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Maricopa County Animal Care And Control 2500 South 27th Avenue Phoenix, AZ 85009 (602) 506-7387 Tele. (602) 506-2739 Fax KENNEL PERMIT APPLICATION fl New ys Renewal Permit # Name: Kennel Name: Ace \Krit4PAS Mailing Address: 4 Li Di A) 379 Aije Kennel Location: L-1(401-7 •. 3 71411,40_ City TOyN(pc,kak, , AZ ZIP Oc351-1 County Supervisorial District Kennel Phone: é.3OS7' CY/6 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 "operating a kennel" must obtain a permit issued by the Board of Supervisors where the kennel is located except if each individual dog is licensed. A.R.S. § 11- 1009 and MC Ordinance No. 13, Sec. 4. define a "kennel" 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 a 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 require individual licensing of each dog under the provisions of ARS 11-1008. PLEASE ANSWER THE FOLLOWING QUESTIONS Initial Each 1. I/We assume complete responsibility for the kennel at the premises for which l/we are making app ica on 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. tA) I/We certify that the kennel has been approved by the local zoning authority (if applicable) at the premises for which I/we are making application for a permit. 3. /We certify that I/We have dogs and that the kennel meets the definition in statute. 4. jjo INVe certify that INVe have not been convicted of a violation of A.R.S. §§ 13-2910 (cruelty to animals) or 1,3-2910.01 (dog fighting), or any other state, county or municipal animal welfare law. (Violations of license and leash laws DO NOT apply.) 5.114) INVe certify that all dogs over the age of three (3) months that are kept, harbored or maintained on the prethises 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 Me certify that Me are submitting a valid copy of the rabies vaccination certificate for each dog with this application. , 1 liWe understand that a dog remaining within the kennel is not required to be licensed individually under rs 4 AR 1-1008. Uwe also understand that a dog leaving the controlled kennel conditions shall be licensed under ARS 11-1008 except if the dog is only being transported to another kennel which has a permit issued under this section. 8. Di5 INVe understand that a person who fails to obtain a kennel permit under ARS 11-1009 is subject to a pengity of twenty-five dollars in addition to the annual fee. 9. kb_. 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. Is this kennel permit being obtained for the purposes of operating a business including bu not imited to , groomers or boarding establishments? (Please check one) YES NO If the answer is "YES", you will need to provide proof of lawful presence in the United States in order to obtain a kennel permit for the purposes of operating a business. The forms of identification accepted for this purpose are listed below. A.R.S. § 41-1080(A) provides: After September 30, 2008, an agency or political subdivision of this state shall not issue a license to an individual if the individual does not present any of the following documents to the agency or political subdivision indicating that the individual's presence in the United States is authorized under federal law: 1. An Arizona driver license issued after 1996 or an Arizona non-operating identification license. • . A driver license issued by a state that verifies lawful presence in the United States. 3. A birth certificate or delayed birth certificate issued in any state, territory or possession of the United States. 4. A United State certificate of birth abroad. 6. A United States passport. • 6. A foreign passport with a United States visa 7. An i-94 form with a photograph. • 8. A United States citizenship and immigration services employment authorization document or refugee travel document. 