EVANZ 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
0 New Renewal Permit # Olio
Name: M;t. ir‘ Kennel Name: n mete,(
Mailing Address: \ 453 Al A'41'' Or, Kennel Location: 63 5-3 ,41. 3 r
• 411 10
City (1O Y1 ZIP g9Ds-3 County Supervisorial District
Home Phone: Kennel Phone:
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. 7r1 I/VVe 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. J' ti vIANe certify that I/VVe have 1--r 0— dogs and that the kennel meets the definition in statute.
3. 2'We certify that IANe have not been convicted of a violation of A.R.S. §§ 13-2910 (cruelty to animals)
or 13-210.01 (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. 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.
I /We certify that INVe are submitting a valid copy of the rabies vaccination certificate for each
dog ath this application.
6. /etc) INVe understand that a dog remaining within the kennel is not required to be licensed individually under
§ 11-1008. 1/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. AO INVe 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. Au(' I/We understand that a person who knowingly fails to obtain a kennel permit within thirty days after
writteh notification from the county enforcement agent is guilty of a class 2 misdemeanor..
9. I1 The undersigned understand that that the kennel permit does not authorize the operation of any'type
of butiness and is solely used for the purpose of licensing multiple dogs.
I/We certify that all of the information I/We have provided is true and accurate under penalty of!aw.
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 J.
Type of Identification submitted
BOS Approval Date Term of Permit
2 of 2

Maricopa County AN -.)3q3 7
Animal Care & Control
2500 South 27th Avenue
Phoenix, AZ 85009
Phone: (602) 506-7387
pets.maricopa.gov
KENNEL PERMIT PREMISE INSPECTION
APPLICANT fir\a_ tj in QC( (A,
STREET ADDRESS L75---3 Af 3 Or
CITY, STATE, ZIP hoe rt't gc0 ST3
PHONE b7C),) Vt1 3 to, ALTERNATE PHONE
COUNTY DISTRICT L-1 KENNEL LICENSE # NO NUMBER OF DOGS LI
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 fatin.
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 Date

Maricopa County Animal Care and Control
2500 S. 27th Avenue
Phoenix, AZ 85009-6797
(602) 506-7387
htto://pets.maricopaoov
Receipt Number: R14-167275 Receipt Date: 08/25/2014
Person ID: P0999788
Phone: 602 8430219
EVANZ KENNELS 8/2512014 2:34:30PM
16853 N 39TH DR
PHOENIX, AZ 86063
Item: Animal ID: Reference No: Price: Each: Amount:
KEN PERMIT A7777777 K15-000040 $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.maricopagov 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
shawcrof EBUSOFF

08/2512014 14:10 6028632805 THE UPS STORE 565 PAGE 01
Ovi OMER'S COPY RABIES VACCINATION CERTIFICATE- '
NASPHV Form #51 Rabies Tag Number
Owner'a Owner'a Name and Address Print - use bull point pen or type .
PRINT - Lent First Mi. Thlaphona
/
4 -(2 ic,;-•ftiAr o.2.1
No. /6- ,StjelidirM State Zi I
.411", ..1:.....% 11° - I • * ,
Species: Sex! . Age: Size: I . Predominant Breed; Colors:
Dog .Pitv Male 0 3 mo to 12 rno 0 Under 20 lba. NA L.-ktr
75* iIdle
at In Female 12 mo or older .% 20 - 50 lbs. 1=1
Other: El Neutered 0 Actual Age.244.,_ Over 50 ibs, 1:1
(sPac[fyl Actual.2___Ibs Name:
-1000?-kit',OCA
.--..........
DATE VACCINATED: Producer: Vaterinarian'S: # IA
0 E 0.1cense No,1
(Firut 0 tett003) ! ...."..-1-
—44fibL /9
Month Day Year 171 1 yr, LIciVacc. CSIgnature)
AddreBa: 32.5' Eiv7-47
71,3 yr. LIc./Vacc.
VACCINATION EXPIRED: Other
,
/r. /j*/ / 7 ,3)/Q i7/6
Month Day Year Vacc, Serial (lot) no.
OWNE.R'S COPY RABIES VACCINATION CERTIFICATE
NAM1V Porrn 46 I Rabies Tag Number
Owner's Name and Address . Print - use ball point pen or type
PRINT. Last ,i Flrst M.I. Telephone
Val4- t /Th44,1 o).--,b7,3- 0
No. tree City State . ..;'.
r A 355,/0-.., i 0 j _
Speuies: Sex; Age: Size; Predominant Ureed Colors:
Dog Male 1=1 3 mo to 12 me q Under 20 lbs. A 0) /e
Cat 0 Female 12 me or ol a 20- 50 lbs. b _I_____
Other: 0 Neutered D Aotual AgeAyr Over 50 lbs. 1=1
(9notiry) AotuallI___Ibs. Name: —
jEfLe
D ATE VACCINATED: Producer: n Veterinarian's'. # _ALI r7
turronew wo
F, –•1
.
Month Day Year (SIgnaturo)
Dii yr. Lio./Vecc. Is- E
1114,3 yr. Lic./Vaco. Addnsms: 3 15-*1 5.7
VACCINATION EXPIRED:
Other
-/ Al.. II-.2iy)
_o_y_k__M
Month Day Year Vaoo. Serial (lot) no.

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 First , MI Telephone
PeALt.le (Thin kft) &CA 1943 - 0).1 cl
N o. S t re- D City n StatAi Z. 9
, 44..,vo 941— r 1_04. _A _ kt....4
Species: Sex: Age: Size: Predominant Breed: Colors:
Dog RI Male 0 3 mo to 12 mo VI Under 20 lbs. Ni Rpodie
Cat 0 Female 12 12 rno or older El 20 -50 lbs. 0 13113de(Yt
Other: El Neutered El Actual Age5:t_n_ Over 50 lbs. CI
(Specify) Actual 6 lbs Name:
. Air 11024 -Fesoco e
DATE VACCINATED: Producer: Z 0 5 Veterinarian's: # 11M AZ
(License N )
(First 3 fetters) a
e8 I S iq
Month Day Year g 1 yr. Lic./Vacc. (T r nature)
Address:
El 3 yr. LiciVacc.
VACCINATION EXPIRED:
Other
Iq 6 16 4 4-tip --r-..„1„, fyi -i35clit
Month Day Year Vacc. Serial (lot) no.
VETERINARIAN'S COPY RABIES VACCINATION CERTIFICATE
,-----„, NASPHV Form #51 Rabies Tag Number
Owner's Name and Addrk ) Print - use ball point pen or type f ,,,/'
PRINT - Last , Fir), _
M.1. Telephone
v I
No. gtreeti, ,
'I ix . 1 \,__:) , 1 DY- Y Pho.c.r, •• Statel) i
I'',•<
Species: Sex: . Age: Size: Predominant Breed: ( -.,,:...Y.......-.‘-
Dog RI Male jal 3 mo to 12 mo El Under 20 lbd. gr (-) Colors:
Cat 0 Female 0 12 moor olderig 20 -50 lbs. • -1Jr-Ir-e-i k , I I iVe-r
(Specify) Other: El Neutered 0 Actual Age..,t)b. -----2 Over 50 lbs. El
Actual Lc) lbs Name:
DATE VACCINATED:
Producer: ,•.") Veterinarian's: #
(License
-1 7;41 \ 3 (First 3 letters) ..-e--.
Month Day Year .....4 ' /17,-1_,./ 4-4..4:•ti.-"et-:' ',
El 1 yr. Lic./Vacc. (Signature)
3 yr. Lic./Vacc. Address: •
VACCINATION EXPIRED:
Other -*&?51 E : ifj1- 5f
7 ._i ., i,D e--\,-)=-1--1 -i3-1 f
Month idayS'Year Vacc. Seriar(fot) no. . ti.try i-- ) 7-- is' )
,

