATE (P Month Month Owner's PRINT NA5 Species: Dog Cat Other: (Specify) DATE Month 142 Month
aciAc. i Number s: 31— ' .
Number 5+ ta g:539 Colo if:5;437/
1-19p Colors: n Tag 1
Tag . -in 1' g5 Telephone 3 (1 • i--) -
Telephone . LI Rabies 1 No. --7
Rabies u).A 15 State (License A
State ense .79/L- A-7— Az, 4_15
2712- M.I. Breed:
Mi. Breed: ie.I 6-r)47 e-, #
1 ) # 71 CERTIFICATE , / ,)5 'refrpe
4 C ,,,preSominant h kOiy Veterinarian's:
type ‘uc,'(\t_I-e, p Predominant C .trl... CU Veterinarian's: 3,9,-5 ---7e-fil type /e) 1 --'' Name* ,----• (Signature) Address: 3
CERTIFI u Name: (Signature) Address: or
#51 or -e- ,,. ". #51 pen iffl 0 EI lbs.
pen r-\ . E E 0 lbs. Form point lbs. lbs.
Form point .eio lbs. lbs. lbs. First 20 50 lbs. 50
First City 20 50 50 VACCINATION NASPHV ball - Actual E A
VACCINATION NASPHV ball z T-Th Size: Under - Over Actual_ ----vl. • use Size: E?'Under 20 Over letters) t,
u use „ 220 0 letters) - Pgrw__ 0 10 3 Lic./Vacc. Lic./Vacc. Other 6 no.
- 0 3 Lic./Vacc. Lic./Vacc. Other no. Print ma older z (First (lot)
Print --A-ArTh ma older Age_.4t Z. (First (lot) 12 Age/____ Inali . -1-iii-ii
Lk 12 or yr. to or '' yr. 3 yr. Serial
RABIES ck to 1 -ErS7'. ' Serial RABIES ‘cyk-Vtin mo mo Actual roducer: 0
\ mo mo Actual Producer: 0 Age: 3 P 6 Vacc.
eil3 Age: 3 Vacc. Er12
le-12 . i Address k:, 0 0 6
Address .-) D 0 1J ":)01.5- EXPIRED: -)C3
Y . 1-411- 1 \ () EXPIRED: 9NCIS and Street Female Neutered Year Year
.;-; e and Street Male Female Neutered CiNATED: Year Year Name Last 5-)cci Sex: I.;VMale 'ACCINATED: • (0.-; ‘'O•
a±F4' Jam _ast ') 0 Oct /Sex: l ay FION • -.)"- ay s - 5: 0 0 I Day JATION 1 Day
I I

1 < 1
Numbe 9:)ici Colors: 'VC Numbt i Colors: kA)c)
Tag • Zi j),11A1 Tag t.A6g-iiaj' ‘41'" A -2-5.: g
9 ‘Skhsi- Fo, • J
Rabies Telephone C4 - 1\b-) Rabies Telephone S9 No.) •.-)c --) --
I +2., \ i
State _ License 671)-t7: • i (License
M.I. le# Breed: 4— -Z M.I. Breed: erir -e-
#1
BcAcp___VAtitC i i )S - 7.0-pe
CERTIFICATE Predominant Veterinarian's: -3;1,5 Tempe CERTIFICATE Predorninant ! Veterinarian's .. u .
type Name: Address: type 6? Name: ,,,.. (Signat Address: -
or \ or 5 .6f
#51 pen E1 El lbs. #51 pen E CI lbs
Form point lbs lbs. lbs. Form point N)e, lbs. lbs. lbs. _
First City. 20 50 50 ball First City 20 50 50
VACCINATION NASPHV ball Size: Under - Over Actual E VACCINATION NASPHV 'Aeo Size: Under 20 - Over Actual letters) A
use e-, 20 letters) use C) c c .
- E 3 Other -no. - ' ID 3 Lic./Vacc. Va Other no.
Print mo al (First Lic./Vacc. Lic./Vacc. 5.q1Aaja_s%:___ (Ipt) Print mo il..._ (First i c . / 1-itiCA0 (lot)
older 2.. older L
12 or ge yr. Serial 4), 12 or Age yr. ..1J‹. Serial
RABIES to ma A Producer: ED 1 RABIES s cii mo to ma Producer: E 1 5%1
Age: mo 12 Actual .Vacc. Age: 3 Actual Vacc.