9. A United States certificate of naturalization. 10. A United States certificate of citizenship. 11. A tribal certificate of Indian blood. 12. A tribal or bureau of Indian affairs affidavit of birth. Please submit a photocopy of both the front and back of your identification with your completed application. Please also be prepared to present your identification at the time of inspection by the field services officer. If the answer to question 10. above is "NO" please answer question 11. INVe certify that the kennel permit is being used solely for the purpose of licensing my own multiple compantbn dogs in my household. Wile certify that all of the information 1NVe have provided is true and accurate under penalty of law. 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 Type of identification submitted BOS Approval Date Term of Permit Maricopa County Animal Care and Control 2500 S. 27th Avenue Phoenix, AZ 85009-6797 (602) 506-7387 http://pets.maricopa.gov Receipt Number: R14-138535 Receipt Date: 07/15/2014 Person ID: P1425621 Phone: 805 4410418 BAIRD KENNELS 4407 N 379TH AVE 7/15/2014 11:31:18AM TONOPAH, AZ 85354 Item: Animal ID: Reference No: Price: Each: Amount: KEN PERMIT A7777777 K15-000026 $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 9114/1999, 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 Rabies Certificate 04/11/2014 Name: CINDERELLA Date of Birth: 04/01/2012 Sex : F Age: 2 Years 0 Months Species: CAN Color: Yellow Breed: LAB RET Weight: 0.00 Procedure Performed: 3 Yr Rabies Vacc. Owned By: Don Baird 4407 N 379th Ave Tonopah, AZ 85354 Microchip # //1 year Lic/Vacc Vacc. Serial # Producer: Pfizer _yeL 3 year Lic/Vacc S288729C For Licensing Date Vaccinated Agency Use Veterinarian # H I(/ Month Day Year Clinic: Squaw Peak Animal Hasp Other Vaccine Expires 3165 E Lincoln Dr #115 Change Add Phoenix AZ 85016 Control # CD Office 602-553-8855 Month pay Year Fax 602-553-0188 Signed ' D.V.M. V Squaw Peak Animal Hospital 3165 E Lincoln Dr #115 Phoenix, AZ 85016 (602) 553-8855 Rabies Certificate 04/11/2014 Name: JOJO Date of Birth: 12/17/2013 Sex : F Age: 0 Years 3 Months Species: CAN Color: Yellow Breed: LAB RET Weight: 0.00 Procedure Performed: 1 Yr Rabies Vaccine Owned By: Don . Baird 4407 N 379th Ave Tonopah, AZ 85354 Microchip # 1// 1 year Lic/Vacc Vacc. Serial # Producer: Pfizer 3 year Lic/Vacc S288729C For Licensing Date Vaccinated Agency Use Veterinarian # 1'1571 1 Month Day Year Clinic: Squaw Peak Animal Hosp Other Vaccine Expires 3165 E Lincoln Dr #115 Change Add Phoenix AZ 85016 Control # Office 602-553-8855 Month Day Year Fax 602-553-0188 Signed fit /IAA - A 11,4 V/010 om D.V.M. Squaw Peak Anil:4a], Hospital 3165 E Lincoln Dr #115 Phoenix, AZ 85016 (602) 553-8855 CERTIFICATE OF VACCINATION Date of Rabies Vaccination: 06-03-13 Certificate No: 0 Next Rabies Vaccination On: 06-03-16 Previous Rabies Vaccination: VETERINARY CLINIC OWNER OF ANIMAL Arizona Spay & Neuter Clinic Liz Baird 6835 E. Thomas RdS 4407 N 379th Ave Scottsdale , AZ 85251 Tonopah, AZ 85354 County: This is to certify... THAT I HAVE VACCINATED AGAINST RABIES THE ANIMAL DESCRIBED BELOW. Patient information... PATIENT: Bliss TAG NO: SPECIES: Canine WEIGHT: 22,60 SEX: S AGE: 5 years Color and markings... Liver and White at e.,0/0Ambli/h, irt Signed I - Mel Pence License: UN Vaccinations done... 06-03-13 MEP Rabies Vaccine 06-03-16 Rabies Vaccine Information... MFG BY: Nob SER.NO: S2820700 LOT EXP: 01/07/14 ADM: SQ Rabies Certificate 01/04/2012 Name: CHLOE Date of Birth: 03/09/2010 Sex : F Age: 1 Years 9 Months Species: CAN Color: Yellow Breed: LAB RET Weight: 0.00 Procedure Performed: 3 Yr Rabies Vacc. Owned By: Don Baird 4407 N 379th Ave Tonopah, AZ 85354 ,1 year Lie/Vace Vacc. Serial # Producer: Pfizer vt 3 year Lic/Vacc S062713C For Licensing Date