Extracted text (via pymupdf_layout)
22624 characters
Maricopa County Animal Care And Control 2500 South 27th Avenue Phoenix, AZ 85009 (602) 506-7387 Tele. (602) 506-2739 Fax KENNEL PERMIT APPLICATION LI New Renewal Permit # I OL(, Name: la PS Lt M 5 0 Y\ Kennel Name: LAD I S 0‘,/--I Q V) lit Mailing Address: 3O9 Kennel Location:0 ic r "' city? -hn e A 7 ZIP gccOg 3 County Supervisorial District 1-1 , Kennel Phone: Ia0g- 0 -- (.3 3 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. Ye5 I/We 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. Ye3 INVe certify that I/We have aq dogs and that the kennel meets the definition in statute. 3. Ye..S 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. Yr ,5 I/We 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 Maricopa County Animal Care & Control 2500 South 27th Avenue Phoenix, AZ 85009 Phone: (602) 506-7387 pets.maricopa.gov KENNEL PERMIT PREMISE INSPECTION — APPLICANT QS •) STREET ADDRESS )o (9e; it/. 3O Ln CITY, STATE, ZIP \ hue t A4 s-o PHONE ALTERNATE PHONE COUNTY DISTRICT KENNEL LICENSE # NI NUMBER OF DOGS (--) 1. Are all dogs over the age of three months properly vaccinated for rabies and in possession of a valid rabies vaccination certificate? Yes No 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 DAYS GIVEN BEFORE REINSPECTION. (Note: There will be $49 re-inspect fee payable to the Inspector by check upon each return visit.) Deputy Enforcement Agerft Maricopa County Animal Care and Control 2500 S. 27th Avenue Phoenix, AZ 85009-6797 (602) 506-7387 http://pets.maricoba.00v Receipt Number: R14-174975 Receipt Date: 0910312014 Person ID: P1205200 Phone: 623 4348338 WILSON KENNEL 9/3/2014 3:28:35PM 28022 N 30TH LN PHOENIX, AZ 85083 Item: Animal ID: Reference No: Price: Each: Amount: KEN PERMIT A1777555 K15-000042 $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: A1777555 DUSTY RAE - BORN 11/10/2003, FEMALE, CHIHUAHUA SH, BLACK AND BROWN DOG License Information: Tag Number: License Expires: Animal# Vacc Date: Vacc Expires: Please retain this receipt with your pers records reyesa EBUSOFF RABIES VACCINATION CERTIFICATE Tag fee $: ADAPTED NASPHV FORM 51 Tag #: Owner's Name & Address PRINT - use ball point pen or iype Cert. Serial #: ,„.. PFIITT LAST F 1 RtSybit( MI TWE (6.- /1/1L- 5 1/(/ —;., NT 4,./f ge ..,,,,. C ,.„ rS:7TE ZIP &Cgs3-' ZW"L"-- ---. .....".