3 Nec-- i El....12
Address El El Address 1E1 CI t5
EXPIRED: k) o EXPIRED: JOkS
CORY and Street x: Female Neutered Year ),I:AS Year COPY and c--Ns- Street { : Male Female Neutered Year Ye Year
Name i-kw+oec:s ki S Male VACCINATED: Name Last /Se VACCINATED: l(g
OWNER'S Last El Day Day OWNER'S - 0 L.) g : El El Day 1,*_ Day
- 15D: El VACCINATION Z VACCINATION
Owner's PRIV — Species: Dog Cat Other: {Specify? DATE Month to Month Owner's PRINT No.. Species Dog Cat Other: (Specify) DATE tO Month 4c,r_ Month
No.
8 . M2 to 1 i
Number tiyx Number ka.559 .1"/ ±h5p-
Colors: FC201_10 lifV:Q- Colors: '11.-ArUAle.,_ g-5reZ
Tag 'ffia;64,61))W Tag -A-CCO
Rabies Telephone 2 No Rabies Telephone tid - isci No 0
1 sAt_t_ .711 1 4z.,)
2 (License c Az (License Prj
m. l. 7-1.-fieifzi M.]. Breed: 18 • # E
B 11;
oz_. * -i-rpe
CERTIFICATE type xe Predominarit VeNekkan's: 3.),5 CERTIFICATE ype , )(Ante Predominant .110_,ut Veterinarian's: .(24 3,23
rne: 41IKa (Signature) Address' t 13 Name: 2_ (Signature) Address: --
or or
#51 pen L2( Cl el CI #51 pen Ale A El 0 lbs
Form point e lbs. lbs. Form point ito lbs. lbs. lbs.
First 20 50 First ,e City it, 20 50 50 E.
VACCINATION NASPHV ball mtety Size: der 20- Over Actual VACCINATION NASPHV ball . A Size: Under - Over Actual ) 4
use (First.gefters) L2 use 20 (5 letters to
- qr El Lic./Vacc. Other no. - th El &? Al 3 (First Lic./Vacc. Lic./Vacc. Other no.
Print ma older (lot) Print Ar no older Z i (lot)
12 or Age r. Serial 9 12 or Age yr. Li Serial
RABIES ma to ma Producer: RABIES nen5 I ma to ma Producer: CI 1 . 9-11
4-1 Age: 3 12 Actual r-5 Vacc. Age: 3 Actual Vacc.
t/12
andINtiiress El El Address .v E E ig
EXPIRED: or+ )015 EXPIRED:
COPY Street Female Neutered Year COPY and, Street Female Neutered Year .- )0 Year
S Sex: Male VACCINATED: Sex: Male VACCINATED: 142
Name Last El El Day INATION Day l'NER'S Name Last 0 CI E j Day !NATION 1 Day
r's r - as: i's I - 5 es: 1 : 1

VETERINARIAN'S COPY RABIES VACCINATION CERTIFICATE
Owner's Name and Addn7 ,-\ - NASPHV Form #51 Rabies Tag Number
Print - use ball point pen or type 1
PRINT - Last First
/ M.I. Telephone
,
No. Street i-,-1,- i(
1 <09 rj Ht-ti‘" 1 City r State Zip ,
Species: Sex: Age: Size: Pred4ninant Breed: Colors:
Dog 0. Male CI 3 mo to 12 mo C1 Under 20 lbs. EJ i . .... ,)
Cat • 0 Female cli 12 mo or older 0 20- 50 lbs. 1=1 t4:i\f'N I CO, I c i' (I 1, ' .-
(Specify) Other: Neutered 0 Actual Age - 3/( 6., Over 50 lbs. 0
Actual I ( )_.lbs Name:
F.- CIL-if-N.
DATE VACCINATED: Producer: p __.. Veter jinarA lkan's: # 1 I -79 1-17
alncensej No.) , • /
i_i_. -)0 i 1 (First 3 letters) •;)
Month Day Yea )• (Signaarre
0 1 yr. Lic./Vacc.
F.4 3 yr. Lic./Vacc. Address: .
VACCINATION EXPIRED:
Other 3Y3
(9 .•)c-) Ll. ) .-4)(Y.'i 0(18
Month Day Year Vacc. Serial (lot) no. -11 cf.rc,ee n? (.5. ) (. l
VETERINARIAN'S COPY RABIES VACCINATION CERTIFICATE
NASPHV Form #51 Rabies Tag Number
Owner's Name and Addre Print - use ball point pen or type
PRINT - Last First , I,. Ml Telephone
V I\ nr \ CjI Y .-1- nr.( — (1,W -1i/1s -
No. ' -Street City 0 ' I State ..