OWNER'S COPY RABIES VACCINATION CERTIFICATE
NASPHV Form #57 Rabies Tag Number
Owner's Name and Address Print - use ball point pen or type
PRINT -ili, st I . ) First M.I. Telephone
14"Auk ina.ilLy iol — 1F-13- co-1 1.
No. groStr J37 / Or City 1 AL, State
V creo,A9 ti
Species: Sex: Age: Size: t Predominant Breed: Colors:
Dog _.)3r Male)141, 3 mo to 12 mo.i3 O Under 20 lbs11411
Cat 0 Female 0 12 rno or older 20-- 50 lbs. 0 /C—IYAWie 02 r ) ILi
Other: 0 Neutered El Actual Age Over 50 lb . n
(Specrty) Actual lbs Name: ipS
DATE VACCINATED: Producer: 2 0 E. Veterinarian's: # A .L 1 i ty.
(license No.)
.
Iv (First 3 letters) iirro, iieiv.d/
at!
Month , Day Year 0 1 yr. Lic./Vacc. (Signature)
El 3 yr. Lic./Vacc. Address: 32., .5-- r`7' itc sil ST
VACCINATION EXPIRED:
Other
17 43/3 0 V 6'
Month Day Year Vacc. erial (lot) no.
VETERNARLAN'S COPY RABIES VACCINATION CERTIFICATE
,---- NASPHV Form #51 Rabies Tag Number
Owner's Name and Addriki ) . Print - use ball point pen or type l
k.. /
PRINT - Last ,,-) , „ First . '----M.I. Telephone
No. Street City . , , 1 State . _.., ZIp
1(05_ N. ) /• 0-y-yr—n i x E.— 7r-tyczi7-) . _
Species: Sex: Age: Size: Predominant Breed: Colors:
Dog 5.e Male 54 3 mo to 12 mo LI Under 20 lbs. ad 0 4 6 / • i v-cr
e " 'D
Cat 0 Female LI 12 moor older gi pa - 50 lbs. El e.,,f,.Y,_ !
Other: CI Neutered El Actual Age 4..J. Over 50 lbs. 0
(Spec) I Actual lbs. Name:
---- , .
-1--TYVI rei .-i r in
DATE VACCINATED: Producer: i) 4:7. Veterinarian's: # 1 AZ Al
(License No.) •
7 / •?-6-1 i 2..) (Ft irsetters) 3 l
Month Day Year (sior'f .1 // ro I ' ::*1;" i --4' J" ' -
ID 1 yr. LiciVacc.
p 3 yr. Lic./Vacc. Address:
VACCINATION EXPIRED: Other f'--1
7 i1 ft -t Sal.44--1)
eirvt, -c-A —
Month Day Year Vacc. Serial (lot) no. 4
, STh

VETERINARIAN'S COPY RABIES VACCINATION CERTIFICATE
Rabies Tag Number
,----„ NASPHV Form #51 ----,
Owner's Name and Addre4"\ Print - use ball point pen or type
PRINT - Last ---- First \---rv1.1. Telephone
„ ,•-,, , 47.: .13 ;
Ii AT
No. , Street , City ,--..8 State Zip
i.--- '-r
Species: Sex: ...., Age: Size: Predominant Breed: Colors:
Dog pi, Male cg 3 mo to 12 mo 0 Under 20 lbs. IX i 1 1 \I-CY
Cat 0 Female 0 12 mo or older cg 20 - 50 lbs. EI pOi'',,,,d
Other: Ei Neutered CI Actual Age Over 50 lbs. 0
(Specify) Actual (-- .5) lbs 1\1,..- me:
DATE VACCINATED: Producer: M. Vt eerinlian's: # peens f'
----.7 -1---
(First 3 letters) 72 I. .... f'cile,,) 1 •
pigr6t.)
Month Day Year 0 1 yr. Lic./Vacc.
Address:
q yr. 3 Lic./Vacc.
VACCINATION EXPIRED: Other 2 Y..-." \ El. i C-3-11 SF -
. e
Itp z.,-:),95/-61I -s-- )_e„ro OZ.- - Z 5a)-'g i
Month D-gY Year Vacc. Serialot) no. _
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 , First M.I. Telephone
ouil,et4 Mari it 4o tpw-7iLig-_Dan
Noit..07,5_ reet i.\..) ,bcc.4±, Dv, City e„ 1 , 6 State
Species: Sex: Age: • Size: Predominant Breed: Colors:
Dog Ni Male 0 3 mo to 12 mo 0 Under 20 lbs. fE pcnett N
ve
Cat 111 Female Cgi 12 mo or older 21 20 - 50 lbs. 0
Other: 0 Neutered 0 Actual Age 1 yr Over 50 lbs. 0
(Specify) Actual t-ci lbs Name;
1 1
DATE VACCINATED: Producer: 2 0 f....... Veterinarian's: (License # _____IliDAZ._____ No.)
B 15 ILI (Feet ) iettere) / ^— . , i Ai. /
Month Day Year 0 1 yr. Lio./Vacc. (signature}
[g] 3 yr. Lief Vace. Address;
VACCINATION EXPIRED: Other 6:3
6 1 Li -7 D'N5C1---162 —1-e.Yripe_ 192:235D-2 i
Month Day Year Vacc. Serial (lot) no.
,r\i>