--- SPECIES: SEX: . t ,,„AGE: SIZE: PREDOMINANT BREED: COLORS: Dog ,›C Male K 3 Mo. to 12 Mo. X Under 20 lbs. tKe' Cat El Female El 12 Mo. or older Li 20 - 50 Ibs CI Other 0 Altered lil Over 50 lbs. D NAME: (Specify) 1614" DATE VACCINATED: PRODUCER: Veterinarian's # i? I ti- ir-TID License No. Month Day Year (First 3 Letters) Veterinarian's 1 yr. Lic.Nacc.( Signature ol. /e, d'17 ) VAgNATITTIR/E;„ 3 r LicNacc , Y . • ' /..2/3-35)A Month Day Year Vacc. Serial (Lot go. VAC0410001 RABIES VACCINATION CERTIFICATE Tag fee $' ADAPTED NASPHV FORM 51 Tag II: Owner's Narrte t 8, Address PRINT - use ball point pen or type Cart. Serial #: PRINT LAST , FIRST , Mi TEt_EPI-SONE ,2._ W/LSa4/ Q/ H rze — 5O 3g NO. STRUT i , CITY ft.....„)c„„. STATE/ 83-083 _.Zt ....2Z-• /‘/' d ''-/ ,K'i i SPECIES: SEX: AGE: SIZE: PREDOMINANTS EEC): COLL, Dog ,K Male la 3 Mo. to 12 Mo. D Under 20 lbs. r" /4 Cat Li Female El 12 Mo. or older 'X 20 - 50 lbs D Other Efi Altered Z. Over 50 lbs. f 7 NAME: (Specify) T DATE VACCINATED: PRODUCER: # Veterinarian's c7 Pi- OEM License No. Month Day Year (First 8 Letters) Veterinarian's q 1 yr. Lic.Nacc. CI Signature ...1. VACCINATI EXPIRES: I 7 3 yr. Lie N cc...kr Address 6' PrIF ACe4/..-5e • • Month Day Year isfro r Vacc. Serial (Lot) No --) VAC0410001 RABIES VACCINATION CERTIFICATE Tag fee $: ADAPTED NASPHV FORM 51 Tag #: Owner's Name & Address PRINT - use ball point pen or type Cert. Serial #: PRINT L.4$1-4 . FIRST MI TELERHON(6:2t' 1411 N syrirETA/ 3 ,.< CITY/91 STAN ZIP ) C.) 1-.4rl- 0,i'VX /7 SPECIES: SEX: AGE: SIZE: PREDOMINANT BREED: COLORS: x- Dog Male 0 3 Mo. to 12 Mo. E Under 20 lbs. Air Cat CI Female ›? 12 Mo. or older 7t. 20 - 50 lbs Li W Other l: Altered El Over 50 lbs. __ NAME: . (r-vi (Specify) f? DATE VACCINATED: PRODUCER: Veterinarian's # 1 e License No. - Month lay (First 3 Letters) Veterinarian's ' 1 yr. Lio.Nacc. C Signatur 2 VACCINATION (...., ;, P , IRIS 4 AISPAIS:MV 3 yr. Lic.Nacc Address /215-3P _ Month Day Year j; of air Vacc. Serial (Lot) No. VAC041000-1 RABIES VACCINATION CERTIFICATE Tag fee $: ADAPTED NASPHV FORM 51 Tag ft: PRINT - use ball point pen or type Cert. Serial #: Owner's Name & Address PRIV 56w FIRST , Aa 6.41 TELEPHON". ‘,/ / i / 47.745-- 3 5 y 0 obmEE AT j„, 30 L.: t, v , C/)( ieTTE ZIPf505 SPECIES: SEX: AGE: SIZE:" PREDOMINANT BREED: COLORS:Ar ov- Dog X Male 0 3 Mo. to 12 Mo. D Under 20 lbs. IS Cat 0 Female 12 Mo. or older S 20 - 50 lbs E Other 0 Altered ,K Over 50 lbs. L NAME.. (Specify) le /&6:1/ DATE VACCINATED: PRODUCER: _________ veterirtarkes# 12 50 Of 1-7 II/ fT7L License No. Month Day Year (First 3 Letters) Veterinarian's 1 yr. Lic.Nacc. 7; Signature .4•A' 'e,f/& VACCINATION EXPIRES: 11.? 