( Ito 1.1-- (A -
Species: Sex: Age: Size: Predomihant Breed: ._...... Colors:
Dog It Male 0 3 mo to 12 mo 0 Under 20 lbs. ci i i ,f p Ir. L C)
Cat 0 Female 9 12 mo or older p 20 - 50 lbs. 0 r../.-Y.711j9 i 1 DIA
Other: 0 Neutered CI Actual Age;2 Over 50 lbs. 0 .0: / 1. (
(Specify) Actual 1 lbs. Name: ,
I '' .
DATE VACCINATED: Producer: - Veterinarian's: # (Licens 1 e No.)
- /
LO 1) LO ILI (First 3 letters) / 7) / • .,.) • i '-'7' . , •'''. i ...„,/ •'` (..t.-4t. - ,
Month Day Year CI 1 yr. Lic./Vacc. (Signature)
E3 yr. Lic./Vacc. Address;
VACCINATION EXPIRED: i Other :=. --) 4.:7-.— f— - 1 e=741,-. t.._,4
:V ...) C...._ 1 ....-...,
_L_Z;__ —._,_,J, ) 17— /-7 , ''' ) 7.,' /...)'ci (l'isie.:, ..-: 1
Mi5hth Day Year Vacc.. Serial (lot) no. "' ,, i ?, II . li If ,e) il l! ' ?6:'-k)-:( i

Nu Ivii Zip Color Nu [Zip , ....--:, Color
Tag Li; Tag 1
Telephone 71- . C - ., Telephone \ 7
Rabies ;' No.)-i - Rabies No
1 i State_ State !
(LicenSe r. (License
)
'-w;:r. Breed: „ , ri•-, '4.1. Breed: #
`'.-r-1-4
i -.- . -,- -(''
CERTIFICATE r ...le „ CERTIFICATE Predominant r-s Veterinarian's:
type /7 4 Predominant Veterinarian's: (Signature)i type (Slgnature)
-----h--,,r V Name: Address: Name: Address:
or tr or 1
#51 pen ,, 0 0 0 #51 pen 0 0 0
- •-•'-•,,3 lbs. lbs. Form ., lbs. lbs. lbs. lbs
Form point -,, lbs. lbs. ) point LI
CitY 20 '-' ,1 First City 20 50 50
ball First 50 50 VACCINATION ball -
VACCINATION NASPHV Size: Under - Over Actual - NASPHV Under 20 Over Actual letters)
use 20 letters) . ' use
- 0 0 ,,,,, 3 Other no. - E p \,-,--. L- 3 Lic./Vacc, Lic./Vacc. Other no.
Print - -,./ i (First Lic./Vacc Lic./Vacc. (lot) Print mo i (First (lot)
mo older 7 older :.'s
12 or Age yr. yr. Serial 12 or ge yr. yr. Serial
RABIES ' / to mo 1 3 RABIES ./ to mo A Producer: 1 0-3
- , 'S._ I, ICfLA--1-1--• Age: mo Actual Producer: 0 F Vacc. ,..„..... Age: mo 12 Actual 0 Vacc.
3 12 Addrec'Th ', 1 ci 3
Address.' 2 E ID 0 p El
COPY ',. COPY _ 't le EXPIRED:
, , EXPIRED: ,
and , Street Female Neutered Year Year and ,-, (-S-t7reer Neutered Year Year
•(--I Sex:' Male VACCINATED: Sex: Male Female VACCINATED: •
VETERINARIAN'S Name Last Day VETERINARIAN'S Name Last c.:. 0 Day Day
' 0 0 0 Day - O 5a. 0 • /ACCINATION
Owner's PRINT- ' Species.: (specify) ivrolitfr VACCINATION Month Owner's PRINT Species: Cat Other: lspecify1 DATE LiL Vlonth olonth
No. Dog Cat Other: DATE No. Dog
.
Nt'
"
, •-, i ) Number ;(
Number --) • , --•: , Colors: <-
Zs , Colors: I tiz, C L Tag d
, -, l'A - -71!--.
Tag 7 .--..- •(----11- Rabies Telephone _ t : No.)
Rabies Telephone A, ", , / 7 ,..,-, -(st-1. ice.) ' -- ,-- -..) L.-7' c —
, 1 1 - • State (License 7
State , I 1 (License (7- .
