EYE DOG FOUNDATION.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
El New Renewal Permit # /( 0i
Name: E)f,e- &7)64'- )ttifLi)\ /47 7704,1 Kennel Name: ,4>V6 Ac9C 6(A/Aqg 7/04.)
Mailing Address: p oX 57r l(Hrini" r
C-44WeileiNT czIF( c1/71.---e)-$77 ebt"oc Aux, Az ?s-ow
city Cour
Home Phone: - Kennel Phope: — Z oo 5/
3Z:7V7
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. I/We assume complete responsibility for the kennel at the premises for which Uwe 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. IIINe certify that I/We have Ct dogs and that the kennel meets the definition in statute.
l/We certify that IIINe 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. /3 INVe certify that all dogs over the age of three (3) months that are kept, harbored or maintained on the
premises of the above named kennel have been properly vaccinated against rabies by a veterinarian licensed to

practice in the state of Arizona and that a current vaccination certificate signed by a licensed veterinarian is
maintained on the premises for each dog.
5. I /We certify that INVe are submitting a valid copy of the rabies vaccination certificate for each
dog with this application.
6. GA INVe 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. GS I/We 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.Vi12 INVe understand that a person who knowingly fails to obtain a kennel permit within thirty days after
written notification from the county enforcement agent is guilty of a class 2 misdemeanor..
9.646 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.
lArtie certify that all of the information I/We have provided is true and accurate under penalty of law.
Appli ant Signature Date:
Gw /sit Z..--)<CC.1.4:)714_- /4 c—c &ye,- Zee, c.co$9. jLJ riFerecc/A (ite
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 6, 2015
Lt Timothy Rummel
Enforcement Division Lieutenant
2630 W. Rio Salado Parkway
Mesa, AZ 85201
(602) 506-6274
trummel@mail.maricopa.gov
Kennel Permit # 2015-000020 (renewal 2016-000020)
Number of Dogs — 9
KENNEL PERMIT INSPECTION
Eye Dog Foundation
8252 S 15th Ave
Phoenix AZ 85262 (County District #5)
602-276-0051
800-393-3641
• 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.gov
Receipt Number: R15-177855 Receipt Date: 07/31/2015
Person ID: P0310051
Phone: 602 2760051
EYE DOG FOUNDA KENNELS 7/31/2015 9:49:54AM
82525 15TH AVE
PHOENIX, AZ 85041
Item: Animal ID: Reference No: Price: Each: Amount:
KEN PERMIT K15-000020 $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.
License Information:
Tag Number: License Expires: Animal# Vacc Date: Vacc Expires:
Please retain this receipt with your pet's records
luffmanm EBUSOFF

SOUTHS1DE ANIMAL HOSPITAL
DR. YOCHAM & DR. TASCON
6045 S. Central
Phoenix, AZ 85042
(602) 276-5505 .
Rabies Certificate
Client ID: 9260 Patient ID: _921(17.7.03_,.. „
Client Name: Eye Dog Foundation Patient Name: CAMERON
Address: PO. Box 519 Species: CANINE
Breed: GERMAN SHEPHERD
Claremont, CA 91711-0519 Sex: Male •
Color: BLK & TAB
Phone: Markings:
Birthday: 07/04/2014
Weight: 35.00 pounds on 10/29/2014
Microchip ID: 038-577-349
Tag Number: 0
Vaccination Date: .10/29/2014
Lot Number: 5407081
Expiration Date: 10/29 .12015
Canine Rabies 1 yr.
Producer: PFIZER
K / / R: Killed Virus
Staff Name/ Mario Tascon DVM
License Number: AZ 4676
# 0909E9606L f 60:66f9L-U-LO