3 yr. c.Nacc ...--. Address IZO 5giA onth Day *7e- / Vac. Serial (Lot) No. VAC0410001 RABIES VACCINATION CERTIFICATE Tag fee $: ADAPTED NASPHV FORM51 Tag it: Owner's Name &Address PRiNT - use ball point pen or type Cert. Serial if: PRINT LAST FIRST MI TELEPHON ').. 1V/ L4/ fi/e4/ NO. STREET lri STAT ZlP '--7 /efrt SPECIES: btx: AGE: SIZE: PREDOMINANT BREED: COLORS: Dog X Male 3 Mo. to 12 Mo. G Under 20 lbs. f Fia,4 1/4t Cat E Female 0 12 Mo. or older X 20 - 59 lbs 7 Other El Altered lil Over 50 lbs. 1-2, NAME: (Specify) 1.--) I DATE VACCINATED: PRODUCER7 Veterinarian 's if 4g/ )j /9 NM License o. Month Day 'fear (First 3 Letters) Veterinarian's 1 yr. Lic./Vace. D Signature .'--t- a.- -. _ ,,..- ...,_ 141/ VACCINATION PI' EXPIRES: / ZAPF 3 yr. Lie.Nacor Address A* /23:4775/ Month Day Y r - c.--- t- _ . - derillr _I., Vane, Serial (Lot) No. VAC0410901 RABIES VACCINATION CERTIFICATE Tag fee $: ADAPTED NASPHV FORM 51 Tag ft: Owner's Name &Address PRINT - use ball point pan or typo Cert. Serial #: PR NWIL5.04/ FIRy/fr/ Ml TELEPHON e--)- 5 6 ,f,--r 4,/, 3c, A cir , S TE , 0 SPECIES: SEX: AGE: SIZE: / PREDOMINANT BREED: COLORS: Dog X Male I: 3 Mo. to 12 Mo. Under 20 lbs. Cat n Female X 12 Mo. or older 0 29 - 50 lbs 0 Other 0 Altered C Over 50 tbs. Fl NAME: (Specify) Mr 11,TED: PRODUCER: Veterinarians if j_.> __ 4-- _____ License No. ii- Month Day Year (First 3 Letters) Veterinarian's _..„ , — 1 yr.13c.A.laccX Signatur- AO" .6- OW VACCINATION EXPIRES: V ) 4) / , 3 yr. Lic./Vacc, 0 , Address a ..,_.•': I/ 6 16111U1 (.... i i 2/53 dr Month Day Year Vacc. Serial (Lot) No. VAO0410001 RABIES VACCINATION CERTIFICATE Tag fee $: ADAPTED NASPHV FORM 51 Tag #: Owner's Name & Address PRINT - use ball point pen or type Cert. Serial #: PRIVITL.5ate FIRS/ , , MI TELEPHONE C ffroz5F? NO STREET „ i go ,,, z CITr 2 , STI, ZIP 231,42 A , , _g.,yz . r"--x SPECIES: SEX: AGE: SIZE: PREt:01,1iiN NT REED: . COS_ORS) /ad__ Dog .N Male 0 3 Mo. to 12 Mo, 17 Under 20 lbs. 7•- W Cat 0 Female JK 12 Mo. or older •De 20 - 50 lbs -1 Other D Altered K' Over 50 lbs. 0 NAIV71/// , 74 / (Specify) • /A/ /2...e.5-0, DATE VACCINATED: PRODUCER: n Veterinarian's 4 License N . F - 1 / f Month Day Year (First 3 Letters) Veterinarian's 1 yr. LIc.Nacc. 0 Signature ,. x: j...:7....e.,9„,..,.....e t, 7ilp VACCINATION EXPIRgS: F 0' 1 3 yr. Lic,NaccX Address II• • . le/ ‘ Z. C 4V-6-38Y• 3 ..