- , l:' c_-_- _ '-- Breed: #
- • ) a.i. Breed: . '1 .1 ...1
,-----.. # .--,kc-) ...,
, . -1.', I 1CV ' i r i -/ - A ,, _ CERTIFICATE S. ( 1
CERTIFICATE r- 4-c ''_..:' , v--yr ./..) i ' - ) _ type Predomilliant Veterinarian's: (Signature Address:
, PredonSinant f-- 0 Veterinarian's: i._, I Name:
type -,f. , ;_,-...' Name: (Signature Address: or --A-r,(
or 4' #51 pen 0
451 pen i,! • co 0 Form ) , lbs.
Form ,, 1,,,L lbs. lbs. point City H0111:: 50 Actual_a_lbs
point . , lbs. lbs. 01'1 First,
First City 20 50 50 I VACCINATION NASPHV ball Size: 51C7 Over letters)
VACCINATION NASPHV ball Size: Under - Over Actual use Under - 3 Other 9 no.
use 20 letters) 20 (S (First Lic./Vacc. LiciVacc.
- T--i, 0 0 — 6 Other no. Print,- D 2 L-} (lot)
-Tr, ) (First Lic./Vacc. Lic./Vacc. tL mo
Print --,, 1.---t, mo older : r (kit) older Age yr. yr. Serial
12 1
12 or Age yr. yr. Serial RABIES to or Producer: 0 1213
RABIES I-__-f-1,-, to mo Producer: 1 0,3 Age: mo mo Actual Vacc.
I Age: mo Actual 0 Vacc. 3
3 12 Addres; 0 12 0
GI 0
Addres: ig1 0 III COPY EXPIRED:
COPY EXPIRED: and e Street Female Neutered Year Year
and . Street \J Neutered ! f ---) I Year Year Sex: Male VACCINATED:
Sex: Male Female VETEP.INARIAN'S Name Last Day Day
ERINARIAN'S Name Last c'-1 VACCINATED: 1 ei - r7:3 0 kCCINATION
- lEj 1=1 El -i, 1 ir Day INATION Day vner's 1INT iecies: her: iecifY) TE (;) onth onth
r's r --^c es: I i I it

Aec Asa - - Nu Zip Colo ;
NOLLV :021VNI00% 4- IsErl al-uEN Tag
JE9A peJeineN eletlJej e'en :xes " s,NvI-HvNIH Telephone 7, - 1 --•
CR8IdX2 Pue Rabies ..' No.)
2PPV State (License
j
-ooeiN renlov c :e6v L. Ado° Breed: P-C2-Vt'CLi \ 1 #
't LE ow 0)0W
lies 8 )0 , , .
e6v 31. S319ATLI CERTIFICATE Predominant . , Veterinarian's: 7'1 LLL
'00eAf3rl r Aepp ow Cri\ut tupd type c Name: (Signature) Address:
-ou '00eAfo!1 e n or ,
- (s-reuel Jen°>f esn #51 pen ED El CI
IsrIPV ng S-0 Jepun :ezis Hag /11-IcISVN Form lbs. lbs. lbs.
point
1- 'so! 1111 4.10 Itmod NOIIVNIOOVA First City 20 50 50
sql ullod VACCINATION NASPHV ball Size: Under - Over Actual
:]] 111 ued use 20 letters)
JO tc# - El 2 3 Lic./Vacc. Lic./Vacc. Other no.
:sseiPPV (air)3801S) H.-t.L/ict :eweN ea; 1E130 Print mo older Age_, (First (lot)
:S4LJEVellp040A i.u9u!w0paid 12 yr. yr. Serial
RABIES to moor 1 3
• # 31VOld Age: mo Actual Producer: El Vacc.
:pearg Addres() 1 11C:''L-1-4-1,- i ' 3 12
inueori) 1 ,424s r‘YrV " El gi CI
(.44 euoudejel serquu COPY and ''' \-- Female Neutered EXPIRED:
_ 14)-c 41 Sex: Male Year \ Year
VETERINARIAN'S Name .Street sci VACCINATED: Day Day
:s.10100 -.,(-- El VACCINATION
2 -7 JegiunN )wner's 1 'Species: )ther: Specify} DATE ./Ionth Aonth
I tT )og )at
i (
Number fi,., Colors: i / Number Colors: - 2-
,i ---) I --a5D*2 Zip n (9.
Tag -if:c 5 „-, . Tag
Telephone 7, c-,;,, Telephone rAL --- gC1
Rabies i ,,,,,, i''' NO -7:--C-11/ A2- Rabies i No.)
