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Maricopa County Animal Care And Control 2600 South 27th Avenue 12.3 315 zb Phoenix, AZ 86009 (602) 506-7387 Tele. (602) 606-2739 Fax KENNEL PERMIT APPLICATION 0 New Er/Renewal Permit # Kt Name: l',/,:le ,r- 4/4/f 4) Kennel Name: SeTt-ei tewt Mailing Adiess: ?.Z-2 / ig..):e4,1 4,--14, /2-2-e. Kennel Location: ,3;?-7,1 144-1- a a City ie ZIP County Supervisorial District 4 Home Phone: Kennel Phone: 66;z-sr -.57,yip Please complete and sign is-appli ation and return it to the above address with payment in the amount of three hundred twenty eight dolla ($328.0 ) with'n ten (10 days (oif 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 §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 Marlowe 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. A/I I/VVe assume complete responsibility for the kennel at the premises for which Ilwe are making appli ation 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). 111Ne certify that I/We hay dogs and that the kennel meets the definition in statute. INVe certify that INVe have not been convicted of a violation of A.R.S. §§ 13-2910 (cruelty to animals) or -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. 4,, 4/4 111Ne certify that all dogs over the age of three (3) months that are kept, harbored or maintained on the pre ises 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. 6. I /We certify that I/We are submitting a valid copy of the rabies vaccination certificate for each do with this application. 6. 441114 INVe understand that a dog remaining within the kennel is not required to be licensed individually under A.R. § 11-1008. l/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. 7.11/1/ l/We understand that a person who fails to obtain a kennel permit under A.R.S.§11-1009 is subject to a peA, Ity of twenty-five dollars in addition to the annual fee. 8. 41117 , I/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.. The undersigned understand that that the kennel permit does not authorize the operation of any type siness and is solely used for the purpose of licensing multiple dogs. IANe certify that all of the information 1/We have provided is true and accurate under penalty of law. Applicant Signature (gill /e/244_- Date: ZZ-) ) 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 Az, 'Drivers i:cenae yeQr 91114' BOS Approval Date Term of Permit 2 of 2 Maricopa County Animal Care and Control 2500 S. 27th Avenue Phoenix, AZ 85009-6797 (602) 506-7387 http://pets.maricopa.gov Receipt Number: R15-167211 Receipt Date: 0711812015 Person ID: P0999290 Phone: 602 8415740 MY SONG PEKINGESE PARK KENNELS 7/18/2015 3:26:58PM 3221 W ALICE AVE PHOENIX, AZ 85051 Item: Anima/ ID: Reference No: Price: Each: Amount: KEN PERMIT A7777777 $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 9/1411999, SPAYED, UNKNOWN/MIX, TRICOLOR DOG shawcrof EBUSOFF 2630 W. Rio Salado Parkway ATTACHMENT D Maricop a County Mesa, Arizoma 85201 Office:602-506-6274 Emaibtrummel@mail,maricopa.gov Animal Care & Control Mobile: Fax:602-372-1692 602-526-1739 KENNEL LICENSE INSPECTION APPLICANT YO IQ() c M a 1+1 h STREET ADDRESS 3c9c9 W Alice ilvc CITY P ho en 64 STATE Az_ zip a50,3 1 -HOME PHONE_ BUSINESS PRONE é L f/1 - 7'-/O KENNEL LICENSE # -033 NUMBER OF DOGS 6 I. Are all dogs over the age of three months properly vaccinated for rabies and in possession of a valid rabies vaccination certificate? (Note: "Properly vaccinated" means, by a licensed veterinarian or Maricopa County Animal Care & Control Services.) Yes 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 NI Ilk , DAYS GIVEN BEFORE REINSPECTION. (Note: There will be $49 re-inspect fee payable to the nspector by check upon each return visit.) Pad eg* iO3 6 (.4 3z21( Deputy Enforcement Agent Date 7//7//cc Page 7 of 14 North Central Animal Hospital, RC. RABIES VACCINATION CERTIFICATE OWNER'S INFORMATION ANIMAL INFORMATION Client ID: 4737 Patient ID: 6466 Client Name; My Song Pekingese Park Patient Name: Autumn 3221 W Alice