-• — Month Day Year _ Vacc. Serial (Lot) No. VAC0410001 RABIES VACCINATION CERTIFICATE Tag fee $: ADAPTED NASPHV FORM 51 Tag #: PRINT - use bell point pen or type Cert. Serial #: Owner's Name & Address MI TELEPHONE FIR ST 920 () CITY fikx STAT I . ZIP • • (-, •^. NO. STREET n .z 6Zi5-7 6 02 2 Ai/ 50 X4A. '...- -2. AGE: SIZE: PREDOMINANT BRED: COLORS: SPECIES: SEX: Dog Di<- Male 0 3 Mo. to 12 Mo. r Under 20 lbs. Cat E] Female IX 12 Mo. or older •TX 20 -50 lbs El Other 0 Altered 0 Over 50 lbs. 0 NAME: (Specify) T-- 2-37%-n DATE VACCINATED: PRODUCER.. Veterinarian's if / License lo, i q i V .F TP Month Day Year (First 3 Letters) Veterinarian's / ,,y- . /V 1 yr. Lic.Nacc. El Signature VACCINATION EXPIRES: H AWN% ,01 I C 7 3 yr. Lic.Nacc.- Address 4., 12 15 1- 747Z Month 1Day Year Vacc. Serial (Lot) No. ' q I... VAC0410001 RABIES VACCINATION CERTIFICATE Tag fee $: ADAPTED NASPHV FORM 51 Tag 4: Owner's Name & Address PRINT - use bell point pen or type Cert. Serial #: PRINT LAST Fill- A d MI TELEPHON i ',Sal/ gcoare NO ST EET A ii CI STATE. ZIP ..---7 25CZ 71/ i , L k , 1-..2 ..... SPECIES: SEX: AGE: SIZE: PFIEDOMINA T Li REED: COLORS: Dog X Male 0 3 Mo. to 12 Mo, 0 Under 20 lbs. p< 7/- IV Cat 0 Female X 12 Mo. or older g 20 - 50 lbs E Other 0 Altered 0 Over 50 lbs. 7 NAME: (Specify) 14/ 1u141/J2 - DATE VACCINATED: PRODUCER: Veterinarian's # / 6-0 License No. Month Day Ye r (First 3 Letters) Veterinarian,W. 1 yr. Lic.Nacc. 0 Signature VACCINATIO EXPIRES: i i 7 3 yr. Lic.Nacck- Address ... ..-lidliffr S' Month Day dar <7.-,14r.iir Vacc. Serial tLat) No. VAC0410001 RABIES VACCINATION CERTIFICATE Tag fee $: ADAPTED NASPHV FORM 51 Tag #: PRINT - use bell point pen or type Cert. Serial #* Owner's Name & Address PRINT /2.5ae„, :llisi)-,m MI TELEPHONE i!7).*) r.-26 `-'50. ,F NO, STREET Ai /iv CITY/9 STATE ZIP g-560:5 2 3o7 2 i ._ .(-1 _ SPECIES: SEX: „AGE: SIZE: PREDOMINANT BREED: COLORS:0 J , Dog IX Male Ok- 3 Mo. to 12 Mo. 0 Under 20 lbs. Cat 0 Female 0 12 Mo. or older 20 - 50 ibs 0 Other 0 Altered 0 Over 50 lbs. 0 NAME: (Specify) DArCINATED: PRODUCER: Veterinarian's # / :2 e.4--e 11___ .....– License No. i 7 / (1- t . ' Month Day Year (First 3 Letters) Veterinarian's V 1 yr. Lic.Nacc. Signatur VACCINATI ON EXPIRES: . (.-7 17 3 yr. Lic.Nacc.r, i ,........, . Address .3..• — ---94- 1 /7/ C 1- K / --2&;* Month I Day Year V a c c . Serial (Lot) No. / . VAC0410001 RABIES VACCINATION CERTIFICATE Tag fee S . ADAPTED NASP1-11/ FORM 51 Tag #. 