Extracted text (via pymupdf_layout)
12007 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
0 New pi. Renewal Permit # 003
Narne:S 1\-Ve B(.1picli) ref Kennel Name: '6 5 0(1'1 \nut!, 'tua
Mailing Address:±- 110 Lrk Kennel Location: Liao ay_
City o'e v-I\L )c. A7 ZIP s-5-3 0 (,--) County Supervisorial District Li
Kennel Phone: — 77Z -8c 76
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. SA.8 INVe 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. SiciB l/We certify that INVe have dogs and that the kennel meets the definition in statute.
3. 668 1/We certify that INVe 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. 5t3a 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. SA. 8 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. 548 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. sA I/VVe 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 5•41 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.
I/We certify that all of the information INVe have provided is true and accurate under penalty of law.
Applicant Signature Date: V - /
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 Lk .)1( —)1,
Animal Care & Control
2500 South 27th Avenue
Phoenix, AZ 85009
Phone: • (602) 506-7387
pets.marieopa.gov
KENNEL PERMIT PREMISE INSPECTION
APPLICANT 0 1 Vet, Pacvvicee r e
STREET ADDRESS L( 1-A 3- 4 LA-) TI e cc 19Duke no Ur\
CITY, STATE, ZIP \1\Oevkic
PHONE ALTERNATE PHONE
COUNTY DISTRICT 1-4 KENNEL LICENSE #Ks--- co 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 Peimit
Premise Inspection form.
2. Is the kennel an enclosed, controlled area, inaccessible to other animals, in which a person
keeps, harbors or m/intains 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 A
Maricopa County Animal Care and Control
2500 S. 27th Avenue
Phoenix, AZ 85009-6797
(602) 506-7387
http://pets.maricopa.dov
Receipt Number: R14-159799 Receipt Date: 08115/2014
Person ID: P1212486
Phone: 602 9783076
B-Z-B CHIHUAHUA KENNELS
4424W TIERRA BUENA LN 8/15/2014 10:59:12AM
GLENDALE, AZ 85306
Item: Animal ID: Reference No: Price: Each: Amount:
KEN PERMIT A7777777 K15-000003 $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 9/14/1999, 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
reyesa EBUSOFF
3NAA0 8: Ad00
SAUMO EILLIBN UTE! p ssampv
1:1
Z
Cn 71)
0 8
0 ill
0 co
1-5 -g 52.
31V3 :031VNI3DVA
LLYNIOOVA NO 031:11dX2I
Number Colors: r;Nclet 4:,..,k Number , Colors:
Tag IT' e" ..,bZip b
Telephone --20, e v I ' ' ' Tag (T-3076 5' atiVefr
Rabies 7e No.) l' tip: Rabies Telephone A2-1/17 )5.-7/51":"'
Statep I. 77
(License j 6/ ri 2-- .4.State (License 7 A
M.I. A.2.4 Breed: ye-Ai # ..- ) M.I. Jo Breed: # £ /
's: -1 7 w A 's: y
CERTIFICATE y-, it16. 5 32_6 .1 kart 323.
Predominant t ' A CERTIFICATE 0,-
type 6.--1,14,:k.i Name: Veterinarian el (Signature) Address: type 6LeAriele Predominant Name: Veterinarian (Signature) Address:
or or
#51 pen • . CI #51 pen . CI IN
Form IbZiKI Albs. .. lbs.
point City 20 lbs. I.V1/ Form point lbs lbs. w. lb 477/1
VACCINATION ball First 50 50 Actua0-,.) ) ball First City 20 50 50,
NASPHV use not03 i 4,0-4 Size: Under 20 - Over letters) VACCINATION NASPHV Size: Under - Over Actual
- i X 0 F 3 Other no. - use iii..4 / 20 r. 3 letters) Other
Print / I leue,ve mo older rs. P (First Lic./Vacc. Lic./Vacc. (lot) Print Riy-ooc3 molligi- 0 (Al (First lic./Vacc. Lic./Vacc. no.
k 3 older p ios-77,7 (lot)
RABIES to 12 or Age 1 yr. 3 yr. Serial 12 or Age yr. yr. Serial
Age: mo mo Actual Producer: RABIES i mo to mo Producer: -It(1 3
iteadyivd_ Tieryf-6.- 3 12 Vacc. Age: 3 12 Actual Vacc.
Address El *--Ff CI Address kemvet g "AA CI
COPY and Street of, Female Neutered Year EXPIRED: Year COPY and itt",,, Neutered /9 Year EXPIRED: kr Year
Name 528 Sex: Male VACCINATED: /Y s Sex: Male Female
OWNER'S - Last im.2...-/ -16 0 CI 3 Day Day OWNER'S Name - Last aze CI CI VACCINATED: 3 Day 3 Day
VACCINATION .16 VACCINATION
Owner's PRINT No. Species: Dog Cat Other: (Specify) DATE 3_ Month Month Owner's PRINT No. t Species: Dog Other. (Specify) DATE 3 Month 3 Month
Cat
OWNER'S COPY RABIES VACCINATION CERTIFICATE
NASPHV Form #51 Rabies Tag N umber
Owner's Name and Address Print - use ball point pen or type
PRINT - Last First M .I . Telephone
fiz kep-44, g11/0 003 60) 7 30?
I. &Ci ty af_daate, A 7' State th ON 7sv
Sex: Age: Size:
M ale 3 mo to 12 motl.. • Under 20 lbs .14.