SOUTHSIDE ANIMAL HOSPITAL
DR. YOCHAM & DR. TASCON
6045 S. Central
Phoenix, AZ 85042
' (602) 276-5505
Rabies Certificate
Client ID: 9260
Client Name: Eye Dog Foundation ' Patient
Address: P.O. Box 519 —Species: CANINE
Breed: GERMAN SHEPHERD
Claremont, CA 91711-0519 Sex: Male
Color: SABLE
Phone: Markings:
Birthday: 07/04/2014
Weight: 36.00 pounds on 10/29/2014
Microchip ID: 038-523-373
Tag Number: 0
Vaccination Date: 10/29/2014
Lot Number: S407981
Canine Rabies 1 yr. expiration Date: 1012912015
Producer: PFIZER
K / MLV / ft Killed Virus
Staff Nate: Mario Tascon DVM
License Number: AZ 4676
6 I L # 0909t696061

SOUTHSI DE ANIMAL HOSPITAL
DR. YOCHAM & DR. TASCON
8045 S. Central
Phoenix, AZ 85042
(602) 278-5505
Rabies Certificate
Client ID: 9260 Patient ID: 9260-705
Client Name: Eye Dog Foundation Patient Name: CHAMP
Address: P.O. Sox 519 CANINE
Breed: GERMAN SHEPHERD
Claremont, CA 91711-0519 Sex; Male
Color SABLE
Phone: Markings:
Birthday: 07/04/2014
Weight: 32,00. pounds on 10/29/2014
Microchip ID; 038-549-769
Tag Number: 0 Vaccination Date: 10/29/2014
Lot Number: S407981 Expiration Date: 1012912015
Canine Rabies 1 yr.
Producer: PFIZER
K / MLV / R: Killed Virus
Staff Nanie: Mario Tascon DVM
License Number: AZ 4676
# 0909Z9606t ! 00:Wgt-U-LO

SOUTHSIDE ANIMAL HOSPITAL
DR. YOCHAM & DR, TASCON
6045 8, Central
Phoenix, AZ 85042
(602) 276-5505
Rabies Certificate
Client ID: 0260 Pgpotill 9260-704
ClientName Eye Dog Foundation Patient _ . Narne: COOPER
Address: RD. Box 519 8Pecles: CANINE
Breed: GERMAN SHEPHERD
Claremont, CA 91711-0519 Sex: Male
Color: BLK & TAN
Phone: Markings:
Birthday: 07/04/2014
Weight: 36.00 pounds on 10/29/2014
Microchip10: 038-552-620
Tag Number: 0 Vaccination Date: 10/29/2014
Lot Number: 5407981
Canine Rabies 1 yr. Expiration Date: I 0/20/201 5
Producer: PFIZER
K R: Killed Virus
Staff Narne: Mario Tascon DVM
License Number: AZ 4676
6 IC # OS0917696061 00W91-N-LO

RABIES VACCINATION CERTIFICATE
..I—
• OWINInt's INFORMATIONt
----
KENNELS EYE DOG FOUNDA P0310051 (602) 2760061 AZ OFF!
AET NAME ....--,—,-- flRET MAL 1, MON lo TEMMONTINUMBEE EAT:
8252 S 15TH AVE PHOENIX AZ ' ' 86041
• ARREET AD on.Rr;.g APT WY EIT TE Z' ODE
ANIMAL INFORMATION
DOG SPAYED 8116/2013 GERM SHEPHERD MIX .
ANIMA FF D . Au& EWE OF BIRTH pa PRIMARY BREED BECONDARYEa m
_.,
A3494204 BLACK TAN -
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MINAL NAmE HICROOkKE EMBER .-1 GOLOR
• VACCINATION IIVORmATIoN
....---/
RABDOMUN 36 Months 1/22/2015 1/22/2018 1/22/16
1,------ vAncluff Pummel vAcc. LENE.H 1 DATE VAgclHATED VACC/NATEkt iixo:REs EFUNTOATE
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KILLED /4de-d.S'-7.-4? " • a --;'13/r2/1
Maricopa County
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2500 S 27th Avalue, Phoenix, AZ 85009
8406516 002) 506-7387
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SOUTHSIDE ANIMAL HOSPITAL
DR, YOC HAM & DR. TASCON
6045 5, Central
Phoenix, AZ 85042
(602) 276-5505
Rabies Certificate
Client ID: 9260 Patient ID: 9260-702
Client Name: Eye Dog Foundation r—PatierEHT-07F-E .
Address: PO. Box 519 Specles CANINE
Breed: GERMAN SHEPHERD
Claremont, CA 91711-0519 Sex: Female
Color: LIGFIT SABLE
Phone: Markings: '
Birthday: 07/04/2014
Weight; 30.00 *Inds on 10/29/2014
Microchip ID: : 016-592-053 -
Tag Number: 0 Vaccination Date: 10/2912014
Lot Number: 6407981 Expiration Date: 10(29/2015
Canine Rabies 1 yr.
Producer: PFIZER
K I MLV / R: Killed Virus
Staff Name; t Mario TascOn DVM
License Number: AZ 4676
0909 tN608 ! 1.6:81!9I-N-L0