044sIOV's Name & Address Print - use bell point pen or type Cert. Serial IV_ PRINT F4T M.I. I rFi PPi-nr,IF . i !SOL() J 1 69 NO , STREET C Ilivr_ S li 172_ ZIP -2 0 —) SPECR_ SEX: AGE: SIZE: PREDOMINANT BREED: COLORS: Dog Male 0 3 Mo. to 12 Mo. Under 20 lbs. Cat LI Female riii 12 Mo. or older IM" 20 - 50 lbs. 111 COI' epa& 1‘,04-1- Other n Altered [11 Over 50 lbs, NAME: (Specify) 19-0I DATE VCCINAVD: PRODUCER: 7 / 267 14,2 Veterinarian's 4 License I 2- No. 5-0 Month Day Year F D (First 3 Letters) .... 1 yr. Lio.Nacc. III Volerinaria ' VACCINATION EXPIRES. . 3 yr. Lic./Vacc. 4 SIgnatu 7 2C74. 21 5- 3.5-7/ Address Month Day Year Vacc. Serial (Lot) No. S 6t) r .5 2 FDPC01930 RABIES VACCINATION CERTIFICATE Tag fee $. ADAPTED NASPHV FORM 51 Tag Sr Owner's Name & Address Print - use ball point pen or type Cert. Serial it . POINT LA F ,.W, , TN Kt. T11 PPI4CI1F Vlif 5 0 V/ e j i Ill 1 • - - .• N. , STREET A ST 1: ZIP e5-0. e 3 ail Va)._ 3/0 1, 04 SPECIES: SEX: AGE: SIZE: DOMINANT BREED: BREED: CO)..OFIS: Dog Male III 3 Mo. to 12 Mo. Under 20 lbs. Cat EI Female 12 Mo. or older 20 - 50 les. D Other El Altered J Over 50 lbs. 111 NAME: (Specify) 6 1 ITS. f DATE Vi6.CCINATEDI PRODUCER: r 1 I 025—V 7 Lze IQ r-- Veterinarian's It License No, Month Day Year (First 3 Letters) 1 yr. Lic.Nacc. 0 Veterinarian's VACCINATION EXPIRES: 3 yr. Lic.Nacc. gial Signature . . LC i 21 53 6-174-- IIIIMAIRM i a Address Month Day Year Vacc. Serial (Lot) No. ._ • WY % 2, .5- FDPC0193C RABIES VACCINATION CERTIFICATE Tag fee S' ADAPTED NASPHV FORM 51 Tag #' Owners Name & Address Print - use bell point pen or type Cert. Serial ft . P NT LAS F IR-47 , , M.I. TELEPHONE -1.500 i / )1'1 nit_ ;r".._ NO. STREEI * - — ZIP s) ,5 --- 02 :3(o to . 08 s IS '.. N . SPECIES: SEX: AGE: SIZE: 'PREDOMINANT BREED: COLORS: Dog iZr Male jjj 3 Mo. to 12 Mo, 0 Under 20 lbs. "idliN c+f-.I. Tq il Cat Female K- 12 Mo. or older V' 20 - 50 lbs. • fl • Other 0 Altered • Over 50 lbs. NAME: (Specify) C k 1 eot DATE VACCINATED: PRODUCER: 1 25-70 / r Veterinarians # : // 2 'ill) License No. Month Day Year First 3 Letters 1 yr. LIC.Nacc. 0 Veterinarian's VACCINATION EXPIRES: 3 yr. LIc.Nacc. igl Signature 7 % /3-- j a 1 5-3 5-7-2/f- A i n (0 Address m • A _. • 0 Month Day Year VC. Sera clot) No. 30 - 1 e 7,- e ..2 s-.. - / FDPC0193C RABIES VACCINATION CERTIFICATE Tag fee S' ADAPTED NASPHV FORM 51 Tag *P- Print , use ball point pen or type Cert. Serial # Owner's Name & Address P INT LIT WT MI TELEPHONE J i 61 - -- i 500 ZIP— ' NO. STREET A , ri j,,) i AA-2 41 .80.2 iv i Ai 1 —0 . 