VE1ERINAF1IAN'S COPY RABIES VACCINATION CERTIFICATE
Rabies Tag Number
NASPHV Form #51
Owner's Name and Addm ..--"N. 1 Print - use ball point pen or type ,(--. I
PRINT - Last . First M.I. Telephone
i '11-{Ar 1 , Jr._ ....
.0 re z
ar
Species: Sex: Age: Size: Predominant Breed: Colors:
Dog % Male I;;1 3 mo to 12 mo 0 Under 20 lbs. IXI ,,) le 5i}oewe
Cat 0 Female 0 12 rno or older Dit 20 - 50 lbs. EL '
Other: 0 Neutered 0 Actual Age_11'f_ Over 50 lbs. 0
(Specify) ' Actual_62_.lbs. Name:
eL
DATE VACCINATED: Producer: p (Lk Veterinarian's: nsello.) #
1
(First 3 !attars) 7,21 4 /6'n j•-• aii/: v'e: '
,_ --) (sIgnalure)
Month Day Year 0 1 yr. Lic./Vacc. Address:
g 3 yr. Lic./Vacc.
VACCINATION EXPIRED: Other ?,;(;),5 E IS II-c- i-
e: --1-Q. 1 lc --/ ( _.. A7
7 ,n IVP -, 7 r, --a .? I r ern
Month Day Year Vacc. Serial (lot) no.
...... Ahx.
COPY RABIES VACCINATION CERTIFICATE Rabies Tag Number
VETERINARIAN'S NASPHV Form #51 7---,
and Addren Print - use ball point pen or type ( )
Owner's Name -NC. Telephone
PRINT - Last c-) ,• '' ‘------ First i tC) lir- 6 - 6)-je
1 I ils' ''.Y. 1 i LIP State Zi
C ity r,.. v
No. Stre-et .5 t.-. 1-1.7
Size: Predominant Breed: Colors: •
Species: Sex: Age: Under 20 lbs.r1 c) k
Dog V Male El 3 mo to 12 mo 0 ......_.":,' rC,C.,-/-1 11P ---4--": .7\ ''. IL.) —A"— . "" 1...
0 Female pr 12 me or older p 20 - 50 lbs. Li 1-tily- j / C)-1
Cat Actual Age... Over 50 lbs. 0+ r
Other: 0 Neutered 0 1 Actual lbs. Name: .,
(SPecitY) ( 4 1"Pit,lfn 1 k) I 0
Veterinarian's: #
DATE VACCINATED: Producer: I,)
(First $ letters) 111 -1- 1 ...- .-R . -0 --- t• "..
(Signiture) /
Month Day Year El 1 yr. Lic./Vacc. Address:
,.. K 3 yr. Lic./Vacc. C '.5
..-
VACCINATION EXPIRED: Other
-1 4 k9 ---21L L--;.- --2 - . '-- --7J
Month Day Year Vacc. Serial (lot) no.

VETERINARIAN'S COPY RABIES VACCINATION CERTIFICATE
NASPHV Form #51 /Th Rabies Tag Number
Owner's Name and Addren Print - use bail point pen or type (,.....___I___
PRINT - Last ......_, First . , Nil. Telephone
_1 6.1G1 IAA ..:._.:2.,_city-,, f t) 1 04/ I I iit
Not.tleH.,.:1.41 ,...,..e rLLiy._._.___srty__,__I_;.
Species: Sex: Age: Size: Predominant Breed: Colors:
Dog iX Male -K 3 mo to 12 mo 0 Under 20 lbs. IX (-) i i
Cat CI Female 0 12 me or older 20 - 50 lbs. CI '.f10,0() I -C h . k
(Spacity) Other: 0 Neutered 0 Actual Age Over 50 lbs. CI
Actual lb Name:
rkvin r -e i"
DATE VACCINATED: Producer: Veterinarian's. # I .rik 02-
..' • (License No.)L' , '
''-7 '.(31 . i ?_.7 - (First 3 letters) /7/ Id et/
Month Day Year (Signe) )
0 1 yr. LiciVacc.
N 3 yr. Lic./Vacc. Address:
VACCINATION EXPIRED:
Other
Month Day 'Year Vacc. Serial (lot) no. n ,..:- - .....-
CrlY
OWNER'S COPY
NASPHV Form #51 Rabies Tag Number
Owner's Name and Address Print - use ball point pen or type
PRINT - Las First M.I. Telephone
,
'NO •
No. eet City 0 ,, state'h e
T 6A A I AINPAPAIP
Species: Sex: Age: Size: Predominant Breed: , Colors:
Dog X Male CI 3 mo to 12 mo lg Under 20 lbs. m nocri I k f.)I iVer
Cat CI Female IN 12 mo or older 0 20 - 50 lbs. El r
Other: CI Neutered E] Actual Age 1P)rel Over 50 lbs. CI
(Specify) Actual 5 ibs Name:
Pop
DATE VACCINATED: Producer: 2_ 0e Veterinarian's: # ) 1 12)61 INZ
(License No.)
S nI 14 (First 3 fetters) a ''' 70")..r,' 1FaL1421/1
Month Day Year ist 1 y r. Lic./Vacc. (Signature)
El 3 yr. Lic./Vacc. Address:
VACCINATION EXPIRED:
Other
S ii-1 15
S 315CY-4Lei I
Month Day Year Wee. Serial (lot) no. —P--fr- rt 47--- Z52-.3

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 First % M.1. Telephone
P. ar • (gal - 71.10 e 11
No. reet r City • State a Zip
•• dB 9-44— II Ai Ilk Kw. —rip
Species: Sex: Age: Size: Predominant Breed: Colors:
Dog RI Male EI 3 mo to 12 mo El Under 20 lbs. 2 ,
Cat 0 Female RI 12 mo or older ii 20 - 50 lbs. 0 Pcoel k . Lob i+t
Other: El Neutered E] Actual Age I yr Over 50 lbs. 0
(Specify) Actual Iv/ lbs. Name:
a) Int
DATE VACCINATED: Producer: z., 0 e Veterinarian's: # )1 (861, Fri
(License No.)
15_ 14 (Ffrst 3 letters)
Month Day Year El 1 yr. LIc./Vacc. (Sign e)
Address:
IN 3 yr. LiciVacc.
VACCINATION EXPIRED: EXPIRED: Other 1544-
6 14 17 PR- 35)-g t
Month Day Year . Woo. Serial (lot) no.
C? -"TilfifC-
VETERINARIAN'S COPY RABIES VACCINATION CERTIFICATE
Rabies Tag Number
NASPHV Form #51
Owner's Name and Ad( ') Print - use ball point pen or typti-,....„
First M.I. Telephone •
PRINT - Last
i 1 ) -1-
No. , . Street City State
t Ct g
Species: Sex: Age: Size: Predominant Breed: Colors:
Dog Male g 3 ma to 12 ma LI Under 20 lbs. g
/ I A' IT.
Cat 0 Female CI 12 mo or older 20 - 50 lbs. 0
Other: 0 Neutered 0 Actual Age' Over 50 lbs. LI
(Specify) Actual lbs. Name:
T:t tit
DATE VACCINATED: Producer: Veterinarian 's: # 1,,LIcense Ng.)
(Fret :3 letiers}
I •-)
iSignEddre)
Month Day Year 0 1 yr. LiciVacc,
Address:
3 yr. Llo./Vacc,
VACCINATION EXPIRED: Other
Month ay ar Serial (lot) no,

