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Raricopa 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 NA Renewal Permit # KIS-000 Name: (7.;‘,..„,er,-, emu), Kennel Name: Dod Fott ricia4; 011 Mailing Address:gas-a 0. is'Aue Kennel Location: ?).--a5--(9, z • t. S Ave AZ ZIP W14 I County Supervisorial District Hc Kennel Phone: goo-3473-36 y/ 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 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 andIor 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. 66 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). 2.6'6 INVe certify that the kennel has been approved by the local zoning authority (if applicable) at the premises for which !Awe are making application for a permit 3. INVe certify that I/We have 9 dogs and that the kennel meets the definition in statute. 4.6LIIINe certify that IfiNe have not been convicted of a violation of A.R.S. §§ 13-2910 (cruelty to animals) or 13-2910.01 (dog fighting), or any other state, county or municipal animal welfare law. (Violations of license and leash laws DO NOT apply.) 5. 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 I/We are submitting a valid copy of the rabies vaccination certificate for each dog with this application. 7. 66 IANe understand that a dog remaining within the kennel is not required to be licensed individually under ARS 11-1008. liwe 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. 8.66 le understand that a person who fails to obtain a kennel permit under ARS 11-1009 is subject to a penalty of twenty-five dollars in addition to the annual fee. 9. 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. 10.66 Is this kennel permit being obtained for the purposes of operating a businesncluding but not limited to breeders, groomers or boarding establishments? (Please check one) V 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. 2. 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. 5. 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. 11. — INVe certify that the kennel permit is being used solely for the purpose of licensing my own multiple companion dogs in my household. Iffle certify that all of the inforrnajjon I/We have provided is true and accurate under penalty of law. Applicant Signature Applicant Signatt.ife DG 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: R14-133241 Receipt Date: 07107/2014 Person ID: P0310051 Phone: 602 2760051 EYE DOG FOUNDA KENNELS 8252 S 15TH AVE 7/7/2014 12:00:40PM PHOENIX, AZ 85041 Item: Animal ID: Reference No: Price: Each: Amount: KEN PERMIT A7777777 K15-000020 $328.00 1 $328,00 Total Foos 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 APODA CAP EBUSOFF Maricopa County Animal Care & Control 2500 South 27th Avenue A lqq33 Phoenix, AZ 85009 Phone: (602) 506-7387 pets.maricopa.gov KENNEL PERMIT PREMISE INSPECTION APPLICANT E old ri eta I ion STREET ADDRESS Fa3,; 3 cc."-‘ CITY, STATE, ZIP Deni)c A SOLLt PHONE WO -1)q 3 36( I ALTERNATE PHONE Z., ;) - 7 6 COUNTY DISTRICT KENNEL LICENSE # KI,5-.0)D NUMBER OF DOGS la 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 ofeach 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 t/ No CORRECTIVE ACTION NEEDEDFOR COMPLIANCE AND DAYS GIVEN BEFORE REINSPECTION. (Note: There will be $49 re-inspect fee pa yable to the Inspector by check upon each return visit. ) Deputy Enforcement Agent Date 7-18—(4 SOUTHSIDE ANIMAL HOSPITAL DR, YOCHAM 6045 5, CENTRAL Phoenix, AZ 85040-2135 (602) 276-5505 Ad03 Rabies Certificate Patient ID: 9260-678 Client ID: 9260 Patient Name: STELLA Client Name: Eye Dog Foundation Species: CANINE