'Tr SPECIL,. SEX: AGE: • SIZE: K-PREDOMINANT BREED: COLORS: Dog Al Male jJ 3 Mo. to 12 Mo. Under 20 lbs. C Mr km914 c,/ Cat D Female PSr.- 12 Mo. or older iSr 20 - 60 lbs. Other • Altered • Over 50 lbs. 0 NAME: (Specify) Sq5sy DATE V k CCINNTED: 1 PRODUCER: t 2 SY) Veterinarian's # 7 /2e11.2 F 1-0 License No. Month Day Year (First 3 Letters .. .„ 1 yr. Lic.Nacc. Veteripa VACCINATION EXPIRES: - 3 yr. LIc.Nacc. 4 SI‘ it6' 7 .2-5<: - it,//- / 2153 57 Address 0 Month Day Year Vacc. Serial (Lot) No. .S-(d-felq e4.2 e 525 .2 / FDPC0193C RABIES VACCINATION CERTIFICATE Tag fee S. ADAPTED NASPHV FORM 51 Tag it• Owner's Name & Address Print -use ball point pen or type Cert. Serial #. P INT LAS/ .F.JiaST M.I. TELEPHONE _ OV? 1,4 I , - 1 8 ) dor ,S .-1 ) i/Vi s:77._E, ZIP 6)5_0 cF3 Aft 30 Lv. SPECU, SEX: .._.4. AGE: SIZE: PREDOMINANT BREED: COLORS: Dog ..& Male N 3 Mo. to 12 Mo. Under 20 ibs. 041 Cat Female 12 Mo. or older iiir 20 - 50 lbs. C1/1 60( irkr Other Li Altered D Over 50 lbs. NAME: (Specify) S 11/fOk t e DATE yACCINAITED: PRODUCER: .5-V 1712.8IQ Veterinarians a i 2 Fr" D License No. Month Day Year (First 3 Letters) 1 yr. Lic.Nacc. --- -- - Veterinariay s" VACCINATION - EXPIRES: 3 yr. Lic.Nacc. Signature -- :/f.' b. 12163 57)9 ° vie ,( Asddcroess 0 OA— 41 I i Month Day Year Vacc. Serial (Lot) No . , . FDPC0193C RABIES VACCINATION CERTIFICATE Tag fee S: ADAPTED NASPHV FORM 51 Tag ll' Print - use ball point pen or type Cert. Serial 4I• Owner's Name & Address TFI PPI-1414I1P -- PRINT LA1T ...F4RST M.I. W t SOO J i 141 STr....i ZIP e STREET ti) 50 3 N.3/0 14r / / •Z 11./ 80 2 SPECIES' EX: AGE: SIZE: ' PREDOMINANT BREED: COLORS: Dog IN Male D 3 Mo. to 12 Mo. Under 20 lbs. BLK liviii\ • CHI Gat Female g 12 Mo. or older X 20 - 50 lbs. • Altered • Over 50 lbs El NAME: Other (Specify) q 543k DATE VACCIN ) TED: PRODUCER: 2. 5--v Veterinarian's # I 1) 1.2e / a r-11--D License No. Month Day Year (First 3 Letters -7/ -- 1 yr. Lic.Nacc. Veterinaria ' VACCINATION EXPIRES:- .-- .., ..1 yr. , LICA „, v aCC. ....- A Signature ../-9: (il 1215"35"7fi Address • Month Day Year Vane. Serial (Lot) No. C ifillf WI 2 4 . -.)(41 - FDPC0193C RABIES VACCINATION CERTIFICATE Tag fee S . ADAPTED NASPHV FORM 51 Tag IP Owner's Name & Address Print • use ball point pen or type Cert. Serial If P INT LA T M.1. TELEPHONE ' - " -- - 1 1 ori ...) i vv? 3 30,• 6 5 0 e 3 Ntd.. 6N _ ST .ATE ZIP im 1 7kr— SPECtkg SEX: AGE: SIZE: K PREDOMINANT BREED' COLORS: Dog A Male 0 3 Mo. to 12 Mo. Under 20 lbs. Cat Female rx--- 12 Mo. or cider 20 - 50 lbs. 0 C I-a WW-1-16yt-1/11 Other U Altered 1111 Over 50 lbs. NAME: (Specify) 1 16C-170r i e7 DATE V4,CCINAT : PRODUCER: Veterinarian's tt I a • 5--'3 t) 12 /12 FTD License No. Month Day Year (First 3 Letters) • __ .4.. 