Aillate i l (License State i License 7 i
.. Breed: 1 .1. Breed: - --j F-2--
c , r;hrGt # Cr^,--T 7-----,, " # .,AY"tp,c . /
t-.-7- s. 1--e(Nn i Cl Siy r ,;5
CERTIFICATE ,.... 2)L: CERTIFICATE C
type Predominant .,.., p PrP Veterinarian's: 'OA type Predominant A - Veterinarian's:
Name: (Signature) Address: f hi . Name: .(Sigrarre) Address:
or or c)/
#51 pen la CI CI #51 pen CI p
lbs
Form point lbs. lbs. lbs. -1 Form point lbs. lbs. lbs.
First Oily 20 50 50 First City tYpi_A 20 50 50 Actual5.01bs.
VACCINATION NASPHV ball Size: Under - Over Actual 97 VACCINATION NASPHV ball Size: Under - Over 7
use 20 letters) use 20 letters)
- El Ei 3 LlolVacc. Lic./Vacc. Other no. - 0 CR] (5. ,1_ 3 UcVacc. Lic./Vacc. Other no.
Print t,..( mo !-.e'cl ‘ (First (lot) Print mo hol ; .-) t i (First ./
older :Dc older
A 12 or Age." yr. yr. Serial - 12 or Age yr. yr. Seal
RABIES f.1 mo to mo Producer: El 1 [5:13 RABIES ' mo to mo Actual Producer: 0 1 a? 3 "
Age: 3 12 Actual VacC. Age: 3 12 Vacc.
c.2‘„ri i
Addre i N El El . Addre( 0 a CI
COPY EXPIRED: COPY nn-c EXPIRED:
and St/rt.,. Female Neutered Year Year and Street Female Neutered Year 17 Year.
Sex: Male VACCINATED: )5_0_ Name _,-r Sex: Male VACCINATED:
VETERINARIAN'S Name Last - pi-0,7 1:1 II El Day 'ACCINATION Day VETERINARIAN'S - Last 2 I=1 El Day 4CCINATION Day
:
Mner's ,RINT Jo. Ipecies: tog at Ither: ;pacify) /ATE ionth (":. lonth 1wner's 'PINT lo. pecies: log at 'then pacify) ATE lonth P 'onth

-
Numt Colors: P, Nun Zip Colon
Zip 0.
Tag , Y'r 1 Tag /
Telephone - _ ' Rabies Telephone ye,)
Rabies II6 No.)
State_ State (Licens
(License
'iv1.1. Breed: kr- Breed: I #
..rA &lit #
.Nt CERTIFICATE fl
CERTIFICATE Predominant k ()OP Veterinarian's: type -f Predominant Veterinarian's:
type Name: iSigristbi'd) Address: ' (Sigdatiie) Address:
{rT or
#51 or ii I #51 pen L(( 0 0 0
pen -.i E] 0 0 >•", lbs. lbs. lbs
Form point V)) i- lbs. lbs. lbs. Form point lbs.
City 50 50 Actual_.?..a_lbs First City 20 50 50
VACCINATION ball First 20 - VACCINATION NASPHV ball Size: Under - Over Actual
NASPHV Size: Under 20 Over letters) use 20 1-7 letters)
use - 3 Other r) no. - 0 El 3 Lic./Vacc. Lic./Vacc. Other no,
--e 0 2 yr"- 1 (First Lic./Vacc. Lic./Vacc. Print ma -lire', (First (lot)
Print ma older LI ' , (lot) 12 older
i--'-)-1 12 or Age yr. yr. Serial to or Age yr. 1 yr. 3 Serial
RABIES to mo Producer: LI 1 3 RABIES mo mo Producer El
-- it-rilr's Age: ma 12 Actual Vacc. . qt Age: 3 12 Actual Vacc.
, ?..- 3 g Addree E E
Addres( 0 P COPY EXPIRED:
COPY and Street N.) N EXPIRED: Year and Street Female Neutered Year -7 Year
Neutered Year Sex: Male VACCINATED:
Name Last Sex: Male Female VACCINATED.: VETERINARIAN'S Name Last Day Day
VETERINARIAN'S ' 0 Day Day- - LI LI 0 JACCINATION
- [,,, r--.;( Species: W 0 VACCINATION Owner's PRINT I Species: Other: ,Specify) DATE 1,1? Month Vlonth
Owner's PRINT No. Dog Cat Other: (Specify( DATE Month Month No. Dog Cat
i , ,..