Address: P.O. Box 519 Breed: GERMAN SHEPHERD Sex: Spayed Female Claremont, CA 91711-0519 Color: BLACK/TAN Phone: (909)626-5131 Markings: Birthday: 08/15/2011 Weight: 55,00 pounds on 12/6/2012 Tag Number: 0 Vaccination Date: 1216/2012 Lot Number: 12568 Expiration Date; 1216/2015 Producer- Rhone/Merial K / MLV / Killed Virus ) tet," Staff Name: G. ID, Yeoham, DVM License Number: AZ 962 SOUTHSIDE ANIMAL HOSPITAL DR. YOCHAM 6045 S. CENTRAL Phoenix, AZ 85040-2135 (602) 276-5505 Rabies Certificate Patient ID: 9260-679 Client ID: 9260 Patient Name: ROXY Client Name: Eye Dog Foundation Species: CANINE Address: P.O. Box 519 Breed: GERMAN SHEPHERD Sex: Spayed Female Claremont, CA 91711-0519 Color: BLK & TAN Phone: (909)626-8131 Markings: Birthday: 08/15/2011 Weight: 62.00 pounds on 12/6/2012 Tag Number: 0 Vaccination Date: 12/6/2012 Lot Number: 12568 Expiration Date: 12/612015 Producer: Rhone/Merial K / MLV / R: Killed Virus Staff,Name: G. D. Yocham, DVM License Number: AZ 962 SOUTHSIDE ANIMAL HOSPITAL DR. YOCHAM & DR. TASCON 6045 S. Central Phoenix, AZ 85042 (602) 276-5505 Rabies Certificate Client ID: 9260 Patient ID: 9260-685 Client Name: Eye Dog Foundation Patient Name: BELLA Address: P.O. Box 519 Species: CANINE Breed: GERMAN SHEPHERD Sex: Female Claremont, CA 91711-0519 Color: BLACK/TAN Phone: (909)626-8131 Markings: Birthday: 08/1612013 Weight: 43.00 pounds on 1/16/2014 Tag Number: 0 Vaccination Date: 1/16/2014 Lot Number: 8305798D Expiration Date: 111612015 Canine Rabies 1 yr. Producer: PFIZER K / MLV R: Killed Virus c ç Qe *1/64.1 Staff Name: G. D. Yocham, DVNI License Number: AZ 962 1 # 0S0917698061 uo!lepunod boa aA3f al:Nfti-SZ-90 SOUTHSSIDE ANIMAL HOSPITAL DR. YOCHAM & DR. TASCON 6045 S. Central Phoenix, AZ 85042 (602) 276-5505 Rabies Certificate Client ID: 9260 Patient ID: 9260-687 Client Name: Eye Dog Foundation Patient Name: BARKLEY Address: P.O. Box 519 Species: CANNE Breed: GERMAN SHEPHERD Claremont, CA 91711-0519 Sex: Male Color Phone: (909)626-8131 Markings: Birthday: 12/03/2013 Weight: 43.00 pounds on 4/9/2014 Tag Number: 0 Lot Number: S305798K Vaccination Date: 4/9/2014 Canine Rabies 1 yr. Expiration Date: 4/9/2015 Producer: PFIZER K / ML.V / R: Killed Virus Staff Name: con D License Numbkr: AZ 4676 OSOW9606 uo!lepunoj 6oG 9A3: 90:06!t1-S6-90 SOUTHSIDE ANIMAL HOSPITAL DR, YOCHAM & DR. TASCON 6045 S. Central Phoenix, AZ 85042 (602) 276-5505 Rabies Certificate Client ID: 9260 Patient ID: 9260-686 Client Name: Eye Dog Foundation Patient Name: BRETT Address: P.O. Box 519 Species: CANINE Breed: GERMAN SHEPHERD. Claremont, CA 91711-0519 Sex: Male Color: Phone: (909)628-8131 Markings: Birthday: 12/03/2013 Weight: 41,00 pounds on 4/912014 N•11.11I11• Tag Number: 0 Lot Number: S305798K Vaccination Date: 4/9/2014 Canine Rabies 1 yr. Expiration Date; 4/912015 Producer: PFIZER K / MLV / R; Killed Virus ttaaffff NNaammee:: MMeerroo TTaasoon DVM MIIN•••• E A # 090917Z9806 uo!iepunoj 600 eA3: SO:E:t1-9-90 SOUTHSIDE ANIMAL HOSPITAL DR. YOCHAM & DR. TASCON 6045 S. Central Phoenix, AZ 85042 (602) 276-5505 Rabies Certificate Client ID: 9260 Patient ID: 9260-689 Client Name: Eye Dog Foundation Patient Name: BAILEY Address: P.O. Box 519 Species: CANINE Breed: GERMAN SHEPHERD Claremont, CA 91711-0519 Sex: Female Color: Phone; (909)626-6131 Markings: Birthday: 12/03/2013 Weight: 41,00 pounds on 4/9/2014 Tag Number: 0 Lot Number: 8305798K Vaccination Date: 4/9/2014 Canine Rabies 1 yr. E.xpiration Date: 419/2015 Producer: PFIZER K I MLV / R: Killed Virus Staff Name: Mario Tascon DVM License Number: AZ 4676 IC 4 090919606 1, uo!lepunod 6113 3A]: 90:0C171-9-90