VETEMNARIAN'S COPY RABIES VACCINATION CERTIFICATE
NASPI-11/ Form #51 ,-------, Rabies Tag Number
Owner's Name and Addre( Print - use ball point pen or type (. )
PRINT - Last ---," First , M.I. Telephone
1)0,1 Oe f _ t CY-161,Y 1 OAT) Ltioc)- 74.3- ei i.c
No. Street- . 1 Citj, I ' State Zip
Species: Sex: Age: Size: Predominant Breed: , Colors:
Dog 91, Male CI 3 mo to 12 mo D Under 20 lbs.14 Li
Cat Cl Female p, 12 mo or older 20 - 50 Ibs, El I tiVihr,i nr5e j) )1(..,1i i'....
Other: 0 Neutered 0 Actual Age .?) \i Over 50113s. ili LiC):V‘
(Specify) I Actual 5", lbs. Name:
a Ii1X'
DATE VACCINATED: Producer: ,-- .-. Veterinarian's:* „,cert4Nal
F 1 ? „
1 (First 3 letters)
Month Day Year ...,, CI (Signature)
1 yr. Lic./Vacc.
q 3 yr. Lic./Vacc. Address: 5f- "
VACCINATION EXPIRED: Other „.), L.. I. -....,
c:37 /
Month Day Year Vacc. Serial (lot) no.
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 First M.1. Telephone
1111 it 4:7-_-I M ar; I n 4 ..w $ .. - 19
No. Street City p hoe!, , Statefyi, -j- Zin
;t053
Species: Sex: Age: Size: Predominant Breed: Colors:
Dog X Male 0 3 mo to 12 mo 0 Under 20 lbs. XI
Cat CI Female j)4 12 mo or older KI 20 - 50 lbs. 0 Pocrtif Whi4e
Other: LI Neutered 0 Actual Age iir- Over 50 lbs. CI
(speoy) Name:
Actual IQ lbs
c-,1 Mini
DATE VACCINATED: Producer: z Veterinarian's: # OC\ F12
E (License No
B . 6 14 _ fRrst 3 tettere) 04.-ip7,07, ,frei
Month Day Year El 1 yr. Lic./Vacc. (Signature)
g 3 yr. Lic./Vacc. Address:
VACCINATION EXPIRED:
Other 3a5 tc6-11--5-/
14 i/ _S.Z.A3___cRo___. --)---inve_ ftz_ 353,3 I
Month Day Year Vacc. Serial (lot) no.

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 First Mi. Telephone
n
ina _le I 1 n (aa-zi-13-0Fi
No tre t City phxn , Stath._, Zip
.1117K8 b 3944- Or
Species: Sex: Age: Size: Predominant Breed: Colors:
Dog I R Male N 3 rno to 12 mo CI Under 20 lbs. N
Cat El Female 0 12 mo or older 20 - 50 lbs. El ftWanrSe 17jaCk--
Other: 0 Neutered CI Actual Age Over 50 lbs. LI wiN714-e_
(Specify) Actual_lte_lbs. Name: 1
Sori416
DATE VACCINATED: Producer: 2_ 0 e Veterinarian's: # J 1'8r 9 Pz -
(License No.) d/
14 (First 3 letters)
B -6- nt-
Month Day Year CI 1 yr. Lic./Vacc. (Signe tire)
3 yr. LiciVacc. Address:
VACCINATION EXPIRED: e&:)5 it0"--St
Other
iLi p G3150-Kp -Terrir Pa_05D.S 1
lk .
Month Day Year Vacc. Serial (lot) no.
VETERINARIAN'S COPY RABIES VACCINATION CERTIFICATE
NASPHV Form #51,,- - . Fiables Tag Number
Owner's Name and Addrk Print - uee ball point pen or type (.„ ./
PRINT - Last First Mi. Telephone
r'
No. _. , Street City '- 1 State . . Zlp
t )z..5 i ;,.._. :' , _, f
Species: Sex: Age: Size: Predominant I.+ Breed: Colors:
Dog jk}, Male 0 3 mo to 12 mo CI Under 20 lbs. 0
Cat 0 Female ,51 12 mo or olcier. je 20- 50 lbs. CI I 1?). Ifx cik
Other: 0 Neutered 0 Actual Age 34 V Over 50 lbs. 0
(Spoory.) kff
( Actual !'3,) lbs Nam",:
DATE VACCINATED: Producer: Veterinarian's: # .1 1
i -I- ..,4 LIcebse NP.)
i (First 3 letters)
47..../,',4 :/i, ' ..) ,,,, ,e-
Month Day Year {Signature)
0 1 yr. Lic./Vacc.
0 3 yr. Lic./Vacc, Address:
VACCINATION EXPIRED: ..,. il ,./.
Other
1- a ' . I; ii. 2 1' i ri: .). i'l
Month Day Year Vac°, Serial (lot) no.
r----r,t

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 - LaA First Md. Telephone
Z6,./ i 7726rY lyoti 0 sl---iFii.3 —N-),
No. Street '-'• - City Stat
0-5-3 .A.A. 37/i Or /0 134. sIP
Species: Sex: Age: Size: PredomIngint Breed: dors:
Dog Male c 0 ).. 3 ma to 12 mo 0 Under 20 lbs. lig
Cat1111 Female -1Piilh 12 mo or older 20 - 50 lbs. 0 • R 4. le
.
Other: 0 Neutered 0 Actual Age.2)r Over 54),t 0 441"ltii)^-
(Specify) Actual At %b S. Name:
atiklairtiVJ
TA4
DATE VACCINATED: Producer: 2 0 ..g Veterinarian's: # 1j12/
!cense No-.
r),,/ J;? (First 3 lettere)
L240
Mdfrth Day Year .._ 0 5. 1 yr. Lic./Vacc. (signature) . .
Address: 2.2s E. /5- ),./ sy-:..
'11a1 3 yr. Lie./ Vacc.
VACCINATION EXPIRED:
Other
1' 2/J2 c_03oii‘
Month Day Year Vacc. Serial (lot) no.
°Mars COPY RABIES VACCINATION CERTIFICATE
Owner's Name and Address WASPHV Form #51 . Rabies Tag Number
Print - use ball point pert or type
PRINT - Last
, M.I. Telephone
No. Pai A. Mari ) Lin uce-"V+3-09)G.
Street City
It.p4A5:23 N..S 2, DY-- rhotnix StatkL
Species: Sex: Age: Size: (YA3
Dog :i'• Male CI 3 ma to 12 mo ID Under 20 lbs. tgl —T- Predominant Breed: .., . Colors: ,
Cat 0 Female gl 12 ma or older N 20 -50 lbs. 0 J ot 1 r rc
Other: 0 Neutered 0 Actual Age -r- Over 50 lbs. El
(Specify)
Actual —1 lbs. Name:
T.
DATE VACCINATED: Producer: T 0 E Veterinarian's: # 1 1. e 9 ICI-Z-
(License No
3 j _ILI (First 3 letters) ..., /
Month Day Year pia)
0 1 yr. Lic./Vacc.
g 3 yr. Lic./Vacc. Address: '
VACCINATION EXPIRED:
Other -6;6 e ).6-1-1-s-i--
.8 14 1-1 62)104(.0
Month Day Year Vacc. Serial (lot) no. T -crnix- WI- 3513c3 i
(iDr