SOUTHS1DE ANIMAL HOSPITAL
DR, YOCHAM & DR. TASCON
6045 S. Central
Phoenix, AZ 65042
(602) 276-5508
Rabies Certificate
Client ID: 9260 Patient ID: 9260-
Client Name: Eye Dog Foundation Patient Namz_CRICKE
Address: PO, Box 619 pecies: CANINE
Breed: GERMAN SHEPHERD
Claremont, CA91711-0519 Sox: Female
Color: SABLE
Phone: Markings:
Birthday: 07/04/2014
Weight 30.00 pounds on 10129/2014
Microchip ID: 016-775-042
Tag Number: 0
Vaccination Date: 10129/2014
Lot Number: 5407981 Expiration Date: 10129/2015
Canine Rabies 1 yr.
Producer: PFIZER
/ MLV / Killed Virus
Staff Ni9h7: `•10Tario -rascal, DVM
LicenneiNumber AZ 4676
1€ # 090917696061 L 6 :61,!9 t -N-al

07/24/2015 @2:27 6022768090 RUBY BILDUCIA PAGE 02/03
SOUTH SIDE ANIMAL HOSPITAL
DR. TASCON & DR. EVANS
6045 S. Central
Phoenix, AZ 65042
(602) 276-5505
Rabies Certificate
--9260.11111._
Client ID: 9260 Patient Name: COLBY
Client Name: Eye Dog Foundation Species: CA
Address: P.O. Box 519 Breed: GERMAN SHEPHERD
Sex: Neutered Male
Claremont, CA 91711-0519 Color: BLK & TAN
Phone: Markings:
Birthday: 07/04/2014
Weight: 49.00 pounds on 51612015
Microchip ID: 016822016
Tag Number: 0 Vaccination Date: 10/2912014
Lot Number: 5407981 Expiration Date-. 1012912015
Canine Rabies 1 yr.
Producer: PFIZER
K MLV / R: Killed Virus
Staff Name: Mario Tascon DVM
License Number: AZ 4676

07/24/2015 @2:27 6022768090 RUBY BILDUCIA PAGE 03/03
SOUTHSIDE ANIMAL HOSPITAL
DR, TASCON & DR, EVANS
6045 S. Central
Phoenix, AZ 85042
(602) 276-5505
Rabies Certificate
exp aent-ILI_9260A0— ti .1-
Client ID: 9260 Patient Name: CLAUDE
Client Name: Eye Dog Foundation —Species:
Address: P,O. Box 519 Breed: GERMAN SHEPHERD
Sex: Neutered Male
Claremont, CA 91711-0519 Color BLK & TAN
Phone: Markings:
Birthday: 07/0412014
Weight: 66.00 pounds on 5/13/2015
Microchip ID: 016-797-870
Tag Number 0 Vaccination Date: 10/29/2014
Lot Number: 8407981 Expiration Date: 1012912015
Canine Rabies 1 yr.
Producer: PFIZER
K / MLV I R: Killed Virus
if Name: Mario Tascon DVM
License Number: AZ 4676