1 yr. Lic.Nacc. jjj Veterinarie - VACCINATION . EXPIRES ... 3 yr. LioNacc. Sigrigt / .} ' ' 1 21 5-3 5.'"?4- Address ial • $ 7 0 V Month Day Year Vacc. Serial (Lot) No. ( .• - diMi 2 47 0C FDPC0193C RABIES VACCINATION CERTIFICATE Tag fee $: ADAPTED NASPHV FORM 51 Tag #: Cert. Serial PRINT - use bell point pen or type I Owner's Name & Address MI hLEPHONE PRM)g 014 FIsT )vv) NO), o EET 30 CITY 8/152, ZIP6)99 e-3 SPECIES, SEX: AGE: SIZE: PREDOMINANT BREED: Dog Male 3 Mo. to 12 Mo. 0 Under 20 lbs. Cat Ei Female 12 Mo. or older 0 20- 50 lbs 0 / I Other Altered 0 Over 50 lbs. E NAME: 4 v b i (Specify) 13q ) 2 qt) DATE VACCINATED: PRODUCER: Veterinarian's # e F1-11) License No. 13 Month Day Year First 3 Letters) Veterinarier. 1 yr. LIc.Nacc. Signature VACeNATIONJ EXPIFia 3 yr. Lic.Nacc. Address 1.2153 6271- Month Day Year Vacc. Serial (Lot) No. 5:252, VAC0410001 RABIES VACCINATION CERTIFICATE Tag fee $: ADAPTED NASPHV FORM 51 Tag #: Owner's Name &Address PRINT - use bell point pen or type Cert. Serial 41: MI TELEPI-InNp PrAgs00 nvo 30 NO 0 :MEET. Cl r3 SPECIES: I SEX: AGE: SIZE: PREDCeIrT BREED: COLO S: Dog )gr' Male Mo. to 12 Mo. 0 Under 20 lbs. re Cat E Female 12 Mo. or older 20 - 50 !Os 0 Other Altered El Over 50 lbs, 0 , NAME: 6r0w119 (Specify) t3 VACCINATED: , I PRODUCER: 1, 2. 5-0 Veterinarian's # DATi- 1 1) ETD License No. Month Day Year (First 3 Letters) Veterinarian's I 1 yr. Lic.Naca 0 Signature VAC INATIlf EXPIT 3 yr. Lic.Nacc. Address 1 263 6/4 Month Day Year Vacc. Serial (Lot} No. VAC0410001 RABIES VACCINATION CERTIFICATE Tag fee $: ADAPTED NASPHV FORM 51 Tag #: PRINT , use ball point pen or type Cert. Serial #: . k Owner's Name & Address I-- MI TPI Fr,Hrudk -% PRINT $1-1 ,,,, 0 FIRgt1 I lAif i ,'.› 75_9673 N510.25.REETN, 30 t , CITY A sirt 1.,- . ),-- SPECIES:z_ SEX: AGE: SIZE: ,k/PREDOMINANT BREED: COLORS: Dog DK , Male 0 3 Mo. to 12 Mo. El Under 20 lbs..41 Cl/ ) C reri vv) Cat D Female INr 12 Mo. or older X20 - 50 lbs El Other 0 Altered (il Over 50 lbs. 0 NAME: (Specify) 0 t4 Cti e-S,...S DAVACCINATED: S) PRODUCER: Vetertnartan's 71-7-7670 f 13 0 License No. Month Day Year (First 3 Letters) Veterinarian's,..---' L. 1 yr. Lic.Nacc. D Si gnature i AiditK . ... I, jr ''' 7/1 VA9INATION EXPIZ: AleattiCM" I 3 yr. Lic.Nacc.)1f Address 0 J 2 ),!