VETERINARIAN'S COPY RABIES VACCINATION CERTIFICATE •
NASPHV Form #51 -----, Ftabiee`Tag Number
Owner's Name and Addre( Print - use ball point pen or type ( )
PRINT - Last First ,-,. . ----NI.I. Telephone
ri,I,A .e_i.4 1\1 16V i f (1 (LAI 1 .-t 1 ..-`-- : t t_ +--;-;,-- ixf,-d
No. Street - i City. ' 'I State
01,--ve—n -*.
Species: Sex: Age: Size: Predominant Breed: . Colors:
Dog [5z Male 0 3 mo to 12 mo 0 Under 20 lbs.ICA
Cat E Female N 12 mo or older 20 - 50 lbs. P
Other: 0 Neutered 0 Actual Age i Over 50 lbs. 0
(Specify) Actual lbs Name:
Li i vri
DATE VACCINATED: Producer: p Veterinarian's: #
1-" — (Lreen.se`Ne.) '
{Ffrst 3 /eters)
Month Day Year 0 1 yr. Lic./Vacc. (Signature)
Address:
ig3 yr. Lic./Vacc.
VACCINATION EXPIRED: ...''' Other 2 s): ..,) t--- — '')i-.<..-"I'- - '
1
Month Day Year Vacc. Serial (lot) no.
I/". n,
VETERINARIAN'S COPY RABIES VACCINATION CERTIFICATE
- Rabies Tag Number
,------, NASPHV Form #51
Owner's Name and Addrei '. Print - use ball point pen or type
-,,,, ' .1 First .. Telephone
PRINT - Last - I\ , 1
_. Street - City State Zip
9, a, 2, X. "--2, 6i-l'h Dr- . 'no e x'` f-V-
- , --, Size: Predominant Breed: Colors:
Species: Sex: Age:
Dog R Male g 3 mo to 12 mo 0 Under 20 lbs. W n j i + ., Q.
Cat 0 Female 0 12 mo or older p 20 - 50 lbs. 0 Fa's( A te,
Other: 0 Neutered 0 Actual Age r' j Over 50 lbs. 0
(Specify) Actual I-) lbs. Name: ,
,--, Veterinarian's: # 1 1 741 1-'7_
DATE VACCINATED: Producer: , : (License No) i A 44
r 'T"' i ,1,1- -",:: .." k ' /
(First 3 letters) 0,1 ,, Grel-N, ), (--e ',et(
Month Day Year CI 1 yr. Lic./Vacc. (signature)
173 yr. LiciVacc. Address: 1 ---z- .':-.'." r:...-'-..4-4,‘ ,:_,1
VACCINATION EXPIRED: .--) 1:--- L.--j ---,it
Other
Month Day Year Vacc. Serial (lot) no.
"C.)C)

RABIES VACCINATION CERTIFICATE Rabies Tag Number
VEIERINARIAN'S COPY
NASPHV Form #51
Print - U60 ball point pen or type M.I. Telephone
Owner's Name and Addr First
PRINT - Last
State Zip
City „
No. Street Colors;
Predominant Breed:
Age: Size;
Species: so Sex: \ 3 ma to 12 ma 0 Under 20 lbs.
Dog Male 12 moor older 20 - 50 lbs. 0
Cat 0 Female 0 Over 50 lbs. 0
Other: 0 Neutered 0 Actual Age Name:
(Specify) Actual
Veterinarian's: # (License No,) :
DATE VACCINATED; Producer: ,1 • /1
_ _.,_" /.1 '--------- --,,--
- Panature)
Month Day Year 0 1 yr. Lic./Vacc. Address! •
p.,3 yr. Lic./Vacc.
VACCINATION EXPIRED: Other
Vacc. Serial (lot) no.
Month Day Year
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 First A M.I. Telephone
1)1t6it.A Irf.- - Mar I IT ipa?-693-60-ici
Nil joi267"treit) City State
PhtEr_fl 'i X, l I t1)66.
Species: Sex: Age: Size: Predominant Breed: Colors: .
Dog til Male M 3 mo to 12 ma KI Under 20 lbs. 0004
Cat 0 Female 0 12 mo or older 0 20 - 50 lbs. CI T
Other: • Neutered 0 Actual Age Ser. Over 50 lbs. 0
(Specify) Actual (0 _lbs. Ni .nle'
&Ivo( male
.
DATE VACCINATED: Producer: -i____ 0 Veterinarian's: # I iect ik-z_
(License No.)
11 ,W) (First 3 letters)
i Li
Month Day Year 1 yr. Lio./Vacc. (Sionifure)
Address:
0 3 yr. Lio./Vacc.
VACCINATION EXPIRED: Other
il-t t S•51?)01-14p --i-Teirr._ prz 3s,o-?i
Month Day Year Vacc. Serial (lot) no.
\C)11)

OWNER'S COPY RABIES VACCINATION CERTIFICATE Rabies Tag Number
NASPHV Form #51
Owner's Name and Address Print - use ball point pen or type M.I. Telephone
PRINT - Lisp i First 6.014V ? -0-4 7
ra-14-1-€ /Air/44J City .6/ . , Zip
No. iiiie.,3e iA 0 r, 1-.
Predominant ..) Breed: Colors:
Sex: Age: Size: / / /
Species: Male 3 mo to 12 ma El, Under 20 lbs.
Dag X 0 12 mo or older)1! 20 - 50 lbs. 0 _ A
Cat 0 Female Actual Agegy( Over 50 U
Other: 0 Neutered 0 Actual I s Name:
iSPeciFY) Otri-
a )
2 Veterinarian's: # (License No.)
DATE VACCINATED: Producer: 0 E ' AI _ or „
4,4 (First 3Fetters) OF 4. iTAIIIt I i ' AMIE/
P (Signature) is-y..4377,
Month Day Ye r 0 1 yr. Lic./Vacc. Address:
)14.3 yr. Lic./Vacc.
VACCINATION EXPIRED: Other 744-702-i A2-, FS:4 )
4F, jj_, _ --a 3)30 iit
Month Day Vaoc. Serial (lot) no.
tr.-. r-...
OWNEFi'S COPY RABIES VACCINATION CERTIFICATE Rabies Tag Number
NASPHV Form #51
Name and Address Print - use bait point pen or type M.I. Telephone
Owner's First I- , ' 6419
PRINT - L t mart Gin trig- cos
IN 1 Statepsi .&, :)
No. i (44:59)reet t.... j 31144_ „ City phouv ) X.
L.Jr" Colors:
Size: Predominant Breed:
Species: Sex: • Age: 3 ma to 12 ma tin Under 20 lbs. g e) lotk-
Dag 50 Male Cg 12 mo or older 0 20 - 50 lbs, 0 rta.‘facte-se-- LOVV; -le
Cat 0 Female Agetath... Over 50 lbs. 0
Other: 0 Neutered 0 Actual Actual ..ta-- lbs Name:
(Specify) Rom- tetkl
1 It9 A2
Veterinarian's: Veterinarian's: # (License Nn.1
DATE VACCINATED: 2_ 0 1.E.... / / / ii
(First 3 letters) 4.41.-...r .4
)i+ (Signature)
Month Day Year INII 1 yr. Lic./Vacc. Address:
0 3 yr. Lic./Vacc. -
VACCINATION EXPIRED: Other ---ruyte_ AZ_Zt5D-Y1
14 6 s?)160-tip
Month S Day Year Vacc. Serial (lot) no.
n6