Ave Species: Canine Phoenix, AZ 85051 Breed: Pekingese Sex: Female Color. Red Phone: Birthday: 10/14/2013 Weight: 13.4 pounds VACCINATION INFORMATION Vaccine Producer: Merial Vaccine Type: Killed Virus Vaccine Lot #: 18261 Vaccine Length: 3 year(s) Date Vaccinated: 4/12/2015 Print Date: 4112/2015 Vaccine Vial Expires: 6/15/2016 North Central Animal Hospital, PC 20W Dunlap Ave Phoenix, Arizona 85021 (602) 395-9773 tura: Ivy Thomas Veterinarian's License Number 76 Page 9 of 14 North Central Animal Hospital, RC. RABIES VACCINATION CERTIFICATE OWNER'S INFORMATION . ANIMAL INFORMATION Client ID: 4737 Patient ID: 5598 Client Name: My Song Pekingese Park Patient Name: Billy Jean 3221 W Alice Ave Species: Canine_ Phoenix, AZ 85051 Breed: Pekingese Sex: Female Color: Black Phone: Birthday: 6/1/2013 Weight: 10.9 pounds. VACCINATION INFORMATION Vaccine Producer: Medal Vaccine Type: Killed Virus Vaccine Lot #: 18242 Vaccine Length: 1 year(s) Date Vaccinated: 1/30/2015 Print Date: 113012015' Vaccine Vial Expires: 3/11/2016 North Central Animal Hospital, PC 20 W Dunlap Ave Phoenix, Arizona 85021 ' (602) 395-9773 Veterinarian's Signature: Felicitas Tantiyatyanon Veterinarian's License Number 76 Page 11 of 14 North Central Animal Hospital, P.C. RABIES VACCINATION CERTIFICATE OWNER'S INFORMATION ANIMAL INFORMATION Client ID: 4737 Patient ID: 5592 Client Name: Yolanda Martin Patient Name: Eve 3221 W Alice Ave Species: Canine Phoenix, AZ 85051 Breed: Pekingese Sex: Female Phone: (002) 841-6740 Color: Black/Gold Birthday: 6/29/2009 Weight: 12.5 pounds VACCINATION INFORMATION Vaccine Producer: Merial Vaccine Type: Killed Virus Vaccine Lot #: 18203A Vaccine Length: 3 year(s) Date Vaccine 12/1/2013 ' Print Date: 12/112013 Vaccine V' Expires: 1/25/2015 North Central Animal Hospital, PC 20 W Dunlap Ave Phoenix, Arizona 85021 (602) 395-9773 ure: Iv arian's License Number 76 Page 14 of 14 North Central Animal Hospital, P.C. RABIES VACCINATION CERTIFICATE OWNER'S INFORMATION ANIMAL INFORMATION Client ID: 4737 Patient ID: 7311 Client Name: Yolanda Martin Patient Name: Ruby • 3221 W Alice Ave Species: Canine Phoenix, AZ 85051 Breed: Pekingese Sex: Female Color: Red Fawn Phone: (602) 841-5740 Birthday: 6/3/2014 Weight: 5.4 pounds VACCINATION INFORMATION Vaccine Producer: Merial Vaccine Type: Killed Virus Vaccine Lot #: 18214A Vaccine Length: 1 year(s) Date Vaccinated: 9/29/2014 Print Date: 9/29/2014 Vaccine Vial Expires: 4/24/2015 North Central Animal Hospital, PC 20 W Dunlap Ave Phoenix, Arizona 85021 7 (602) 395-9773 ete/ n ll rian's natur(e: Hillary Frank Veterinarian's License Number 76 Page 10 of 14 ,North Central Animal Hospital, P.C. RABIES VACCINATION CERTIFICATE OWNER'S INFORMATION ANIMAL INFORMATION Client ID: 4737 Patient ID: 7875 Client Name: My Song Pekingese Park Patient Name: Sunday 3221 W Alice Ave Species: Canine - Phoenix, AZ 85051 Breed: Pekingese Sex: Female Color: - White/Black Phone: Birthday: 6/7/2013 ,Weight: 13.8 pounds VACCINATION INFORMATION Vaccine Producer Menai Vaccine Type: Killed Virus Vaccine Lot #: 18242 Vaccine Length: 3 year(s) Date Vaccinated: 1/30/2015 Print Date: 1/30/2015 Vaccine Vial Expires: 3/11/2016 North Central Animal Hospital, PC 20 W Dunlap Ave Phoenix, Arizona 85021 (602) 395-9773 Veterinarian's Signature: Felicitas Tantiyatyanon Veterinarian's License Number 76 Page 12 of 14 North Central Animal Hospital, P.C. RABIES VACCINATION CERTIFICATE OWNER'S INFORMATION ANIMAL INFORMATION Client ID: 4737 Patient ID: 6822 Client Name: My Song Pekingese Park Patient Name: Diana 3221 W Alice Ave Species: Canine Phoenix, AZ 85051 Breed: Pekingese Sex: Female Color: Tr-Color Phone: Birthday: 3/20/2014 Weight: 8.9 pounds VACCINATION INFORMATION Vaccine Producer: Medal Vaccine Type: Killed Virus Vaccine Lot #: 18255 Vaccine Length: 3 year(s) Date Vaccinated: 6/28/2015 Print Date: 6/28/2015 Vaccine Vial Expires: 7/23/2016 North Central Animal Hospital, PC 20 W Dunlap Ave Phoenix, Arizona 85021 (602) 395-9773 uro: Ivy Thomas Veterinarian's License Number 76