Number \, — 7 gEt Number _ Colors: r -- / . ' 1. •
Colors: 7 r ' :--\' Zip -0, „..---- c_.,
i .' Fr:5 Tag .11.--.V.I
Tag ',-...\ ' - el , ----r- ; --. .7i c----e-1,....,
Telephone 03' Rabies Telephone 7\ 11::,'--
Rabies Si \1 e - 3)5-1-. i'7V State 1, i
State ' i s ,i" , 1 (Urania L.- --
7.--xi_ .1. rr, Licer, //7.\ ,, -4' WU. Breed: r',...., '-I ' -CrY-12.4.7. i
1 Breed: „, ').- # ....3-11 (Th \.. # ,
, _., ' V --1-, ; ._ --) , -7- '.
CERTIFICATE ( .7) 7/4- CERTIFICATE r ,. Predotninant Veterinarian's: ,//1.
Predominant C\ Veterinarian's: type
type 1-1 Name: (Signature) Address: 'f'r° yr. • Name: Address:
or _.-- .i. 7 or ',.
#51 pen E 0 0 #51 pen i.---q.zr U E 0 lbs
Form , lbs. lbs Form point r) lbs. lbs. lbs. 1
point City 20 lbs. lbs. 5 First CRY 20 50 50
VACCINATION ball First 50 - 50 1-_-- VACCINATION NASPHV ball Size: Under - Over Actual - . i "•-'
NASPHV Size: Under 20 Over Actual tatters) — use 20 letters)
use - i---; 3 Other no. - ID II -- i 3 Lic./Vacc. Lic./Vacc. Other no.
E L" ,ii_174.,, (First Lic./Vacc. Lic./Vacc. f)clocf? (lot) Print i --, ) (First
Print mo older --, p (L'Il mo older Age...,i,:_v:,(_-, c,
kr P 12 Age yr. yr. Seer's@ 12 to or yr. yr. Vacc7SeHal(lot)
RABIES to or 1 3 72, RABIES ) mo ma Producer: 1 0 3 0 ' '
) ma mo Actual Producer: 0 51 c--,. Via'. ,....--',-.., ,........, (Th--t.-`A'" Age: 12 Actual
4 -4" Age: 3 12 3
Addreic 9/-1 CI 2 0 Addre9 0 f2 0
COPY EXPIRED: COPY ) N EXPIRED:
and Street Neutered Year L-T Year and , Street Female Neutered Year Year
Sex: Male Female Sex: Male VACCINATED:
:TERINARIAN'S Name VACCINATED: bay CINATION •:-)L-:, bajt /ETERINARIAN'S Name Last .13 0 0 Day CCINATION Day
er's IT-Last ;les: cn 0 0 th •ner's - INT ?.cies: ler: !city) FE nth 'nth
r TY) F. th . g t

_ 7ff.
Num Zip Colors Num -- Colors:
at)
Tag Tag 4.•
11 ,
Rabies Telephone - No.) Rabies Telephone No.)
State •1 (License State (License
'WC Breed: # Breed: y #
CERTIFICATE CERTIFICATE t5 It 1_21/7
Predominant Veterinarian's: natUre) Predominant (:( Veterinarian's:
type r Name: Address: type (Signature) Address:
or (Sig or
#51 pen 0 çj 0 #51 pen r 0 0 El
Form , lbs. bs Form lbs. lbs.
point City 20 ibs. lbs. -•-• I point Firstf2) City 20 50 lbs.
ball First 50 50 ball r - 50
VACCINATION NASPHV Size: Under - Over Actual VACCINATION NASPHV Under 20 Actual
use 20 letters) use S Over letters) -
- ED 3 Other no. - 3 Other no.
Print (First Lic./Vacc. LiciVacc. (lot) Print olderffiD 'T6 (First Lic./Vacc. Lic./Vacc. (lot)
mo older mo
12 Age yr. Serial 12 or Age yr. yr. Serial
RABIES to moor yr. 3 RABIES to mo 1 3
, LrL Age: ma Actual Producer: pl Vacc. Age: mo Actual Producer: G Vacc.
3 12 3 12
Addre 0,r). cl p 0 0
COPY ) EXPIRED: COPY Addr V-efinr EXPIRED:
and S_treet Female Neutered Year , 7 I Year and Street Neutered __L-1 Year -7 i Year
Sex: Male VACCINATED: Sex: Male Female VACCINATED:-
VETERINARIAN'S Name Last 0 2')U7- Day Day VETERINARIAN'S Name Last 0 LC: Day Day
- _ /ACCINATION - p 0 rACCINATION
Owner's PRINT Species: Other: Specify) DATE vlonth 1.• vlonth Dwner's RINT Ipecies: /og Xher: pecify) /ATE Aonth lonth
I10__ Dog Dat • at 6
I
_;;, 3 ,..,.