VETERINAFitAN'S COPY RABIES VACCINATION CERTIFICATE
„---,,. NASPHV Form #51 Rabies Tag Number
Owner's Name and Addre( : Print - use Oen paint pen or type ( '
PRINT - Last First M.I. Telephone
No. . Street City , State Zip_
Species: Sex: Age: Size: Predominant Breed: Colors:
Dog Ii4 Male 0 3 mo to 12 mo 0 Under 20 lbs.% p. .P)kelk
Cat III Female A 12 mo or older 0 20 - 50 lbs. 0
Other: El Neutered 0 Actual Ager. Over 50 lbs. 0
{Specify) Actuat__.lbL " Name:
DATE VACCINATED: Producer: Veterinarian's: # (License ligti No) AZ'
4- ,•-•.- ..., .•
i .' i ' ; 1 • ; j (First 3 let-tete) /4 9. •A ' :" ,?.::•', , ,,:- • ( ; .., • -
Month Day Year 0 1 yr. Lic./Vacc. (Signature) '
Addramy '
0 3 yr. LielVacc. .
VACCINATION EXPIRED: Other
3 0 J5.. 5 rigi4X,,) A -
Month Day Year • Vace. Serial (lot) no.
,r\ k
VETERINARIAN'S COPY RABIES VACCINATION CERTIFICATE ,---., Rabies Tag Number
NASPHV Form #51
Owner's Name and Addrek ) Print - use ball point pen or type
First M.I. Telephone
PRINT - Last 6
_.?1/4k.,0-' eC • VI \ t 4- CI 1 ',0••-) '71127- (1)
City _.-„ - 1 , State
No. , Street ...•
2--r.-; ,
Species: Sex: Age: Size: Predominant Breed: ., Colors:
Dog at Male CI 3 mo to 12 mo El Under 20 lbs.,0 ":".:, j . L-) k i Vr ii"
Cat El Female pr. 12 mo or dderip 20 - 50 lbs. 0 _CI v
Other: El Neutered El Actual Age T20,./ ,-- i Over 50 lbs. 0 I
Name:
(Specify) ActuaL ( 9 lbs
i'll-e
DATE VACCINATED: Pro ducer: I.) .J. .-...--. Veterinarian's: ,..., # (Licehse i .- tAl-- A 4
/1
(Flrst 3 letters) 7,1,4
I (SO-store) '
Month Day Year 0 1 yr. Lic./Vace. Address:
3 yr. Lic./Vacc. 3- TII'z'..1 ITT-- ,e- c....-1--
VACCINATION EXPIRED: Other ";er..," 1,....— 3 -7 ---1
—1 ..m7 i „...„ 6----),) -7t-i----1 1 i ---R. iriX Al. 85-?),.,7 1
_÷,_ , ,__.3 A
Month Day Year Vac°. Serial (lots no.
eP

ETERINA IAN'S COPY RABIES VACCINATION CERTIFICATE
NASPHV Form #51 ,4---„ Rabies Tag Number
Owner's Name and Add • Print - use ball point pen or type' =_.. ..i
PINT- Last First M.I. 'Telephone
1 r • , . I& I ! .L.% . ',._.,fil ,,:- ,-:<.) :,..:_=, ,-
. „Street City State Zip.
' 1 (f.=' ,4-i 7 '• ,:5 i-•,, -: ,:,''. i I i--
Species: Sex: Age: Size; / Predominant Breed: Colors:
Dog p Male 0 3 mo to 12 mo 0 Under26 lbs. a. : ;
•• •.(i ;•,f.:'"
Cat 0 Female DI 12 moor older 0 20 - 50 lbs. 0
Other: 0 Neutered 0 Actual Age :-74) \• Over 50 lbs. 0
(Speoify) i Actual._!,„:_lbs, Namei
4„4+1&._
Veterinarian's: # . 12 • ; . i ;—
DATE VACCINATED: Producer: : „ ,.,. 1 (Vcenes No.) ,
I: Y , , • .,-
i,..-"2 e--:-/,'
___L: Ora 3 letters) / ...>.y, ,.:. -?..-,:.1 ) ' -(_:; , ,,•--,,..-.t.
'. --.2C.-._ ; (Signature)
Month Day Year 0 1 yr. Lic./Vacc.
Address:
p 3 yr. Lic./Vacc,
VACCINATION EXPIRED: Other
. ...,,
- . • ' ; . ,'I. :'.1 Z.,...) il v •„,i. , • - .
Month Day Year Vacc.'Serial (lot) no. '
kr-NA
VETERINARIAN'S COPY RABIES VACCINATION CERTIFICATE
Rabies Tag Number
NASPHV Form 151
Owner's Name and Addr( Print - use ball point pen or type
PRINT- Last First M.1. Telephone
No, ' Street City State
,
Species: Sex: Age: Size: Predominant Breed: Colors:
Dog l Male CA 3 mo to 12 mo El Under 20 lbs. 0 P
Gat 0 Female 12 rrio or older 20 - 50 lbs. 0
Other: El Neutered 0 Actual Age Over 50 lbs. 0
iSpecIfy) Actual lbs. Name:
DATE VACCINATED: Producer: Veterinarian's: # (jloense No.) , ,
.„,-,•., „
(First 3 letters) t.,/,4 . 4-7:- f-. ': , . ,---:. /::
Month Day Year 0 1 yr. Lic./Vacc,
Address:
3 yr. Lic./Vacc,
VACCINATION EXPIRED: Other
M6nth IS Year Vacc. Serial (lot) no.