Female 14 12 mo or older 20 - 50 lbs. El AzuaL . 1
Neutered EI Antual Aae I IA., -Over 50 lbs. El
Actuallbs. Name:
0 m < > E > 0 -13 8 D. n LI -11 m
,..._
---- \J. st 3 letters)
K 5.- 0 ei -) rt Vacc. (sid-dathrip, 3.2,5- E if / tisT.
Ad..:
Co] r, Vacc.
< 0 0 E > z 55 m p )ther 7 ti-Slin
...9.--pfe,, '2,
%...... ,-- /
Mi.....
z D- 0 -< \Yam. Serral (lot) no.
,
1074 t-col
Number zw53o 5+ Number Zt.530
Colors: --CM-3611 Colors: 1 .2—.A41
Tag i) Tag win Igei
2-97 —
Rabies Telephone N 15+6 z, Rabies Telephone N-0!
112. kip:{ ate _ ;as—I-154(5,7
6--lenciatse,n2l /License pfl. k_cduLA Pr •76r-pel.A
Mi. Breed: ti /1 # M.I. Breed: #
n 's:
CERTIFICATE inant CERTIFICATE
type (YU Veterinarian's: type Predominant Veterinarian 61/1 (Signature)
Predo Na9N: (Signature) da Name: Address:
or or
#51 pen El 0 lbs. #51 pen 6-1 2'1 111 El
Form -1,-.7040q3 lbs:1! Form -00603 lbs. Xilbs.
point griting),A. lbs. 59)13s.— 5 point 20 lbs. lbs.
ball First 20 50 ball First LArY. 50 50 5
VACCINATION NASPHV Size: Under 20 - Over Actual letters) VACCINATION NASPHV Size: Under 20 - Over Actual letters)
- use E 3 no. use 1413 r F 3 Other no.
CI (First LicJVacc. LicJVacc. - 0 2 (First Lic./Vacc. Lic./Vacc. (lot)
Print mo older Other (lot) Print 13k4EiJ mo older 11 P Sit-11518A-
er 12 Ag yr. yr. Serial 12 Age yr. 12^3-yr. Serial
RABIES to moor Producer 1 RABIES to moor Producer: 0 1
n Age: mo 12 Actual 0 )43 Vacc. Age: mo 12 Actual Vacc.
3 3
Address 0 Address K.'.-)ONE)-- arti-te,IZON 0 12- 0
aioi3 EXPIRED: xib EXPIRED:
COPY and ListTeNK/ Female Neutered Year Year COPY and Female Neutered Year Year
Sex: Male VACCINATED: Sex: Male VACCINATED:
OWNER'S Name Last a 0 30 Day :CINATION 30 Day OWNER'S Name Last 4azi- 2_7_ Day 7.;CINATION Day
- Ba6
ier's NT LI sr: :ify) E 1th Tt-h- lees NT- 1E CI_ nth inth
I C/
9,14T,11v10 Ad00
tn. CP > cc ' •
rz 0 DCC 3 0 0
ULIR,.
44 a a)
z C 64 CD o_
-c 0 CD
\f\-i -TI CD Frr
NOI1VNIOOVA :031:11cD3
Cr) CD 533
0.
.1 . 1 -0q /
'-' 1, 0 . t // 52_4 Number • _ Colors: 1-P / 5-7L, c47791
Number 0 0 Colors: it,i4 - kf,17 / 9s281 Z , 24
Tag 4
Tag -- NEL Fd id , A-.1...i-414L4 ic_th . Telephone e q. 15-44)
ephone i • /V P Rabies No.)
Rabies 0 de Az 4?
P T- e r\lk(\& , Sta 041-Adia (License
L. — p ' 1 M.I. Breed: - E'.
M.I. Breed: . # IPA.' 2c A ivioxie #
OrMe/k 's: imp I
eminent /2 CERTIFICATE Predominant • Veterinarian's: 325-
CERTIFICATE type e (Signature) Address:
type l — 5 Veterinarian (Signature Address: or Na
or MIZEMBIMil /re. 79 #51 pen LI Cl
#51 pen 0 0 lbs. Form lbs.
Form OS lbs. point )4'-00O3 ity 20 lbs. lbs. Actu61_767
point 20 lbs. 59,,Iliii. ball First I 50 50 1
ball First 0 rider 50 •-7- -- , VACCINATION IVASPHV Size: Under - 20 Over letters) 71
VACCINATION NASPHV .Size: - 20 Over Actual letters) use - F 3 Other no.
use f 3 Other no. k 0 yr (Fist Lic./Vacc. Lic./Vacc.
- 0 [2( (First Lic./Vacc. Lic./Vacc. 2b.7.)21-(YB Print I mo oleir14 p (lot)
Print I! mo oilier ..p (lot) ei IP 12 Age'l . yr yr. Sagq6- Serial
12 or Age 5 yr. yr. Serial RABIES to or mo Producer: 1 5(3
RABIES to mo Producer: .). CI 'fa In Age: mo 12 Actual 0 Vacc.
1 Age: mo 12 Actual Vacc. geiW) 3
3 Address 0
Address 0 V 0 — - Femalelif,4 XS EXPIRED: 20/
• EXPIRED: COPY and re Neutered Year Year
COT', and Neutered 13 Year 16 Year ta) Sex: Male VACCINATED:
Sex: Male Female VACCINATED: OWNER'S Name Lasitl 30 Day 30 Day
OWNER'S Name . 2; Day Zs Day - Z • V_ IN 0 VACCINATION
- — PA 0 0 VACCINATION Owner's T Species: Other: (Specify) Month 9 Month
Owner's PRINT P . Species: Other: (specify) DATE 0 Month 4 Month PR Dog Cat DATE
No Dog Cat