\
Number L I .,.:;,, ---,PL" Number .
Colors: 11 :' '',..^.-.:•;'. ..,7 ,'...' Zip Colors: irv • -- 7 t..-. <
Tag Z4/ 7-1. Tag j - ,_.,-,, f- , . rk
Telephone ..._. P -)1 r !...... ' 541- „Th 7 1-it_ Telephone , 1( t2--- I ,--,. i IC:-.--_,.
Rabies 1 cifl. N - .....--, Rabies ,, ' i.- .- 2- : No.)
State07 , } e State k--"' i 1 f'
(License -I- _ E r '' , 1 I.Jcqnse c---
-.7,-.,_,,. I ( -' -77-''
C) M.I. Breed: 1 # , -(1112 -Mi.]. Breed: ---1- 1.-e ' ) # .-- -
r riA)in , 9 — V\ 'icy ' ec- /2(1 -,.,
CERTIFICATE ,L Pim i 2) .,.. 3) ---, CERTIFICATE . if = -tT- )( 7.)
1/2___-if Predominant r- Veterinarian's: ..,,,7 type c Predominant r _ Veterinarian's: /
type \ NarnL,ei (Signature) Address: kr" 171-)(-4.- Name: (signatu/-67' Address:
or or l'-Fl/rf 1 (". '
#51 pen 0/1 El 0 #51 pen ( ,,, ...z•-,; ,[3' 0 0
re) lbs ) H 1 r..: f lbs. lbs
Form point lbs. lbs. lbs. Form point _ lbs. lbs.
City 20 V-... City 20 50 1
VACCINATION ball First - 50 50 1- .-l- - VACCINATION NASPHV ball First Under - 50 Actual -
NASPHV Size: Under 20 Over Actual letters) g use Size: 20 ?Over letters)
use
- li/VCP 0 -41 r - 1 3 Other 0 no. - 0 0 I --- 1- 3 Other no.
1 Lic./Vacc. Lic./Vacc. if \ 3 (First Lic./Vacc. Lic./Vacc.
Print mo ()Ci (lot) Print :=,\ mo older Li (lot)
4-1- 12 older d.--• Age yr. yr. )--) (-- 12 Age ' yr. yr. Serial
RABIES 1-1 to or 1 3 C-, Vacc.-Seiial RABIES 4 to moor Producer: 1 3
C1 mo mo Actual Producer: . ../ i. Age: mo Actual 0 0 Vacc.
1 Age: 3 12 ,..,.. C 3 12
, CS
Addre 0 SI 0 AddrW (1r\ I 0 [S1. 0
COPY t-N,.1 EXPIRED: COPY 1 EXPIRED:
and , Street Neutered Year 17 Year and •.V.-,e. Street i". Female Neutered Li Year Year
, Sex: Male Female Sex: Male VACCINATED: 0
v'ETERINARIANiS Name Last CFI_ VACCINATED: VETERINARIAN'S Name Last n'q :--) ( Day Day
- / W 0 0 Day DCINATION Day - C,' 0 0 0 CCINATION
fners INT • ecies: g ler: cify) TE nth nth mer's ITNT . k ecies: g t ler: mity) TE C Frith ,nth

Nur ,„. Zip Color Nun rte Zip COlorf •
Tag Tag 1( I
TeIephone ' Telephone
Rabies ---, No.) Rabies - No.)
State (License State V\ (License
'
1—^; I)- V:1 Breed: # L V.I. Breed: C:ri #
..fl .'. / I
CERTIFICATE CERTIFICATE inant )1H /if?
Predominant Veterinarian's: (7.-7 ,",'LZ/1 Veterinarian's:
type I Name: t (Signature) Address: type Predom P-)1 Name: (Signature) Address:
or (-2 t or
#51 pen CI 0 0 lbs #51 pen 0 El 0
Form point lbs. lbs. lbs. ,-- ----:'- Form point . ) lbs. lbs. lbs.
City: 20 50 50 -'5 '..•`' First City, 20 50 50
VACCINATION NASPHV F ball Size: Under - Actual VACCINATION NASPHV ball Size: Under - Over Actual
use 20 Over letters) <fr use 20 letters) 1
- Ci El 3 Lic./Vacc. LiciVacc. Other no. - (' 3 LiciVacc. Other no.