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 ,N , First -,, MI Telephone
Foii i,e9 Mar i icirl
No. Street City Noe 1, State D o
1 LE D T6- k) "cr44- DC .g-.5 orDe3
Species: Sex: Age: Size: Predominant Breed: .. Colors:
Dog N Male 0 3 mo to 12 mo 0 Under 20 lbs. WI
Si ivex
Cat 0 Female ER 12 mo or older Z 20 -50 lbs. 0 10(1 PCkla le'
Other: LI Neutered 0 Actual Age 44-yr Over 50 lbs. 0
(specify) Actual 1 fbs Name: rN ,
if() I nil- t,S6
DATE VACCINATED: Producer: 2, Veterinarian's: # i I ?PI IV
(License No.)
t 6 14' (First 3 letters) /*Ir, rill LL' a4A,0141
Month Day Year 0 1 yr. Lic./Vacc. (Signature)
a 3 yr. Lic./Vacc. Address:
VACCINATION EXPIRED: Other
, F5 I LI 1+ -1 SZI 7DOL4(0 -refit AZ 3(.= 81
Month Day Year Vacc. Serial (lot) po.
4---,A
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 First , M.i. Telephone
POGL 1 <Li Mort kor‘ (4)-64-13 -Can
No. freet 1\3_, 6014.1..s, Dr City ,,-. StatA2 fP
V hotol x c
Species: Sex: Age: Size: Predominant Breed: Colors:
Dog p Male 0 3 mo to 12 ma El Under 20 lbs, Xl ,
Cat D Female 12 mo or older fgl 20 -50 lbs. 0 TOL./ pziod,fr
Other: 0 Neutered El Actual Age_;- yr Over 50 s. El Lk.) b i 4e.
(Specify) Name:
Actual lbs.
Eli/ 4)DrIartrA641
DATE VACCINATED: Producer: Veterinarian's: # WI A2_
(License ,
t?) 15 ILI- (First 3 letters) ,---.. / ,
Month Day Year (Signature) A-- 1)10--• % "
0 1 yr. Lic./Vacc,
RI 3 yr. Lic./Vacc. Address:
VACCINATION EXPIRED: 2 .e. 164-1-64-
Other
?) It I 1-7 G S 11604 0 Tery- e ft2- 35
i
Month Day Year Vapc. Serial (lot) no.
JX)

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„ First M.I. Telephone
VaU1-01 111m:t it i n Igo- W-049
No. !treet , , _c.... ,... ,,, City ini State
itz8 57> N.1 39-n7-- Or rriMnik
LiD.5
Species: Sex: Age: Size: Predominant Breed: Colors:
Dog tgl Male N I 3 ma to 12 mo El Under 20 lbs. NI 1,-,,, le Biroz.
Cat El Female El 12 ma or old i r ig 20 - 50 lbs. El
Other: El Neutered CI Actual Age Over 50 lbs. El Ltkj.4e,
(Specify) Name:
Actual lbs.
COnc-e_144-;
DATE VACCINATED: Producer: 7 f--, Veterinarian's: # dk a
C--J V License No
ei
1) f Li _ (First 3 Ietters) ji, 07'0 / 1
Month Day Year Pgnaturo.1 • "/ '' -
El 1 yr. Lic./Vacc.
RI 3 yr. Lic./Vacc. Address:
VACCINATION EXPIRED: Other 6, - 16"-n- 54-
i3 )4 17 63i3cY-ILD Tempt iw. Z5D-Z 1
Month Day Year Vacc. Serial (lot) no.
r. r",,,
VETERINARIAN'S COPY RABIES VACCINATION CERTIFICATE
NASPHV Form #51 Rabies Tag Number
Owner's Name and Addresr \ Print - use ball point pen or type 1-)
PRINT - Last First Telephone
0
POV1 .1/-
No. ,, ,) Tree ,, , _., Cit - 1 State -). 4,5) _
- 1 .-1('' A.-
Species: Sex: Age: Size: Predominant Breed: Colors:
Dog v Male ID 3 rno to 12 ma El Under 20 lbs. p,
,norkr, re,,r t
Cat El Female CT', 12 mo or older R. 20 - 50 lbs. 0 --' - ..„., - - ,
Other: El Neutered Ci Actual Age Lk/ Over 50 lbs. El 0 Pr i U)+-
(spedry) f A ctual ?_, lbs. Name: r1 ,
DATE VACCINATED: Producer: r.. 1: Veterinarian's: # 1 17,6i ,....
r (Licene ,- .e.-
(First 3 letters) "-
A G . - (..i.
Month Day Year El1 yr. Lic./Vacc. (Signature)
Address:
g 3 yr. Lic./Vacc.
VACCINATION EXPIRED: Other : &9 :.:..7,.) .e-- : 7,1 34-
i - 1 0 ( "7,e --y9, 1 , Li , -4.-,----1 ;.....- i I r in C A 1 '71-. ..,., :cg t
Month Day Year Vacc. Serial -(lot) no. -1-C, --'
1...\1\

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 i...,, First r M.I. Telephone
VII " , nr)C45K- phoeni, i i ii )6 statel_2_
, Noi coz.53Streesk City
u r
Species: Sex: Age: Size: Predominant Breed: Colors:
Dog iti:j Male rgl 3 mo to 12 mo 0 Under 20 lbs. 5? D i 1 it 1?-)hdi
Cat 0 Female 0 12 mo or older NJ 20 -50 lbs. 0 i 0 LI r ()net
Other: 0 Neutered 0 Actual Age l'i3Air Over 50 lbs. 0 Lehi -it_
(Specify) Actual 5 lbs Name: Hu
•
DATE VACCINATED: Producer: I 0 E Veterinarian's: # (License l i No en Prz-
.
5 .t_ ti4 (First 3 letters) 6-Y/10-'
Month Day Year CI 1 yr. Lic./Vacc. ature) .
Address:
Z 3 yr. Lic./Vacc.
VACCINATION EXPIRED: Other
7,,,, piz assg f
8 i q ii 56t.?„04.
Month Day Year Vacc. Serial (tot) no.
CNT\,
OWNER'S COPY RABIES VACCINATION CERTIFICATE
Rabies Tag Number
NASPHV Form #51
Owner's Name and Address _ Print - use ball point pen or type
PRINT- Lastr‘ First ., Mi. Telephone
.,
ija_2 1‹.- LI Mir! 1C41-1 &atm 46) -3t1 3-- 0a 19
No. Str eet
1 L9(rt IN) Aci-6- Or-- c'tYPh
Species: Sex: Age: Size: Predominant Breed: Colors:
Dog 14 Male 0 3 mo to 12 mo 0 Under 20 lbs. X ___r, Pond le NCie V
Cat 0 Female r 12 rno or older CA 20 - 50 lbs. 0 10L1
Other: 0 Neutered 0 Actual Age I lierti. Over 60 lbs. 0 Will -R.
(Specify) Actual 6 lbs Name: .
SVA1
tiZci 19
DATE VACCINATED: Producer: E Veterinarian's: # (Licen No.) i
C) /
ILI (First S etters) T
it) (signature)
Month Day Year 0 1 yr. Lic./Vacc.
R3 yr. Lic./Vacc. Address: '60.6 1541-S±
VACCINATION EXPIRED: Other
ILI 11
Month Day Year Vacc. Serial (lot) no.
kirAb