Vaccinated Agency Use Veterinarian # 4677( 01 04 AD/O, Month Day Year Clinic: Squaw Peak Animal Hosp Other Vaccine Expires 3141 E Lincoln Dr Change Add Phoenix AZ 85016 Control # 01 04 ,a015 Office 602-553-8855 onth. Day Year Fax 602-553-0188 bmA Signed /Aqv D.V.M. Squaw Peak Animal Hospital 3141 E Lincoln Dr Phoenix, AZ 85016 (602) 553-8855 CERTIFICATE OF VACCINATION Date of Rabies Vaccination: 06-05-13 Certificate No: 0 Next Rabies Vaccination On: 06-05-16 Previous Rabies Vaccination: 1215538A VETERINARY CLINIC OWNER OF ANIMAL Arizona Spay & Neuter Clinic Don Baird 6835 E. Thomas RdS 4407 N 379th Ave Scottsdale , AZ 85251 Tonopah, AZ 85354 480-874-3647 County: This is to certify,.. THAT I HAVE VACCINATED AGAINST RABIES THE ANIMAL DESCRIBED BELOW. Patient information... PATIENT: Monica TAG NO: 1215538A SPECIES: Canine WEIGHT: 6t30 SEX: F AGE: 23 months Color and markings... Yellow Signed A.12,01444t4-tii,41) #i Mel Pence License: VeLl Vaccinations done... 08-05-13 MEP Rabies Vaccine 06-05-16 Rabies Vaccine Information... MFG BY: FD SER.NO: S285956B LOT EXP: 01107114 ADM: SQ Date of Rabies Vaccination: 02-10-12 Certificate No: 0 Next Rabies Vaccination On: 02-09-15 Previous Rabies Vaccination: VETERINARY CLINIC OWNER OF ANIMAL Arizona Spay & Neuter Clinic Liz Baird 6835 E. Thomas RdS Scottsdale , AZ 85251 480-874-3647 County: This is to certify... THAT I HAVE VACCINATED AGAINST RABIES THE ANIMAL DESCRIBED BELOW. Patient information — PATIENT: Ruby TAG NO: 1215458A SPECIES: Canine WEIGHT: 74.90 SEX: F AGE: 22 months Color and markings-. Yellow Signed Mel Pence License: -Votvi---F Vaccinations clone_ 02-10-12 MEP Rabies Vaccine, #1215458A 02-09-15 Rabies Vaccine Information... MEG BY: FD SER.NO: 873209A LOT EXP: 05/12 ADM: SQ Rabies Certificate 06/19/2014 Name: TRUFFLES Date of Birth: 01/12/2013 Sex : F Age: 1 Years 5 Months Species: CAN Color: Chocolate Breed: LAB RET Weight: 0.00 Procedure Performed: 3 Yr Rabies Vacc. Owned By: Don Baird 4407 N 379th Ave Tonopah, AZ 85354 Microchip # '1 year Lic/Vacc Vacc. Serial # Producer: Pfizer 3 year Lic/Vacc S3118 16C For Licensing Date Vaccinated Agency Use Veterinarian ( (I Month D-ay Year Clinic: Squaw Peak Animal Hosp Other Vaccine Expires 3165 E Lincoln Dr #115 Change Add Phoenix AZ 85016 Control 4 Office 602-553-8855 Month Day Year Fax 602-553-0188 Signed D.V.M. Squaw PeakAnimal Hospital 3165 E Lincoln Dr #115 Phoenix, AZ 85016 (602) 553-8855 Rabies Certificate 06/20/2014 Name: THALIA Date of Birth: 11/19/2012 Sex F Age: 1 Years 7 Months Species: CAN Color: Yellow Breed: LAB RET Weight: 0.00 Procedure Performed: 3 Yr Rabies Vacc. Owned By: Don Baird 4407 N 379th Ave Tonopah, AZ 85354 Microchip # 1 year Lic/Vacc Vacc. Serial # Producer: Pfizer 3 year Lic/Vacc 1S311816C For Licensing Date Vaccinated Agency Use Veterinarian /4 Month Day Year Clinic: Squaw Peak Animal Hosp Other Vaccine Expires 3165 E Lincoln Dr #115 Change Add Phoenix AZ 85016 Control # Office 602-553-8855 Month Day Year Fax 602-553-0188 Signed 0 aeete, 491/4fit D.V.M, Squaw Peak Animal Hospital 3165 E Lincoln Dr #115 Phoenix, AZ 85016 (602) 553-8855 Rabies Certificate 06/20/2014 Name: HEIDI Date of Birth; 10/01/2005 Sex : F Age: 8 Years 8 months Species: CAN Color: Blenheim Breed: CAV KING Weight: 0.00 Procedure Performed: 3 Yr Rabies Vacc. Owned By: Don . Baird 4407 N 379th Ave Tonopah, AZ 85354 Microchip # vf 1 year Lic/vacc Vacc. Serial # Producer: Pfizer 3 year Lic/Vacc S3118 16C For Licensing Date Vaccinated . Agency Use Veterinarian &1_3 c„„)0 / Month Day Year Clinic: Squaw Peak Animal Hosp Other Vaccine Expires 3165 E Lincoln Dr #115 Change Add Phoenix AZ 85016 Control # LL l I Office 602-553-8855 Month Day Year Fax 602-553-0188 Signed 44,e4c ; 4/4-% D.V.M. Squaw Peak Animal Hospital 3165 E Lincoln Dr #115 Phoenix, AZ 85016 (602) 553-8855