Print t----e. mo .._.., ' (First (lot) Print mo 2. \ /First Lic./Vacc. (lot)
f-. older ge:-) older
12 yr. yr. Serial 12 Age yr. yr. Serial
RABIES :-, , -"— to or A Producer: 0 1 3 RABIES ) mote moor Producer: 1 [2] 3
, , Age: mo mo Actual Vacc. .-----, 16f Age: 3 12 Actual 0 Vacc.
, 3 ,
Addresk ,..., ,SI 12 0 ) • 0
COPY I 0 EXPIRED: COPY Add EXPIRED:
and , Street Ni Female Neutered Year 1-1 Year and „Street, Female Neutered Year Year
Name Last ,..„-, )1 Sex: Male VACCINATED: Name , )<1 Sex: Male VACCINATED:
VETERINARIAN'S - 4-j 0:7 0 0 ) ( Day ACCINATION 25 Day VETERINARIAN'S Last - E;t EJ 0 Day ACCINATION Day
)wner's 'RINI ,..-. ;pecies: 1og at ?then ipecify) ATE Aonth Cr, Aonth fwner's RUNT •pecies: og Ither: ipecify) ATE ,Ionth (.9 lonth
10, at
•
,
1
Number . -,-.-„,,c2,.4 rs„- ire - 4--'' Number -1-e -N.r-,7 --
Zip Colors: ; : PZ ''g.-•.,k-‘- Zip Colors: ' Z-
Tag -11 - Tag ;'h 0 •
1:2-.1v- !,-{ .26) ,. , 1'716' .j,
Rabies Telephone i--C<> I No 7.,../' (--)2 ' Rabies Telephone - r 1,P,n a. rz.
State, - ) / f State 1
c) (License ."- ) ,. 1-: (License
----\ —01 Breed: Cil ) • le # f7-'17--, )C.P112,-e ./..4-44' .. Breed: # , .."7 PM"'
\ , i !i.:-.1 ()pi,/ .. • ---;- - 301c"'S 1,,, '..,- Tpn .7, •
CERTIFICATE -(''' II 1 CERTIFICATE L._
type € i I. Predominant 1'1-'0 : 1) Veterinarian's: ri IJA type ..„ Predominant . , Veterinarian's: nil
11,6 ---- 1 Name ( - (SignatUre) Address: 0 i:2 Name: (Signed%) Address:
or ! - or __,..,•••-,,
#51 pen 1 0 2 0 lbs. #51 pen 0 0 0
Form ., -.'-'--., lbs. Form -, • : . ,. lbs.
point City 20 lbs. lbs. i_.2 r., point •-•-- di) City 20 lbs. lbs. ActualJ3....lbs.
VACCINATION ball First 50 50 ball First 50 50
NASPHV Size: Under - Over Actual VACCINATION NASPHV Size: Under - Over .
-use ._ 20 letters) use 20 tatters)
f..--,,..e 0 ;--5. f 3 Lic./Vacc. Lic./Vacc. Other n-o. - CI 0 ',•“<, i--- !-- 3 Lic./Vacc. Lic./Vacc. Other no.
Print mo older .-, — / (First (lot) Print --isi-C mo older !' (Flrst (lot)
/. _'-
Li'-14^ 12 or Age yr. yr. Serial - f 12 or Age yr. yr. Serial
RABIES to mo Producer: E 1 13.1 3 RABIES to mo Producer: El 1 CI 3
--..„, 1 ''3 Age: mo 12 Actual • Vacc. , ) '' ‘ L.4--i--.4- Age: mo 12 Actual Vacc.
(-1,--e 1 3 \,_,,, 3
Addre' n 0 MI - 0 . Addre/ r,,e' 0 p 0
COPY (2 :.,J . EXPIRED: COPY (‘,. _') EXPIRED: ---1
and itil ...„„.Street Female Neutered Year Year and I/ e Street Female Neutered 1 Year • Year
Sex: Male VACCINATED: . f Sex: Male VACCINATED:
VETERINARIAN'S Name Last -/'.)i _ Day Da' VETERINARIAN'S Name Last - ._:,,./....,-....1,' Day <77" Day
- p b 0 . ,CCINATION - --,(' p 0 E .CCINATION -.,
wner's RINT )ecies: ag at :her: mcify) \TE C Dnth inth vner's 1INT recies: )g a her: eeify) ITE ...: )nth )nth