--362)1 f gar I Mara Month Day Year Vacc, Serial (Lot) No. .1° 525a VAC0410001 RABIES VACCINATION CERTIFICATE Tag tee $: ADAPTED NASPHV FORM 51 Tag #: Owner's Name & Address PRINT - use ball point pen or type Cert. Serial #: MI TELEPHONE Wtsoii F 17 CITY ST TE m°210)sTIET N. 3G .4/ ), rriA- ZIP 6)5-06'3 SPECI SEX: AGE: SIZE: PREDOMINANT BREED: COLORS: Dog Male 3 Mo. to 12 Mo, Under 20 lbs. XI Cat CI Female 12 Mo. or older 7( 20 - 50 lbs El Cki (14q41121V/I6j 1 Op Other L Altered Over 50 lbs. 7 NAME: A . ecf DATVACCIN/rED: PRODUCER: Veterinarian's # / a 5- 0 1 r‘ 0 / If I I 1-1-1 1 Month Day Year I (First 3 Letters) .4" Veterinarian's 1 yr. Lic.Nacc. E Slanature Day Year 3 yr. Lic.Naco.V. Address ufv '00.• f 2 1 5-3 62 Month 15ct '2 Wm. Serial kLot) No. VAC0410001 llAiiü CEt-1 fit1CATE Tag (Q.,' ADAPTED NASPHV FORM 51 Tag th Owner's Name & Address PRINT- use ball point pen or type Cert. Serial 4: PRINT LI F4STI MI TELEPFIDNE.. „ IA!, 1,i 00 J vo rty. nn „FREETI EA3 ZIP cmf ix tkf,5W3 uz .2, iv.. -ill L-47 i-- il 4 SPECIES: SEX: I. AGE: SIZE: PREDO INAtIT BREED: COLORS: Dog .!Ve Male >4' 3 Mo. to 12 Mo. 0 1 Under 20 lbs. X it X4/4 Ss' C i Cat 71 Ii 1t- •-•1\ _ r..51 V•e. 71 I ' : NAME: Other 0 Altered I Over 50 lbs. ii (Specify) E cf,VIS 0 0 . . . .v.ACA;INAT Veterinarian's # i 5-0 F .r.D License No. Month Day Year (First 3 Letters) VeleThtt . 7 1 yr. LIc.Nacc. El Signatur VAkCINATI1N EXPIRES: 3 yr. Lic.Nacc.;gr Address 11 p••• •I••I111 IIILLA:0 ff 52 VAC0410001 • RABIES VACCINATION CERTIFICATE Tag tee $: MI TELEPHCIP4 F A 3(i.-) L.) STAT .Zifr SPEC/ES: _ -I SEX: - AGE: SIZE: PREDOMI T BREED: Dort Male D 3 Mo. to 12 Mo. El Under 20 lbs. Car El Fenian:, 24 12 Mo, or order 20 - 60 lb* 0 S Ortclow DATE_ VACCINATED: el PRODUCER: # 0 istrtioiterinarlan's 11 License No. # ith Day Year Letters) 14+terinr 1 yr. Lip- Nara:. 0 rratu._ _ VAgNATICT EX 3 yr. Lic,Nacc. ,.. , ttldress Month Day Year (Ott-A Vauc. (Lut) No. 'LES' RABIES VACCINATION CERTIFICATE Tag tee $: _ ADAPTED NASPHV FORM 5 / Tag #: _ Owntlea Name & Addrms Pow - tatt pc. int pen cw type itaert Mt FTEI_EPHON0 CI STE T / 4 AQE: SIZE: PREDOMINANT BREED: nog Male 0 3 Mo. to 12 Mo. Under 20 lb.:2 Chi Li I Female 12 Mo. or older 20 - 60 Has Other U Mewl Over 50 it*. Li NAM (!-IitecifY) tle C%A,TE VACCINATED: PRODUCER: VeterInarian'a LLi License No_ Mr,r,th Day Year (Firit LetteD_,) /144,7 yr: LIc./Vacc. Signature/ _ VACCINARON EXPIRES: yr. Address ñox PX6 Ce- 53_,,6,Z Wirth Day Thar f L21 ▪ aege VIC.C. Serial (Lot) No.