OWNER'S COPY RABIES VACCINATION CERTIFICATE Rabies Tag Number
NASPHV Form #51
Owner's Name and Address Print - use ball point pen or type
PRINT - Lag.,... . First ,‘. M.I. Telephone
iso)-V13 -019
liaLt IC c 9.4.1„ mart p hotAi, li in )e, Staten
NI is t,treetN 3 or City
Species: Sex: Age: Size: Predominant Breed: Colors:
Dog N, Male . 0 3 mo to 12 mo El Under 20 lbs. N t pocrile ig-pr i Co+
Cat El Female gi 12 mo or old r N 20 - 50 lbs. 0 T. Is I
Other: 0 Neutered 121 Actual Age Over 50 lbs. 0
(Specify) Actual.J__ lbs. Name:
Rhubarb
(12
DATE VACCINATED: Producer: --2._ 0 e Veterinarian's: # ense IlB9 No.)
I,
ILI (First 3 fetters) 4 -
(Signature)
Month Day Year CI 1 yr. Lic./Vacc. Address:
Igi 3 yr. Lic./Vacc. 3a5 E l
VACCINATION EXPIRED: Other
IS_ ILI 17 5 31 'b Ci—iLo "Te_inp-c '92 .3752 I
Month Day Year Vacc. Serial (lot) no.
i rN A
,
OWNER'S COPY RABIES VACCINATION CERTIFICATE Rabies Tag Number
. NASPHV Form #51
Owner's Name and Address Print - use ball point pen or type
First MI Telephone
PRINT - Last 0) 19
1-6 -
No. i to?) teeet NI (...v04._ 1---N City r ni_ no-en t statepa_ &,os
_Ki ke—
Species: Sex: Age: Size: Predominant Breed: , Colors:
Dog A Male 0 3 mo to 12 mo 0 Under 20 lbs.10 16 — pcxxile 51N-0(
Cat CI Female cil 12 mo or older 20- 20 - 50 lbs. 0 Li
Other: 0 Neutered 0 Actual Age 6 Over 50 lbs. 0
(SPecitY) Actual CO Ilas Name: ,
IrrkiteCi 41'
e2
Veterinarian's: # libci
DATE VACCINATED: Producer: (License No.)
0 .-- //
(First 3 letters)
Month Day Year 0 1 yr. Lic./Vacc. (Sig tore)
Address:
Si 3 yr. Lic./Vaco. 23o6 E 1z -4'f. &i-
VACCINATION EXPIRED: Other
11 6 gi- c,--I co Ien-fe al
e) ILI
Month Day Year Vacc. Serial (lot) no.
\i')

VErEfIlNARJAN'S COPY RABIES VACCINATION CERTIFICATE
NASPHV Form #51 Rabies Tag Number
Owner's Name and Acldrek, Print - use bail point pen or type _
PRINT - Last F-Irst MI. Telephone
No. Street City State Zip ,
e
Species: Sex: Age: Size: Predominant Breed: Colors:
Dog Male 3 ma to 12 ma D Under 20 lbs. Eler 1VI
Cat 0 Female CI 12 moor older 0 20 - 50 lbs. 0
Other: El Neutered 0 Actual Age Over 50 lbs. 0
(Specify) Actual Name:
DATE VACCINATED: Producer: Veterinarlan're- :
(License No.)
(First 8 letters)
Month Day Year LI 1 yr. Lic./Vace. (Sig.riatlire)
3 yr. LIciVacc. Address:
VACCINATION EXPIRED;
Other
t3
Month Day ear Vacc. Serial (lot) no.
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 - st ) First M.I. , Telephone
cioitt La__ j 41.,) • 6 4'.1--6PV3-03-11
No. ieFr3 stK .) 3. it City p cretme Ar
te
E-,
Species: Sex: Age: Size: Predorninanfteed: Colors:
Dog cg. Male 0 3 ma to 12 mo* Under 20 ibsta/
Cat EA Female t',Kr 12 mo or older El 20 - 50 lbs. , b Ar/ A641
•---
Other: 0 Neutered IA Actual Age Over 50 I . 0
(specify) Actual lbs. Name:,
1:7
DATE VACCINATED : Producer: Z 0 E • Veterinarian's: # /JP
(Lkense No.) '
f=21- - -41 (First 3 letters)
Month Day Year X, 1 (Signature) e767rIX‘fitid,
yr. Lic./Vacc.
0 3 yr. Lic./Vacc. Address: 3.15 Co, /5-/1St:
VACCINATION EXPIRED:
Other
ei A.7-46-4)
31J 0
nth Day ear Vacc. Serial (lot) no. 5
IN f\

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 - act First M.I. Telephone
OIL 0 1- _,...,, l li 0 ti20 - i Ll d--
N . 1 Lowtreet Iso i2),9,0„, iN City ry . \ Statefiz_ gpsm.
11VDCfil 1 X
Species: Sex: Age: Size: Predominant Breed: Colors:
Dog kj Male CI 3 mo to 12 mo XI Under 20 lbs. K% ....1-- flocs Fe 61 1
Cat El El Female Cii 12 mo or older 0 20 - 50 lbs. CI 1°1.1 r ,
Other: El Neutered 0 Actual Age lOcin Over 50 lbs. 0
(SpecIfy) Actual (0 lbs Name:,,
DATE VACCINATED: Producer: z 0 Veterinarian's: # 0 '69 A-7.
(License No.)
(First 3 letters)
(8 6 144
Month Day Year Wi 1 yr. LiciVacc. (Signature)
ra 3 yr. Lic./Vacc. Address:
VACCINATION EXPIRED: Other
42) ill,
Month Day Year Vacc. Serial (lot) no.
(\6i
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 n First , Ml. Telephone
raM -ei ri)c-Lri 1n
. i • j• Street 6 City 4 State Z •
a m. ' LOC Al i L 4....eakitio
Species: Sex: . Age: Size: Predominant Breed: A i
Colors:
Dog NI Male ig 3 mo to 12 mo 0 Under 20 lbs. IN __,.-
Cat CI Female ID 12 mo or older IN 20 -50 lbs. 0 MCI POCA If
Other: 0 Neutered i=1 Actual Age Over 60 lbs. DI
(specify) Actual (41 lbs. Name:
h- Rick'
DATE VACCINATED: Producer: '2. C.) Veterinarian's: # 1 i3ct Pa
(License No.)
ILI (First 3 letters)
Month Day Year (signature) //,
0 1 yr. Lic./Vacc.
{SI 3 yr. LiciVacc. Address:
VACCINATION EXPIRED:
Other
51 ILI a s?) i 30% , 1 ery-r-e 1512_ 35,01-0.
f
Month Day Year Vacc. Serial (lot) no.
1\A