SHANTE AFGHANS.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 #
Name: Al. t7j_ ric)) ylelVVE Kennel Name: ,31,/r( ifVf-,9 Ityl _s
Mailing Address: b 11) K11,41AlLee Lu Kennel Location: b R a- U Xce re/y1 L to e
City c),(-) (\‘1 A AZ.-- ZIP 6f:9 County Supervisorial District Li
Kennel Phone: 6.-_,25 93 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. 006 1A/Ve 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. 141 IANe certify that INVe have dogs and that the kennel meets the definition in statute.
3. _MO INVe certify that IANe 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. 12/0 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. ilia I /We certify that I/We are submitting a valid copy of the rabies vaccination certificate for each
dog with this application.
6. 71,4_ I/We understand that a dog remaining within the kennel is not required to be licensed individually under
A.R.S. § 11-1008. I/we also understand that a dog leaving the controlled kennel conditions shall be licensed
under A.R.S. § 11-1008 except if the dog is only being transported to another kennel which has a permit issued
under this section.
7. Aterl 1/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. 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..
9. 7I*'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.
//We certify that all of the information 11We have provided is true and accurate under penalty of law.
Applicant Signature 774,44) Date: / /41
C7
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 of2

Maricopa County
Animal Care & Control bog3
2500 South 271h Avenue
Phoenix, AZ 85009
Phone: (602) 506-7387
pets.maricopagov
KENNEL PERMIT PREMISE INSPECTION
APPLICANT fnoq; ‘ t1/4.(j (-\_)0 ry\)()0•9c---
STREET ADDRESS 10ati (A/ V:cotAA1.4/,, Lr-A
CITY, STATE, ZIP poc*ct 3&-3-
PHONE ALTERNATE PHONE
COUNTY DISTRICT ki KENNEL LICENSE # 03 NUMBER OF DOGS
I. 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 Peunit
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 No
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 Agent 11--g-- Date q\-'

Maricopa County Animal Care and Control
2500 S. 27th Avenue
Phoenix, AZ 85009-6797
(602) 506-7387
htto://pets.maricopa.gov
Receipt Number: R14 -167286 Receipt Date: 08125/2014
Person ID: P1224832
Phone: 623 4129739
SHANTE AFGHANS KENNELS 8/25/2014 2:43:52PM
6824 W KAREN LEE LN
PEORIA, AZ 85382
Item: Animal ID: Reference No: Price: Each: Amount:
KEN PERMIT A7777777 K15-000023 $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 911411999, SPAYED, UNKNOWN/MIX, TRICOLOR DOG
License Information:
Tag Number: License Expires: Animai# Vacc Date: Vacc Expires:
Please retain this receipt with your pet's records
shawcrof EBUSOFF

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CERTIFICATE OF VACCINATION
Date of Vaccination: 04-09-14 Certificate No. 0
Next Vaccination on: 04-08-17 Previous Vaccination:
VETERINARY CLINIC OWNER OF ANIMAL
Sunburst Animal Hospital Marilyn Domhoff
5032 W. Thunderbird Road 6824 W. Karen Lee Ln.
Glendale, AZ 85306 Peoria, AZ 85382
602-938-1860 (623) 412-9739
This is to certify...
THAT I HAVE VACCINATED THE ANIMAL DESCRIBED BELOW AGAINST RABIES.
Patient information...
PATIENT: Fancy TAG NO:
SPECIES: Canine BREED: Afghan Hound
SEX: Female AGE: 7 years
WEIGHT: 0.00 lbs COLOR: BLU
MICROCHIP:
MFG BY: PFI, SERIAL: 63057980, EXPIRES: 12/23/14, ADMIN: SQ
Signed:
Vanessa Rucker, M License: 6257
Other Vaccinations...
Vaccinated By Vaccination Next due
04-09-14 VRR Rabies Vaccination & Exam (none)

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