FRIENDS FOR LIFE RESCUE.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
New t: Renewal Permit # — o
Name: vv-fi c-e Kennel Name: eeis F-01---
Mailing Address: 1k3 LA) . (4,5 link Kennel Location: Lo,
city cAvo , AZ ZIP_$(.-r.r) 3 '1 ( County Supervisorial District
Home Phone: VCS-1 (c)CMC Kennel Phone: 145co LIT'? ac0
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 fora 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. CAI'' I/We 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. C}'-)l/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.
3.0 I/We certify that INVe have v3 dogs and that the kennel meets the definition in statute.
4. I/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 any other state, county or municipal animal welfare law. (Violations of license
and leash laws DO NOT apply.)
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 with this application.

INVe understand that a dog remaining within the kennel is not required to be licensed individually under
ARS 11-1008. I/we 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. _ INVe understand that a person who fails to obtain a kennel permit under ARS 11-1009 is subject to a
pen of twenty-five dollars in addition to the annual fee.
INVe understand that a person who knowingly fails to obtain a kennel permit within thirty days after
writl en notification from the county enforcement agent is guilty of a class 2 misdemeanor.
•18:--) Is this kennel permit being obtained for the purposes of operating a bus)Mss including but not limited to
breeders, 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.
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.
INVe certify that the kennel permit is being used solely for the purpose of licensing my own multiple
companion dogs in my household.
IRAfe certify that all of the information I/We 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 & Control A
2500 South 27th Avenue
Phoenix, AZ 85009
Phone: (602) 506-7387
pets.maricopa.gov
KENNEL PERMIT PERMIT PREMISE INSPECTION
APPLICANT Fr ,ge
STREET ADDRESS PI //:5 ,c1
CITY, STATE, ZIP G.; I all f A
HOME PHONE 14W 9L—S- f70/3 BUSINESS PHONE 7, F(3
COUNTY DISTRICT KENNEL LICENSE # SI5-01 0 NUMBER OF DOGS / 13
1. Are all dogs over the age of three months properl y vaccinated for rabies and in possession of a
valid rabies vaccination certificate?
Yes No
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 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. )
sx
Deputy Enforcement Ag at Date

Maricopa County Animal Care and Control
2500 S. 27th Avenue
Phoenix, AZ 85009-6797
(602) 506-7387
http://pets.maricopa.gov
Receipt Number: R14-111098 Receipt Date: 06/0412014
Person ID: P1279029
Phone: 480 4978296
FRIENDS FOR LIFE RESCUE
143W VAUGHN AVE 6/4/2014 10:35:31AM
GILBERT, AZ 85233
Item: Animal ID: Reference No: Price: Each: Amount:
KEN PERMIT A7777777 K15-000010 $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

Control Change Other License For Producer: Namedillik Cat Dog Species: PR1N: Owner's
No. 0 No. Licensing Name
I% &
Add Agency Female Male Sex:
0 (First IC) Address
Year Use 3
letters)
antrAr_la 12 •
Month calaj Month DATE o. or 3mo,tol2mo. RABIES
VACCINATION VAC 0 Ar1 older
a yr. 3 yr. , 0 fig A Print -
Day -7 EXPIRES: Day INATED: Lic.Nacc. Lic.Nacc. Over 20-50 Under Size: use NASPHV VACCINATION
50 lbs. 20 ban
0-615 lbs. lbs. pant Form
Year Year NI pen
or #50
s r a e CI Other type CERTIFICATE
Ceieste i Ciii Predominant
41 I
1459 --34kL,‘ 421 Breed: (4L
Gilbert. 8, liTILVe, Signature Skintin, Vacc.
A7 Higey Msme cense aai Serial Rabies
F15296 Rct No. -•. (lot) —C4aiors: Tag
.g104 4-74:V5° OVIV1#4460 Nc. g5a-a3 2 Number
94

Humane Society of Yuma, Inc.
14050 SOUTH AVE 4 112E
YUMA, AZ 85365
, Phone: (928) 782-1621
Ask About Our Low Cost Clinic Services! 928-247-9115
Vaccination Certificate
Vaccination information:
Vaccination ID HSOY
Vaccination Type RABIES
Effective Date 05-13-2014
Expiration Date 05-13-2015
Issued by PAUL CARNEY DVM
Druu administered:
Manufacturer PFIZER
Vaccine RABVAC 3
Lot ID 1302870
Serial ID
Pet Name DEAN r lej3,5 License None on record
Species DOG !Dr: 13345-0 Vacc ID HSOY
Primary Breed BEAGLE Microchip 982000363734208 (P
Gender MALE/STERILIZED Registration None on record
Age ADULT
Size MEDIUM
Bites NO
Veterinarian Signature
Veterinarian ID # 720
immagenweigilk
Federal Tax ID 86-6053617
Printed using Shelter Pro

Humane Society of Yuma, Inc.
4050 SOUTH AVE 4 1/2E
YUMA, AZ 85365
Phone: (928) 782-1621
Ask About Our Low Cost Clinic Services! 928-247-9115
Spay/Neuter Certificate
Case ID 05-02-2014 18
Species DOG ID#: 133450
Pet Name—DEAN G- j bb
Primary Breed BEAGLE
Crossbreed TERRIER
Gender MALE/STERILIZED
Pickup Date
SPAY/NEUTER CERTIFICATE - This animal was sterilized at the Humane Society of Yuma Spay/Neuter Clinic.
Thank you for sterilizating your pet and saving lives.
Federal Tax ID 86 -6053617
Printed using Shelter Pro

kw-aihrtnizifitileatti-sFerEith*E
(-411
Humane Society of Yuma.
4.0:014.1WAW.4:. *ME Inc.
117404,
Phone. (%.2-8) 782-4621
Ask About Our Low Cost Clinic
Services! 928-247-9116
Vaccination Certificate
-st4vsfkzzfgo kelemr0firvis-:
VaccinViitie10 .-
Effective Vaccinattem Type: 'RABIES-
Expiration Date Date 03-25-2014
Issued by 03-25-2015
CARNEY/ PERRY DVM
Ilciairdarer
Vaccine
Pet Name RASVAC 3 -
Species A131tAtONNI1BOOMER- Serial ID 1370441
Prirtemy arced cow& DOG IOC 131360 Vacc License None on record 5303970
Age Gentler amEz-sw- rJzEz tillirrochip ID None on record
Size *MILT O20=61919132
MEDIUM
Sites
NO
Veterinarian 10 # )-1
720
Federal Tax 10 86.6053617
Printed using Shelter Pro

Humane Society of Yuma, Inc.
4050 SOUTH AVE 4 1/2E
YUMA, AZ 85365
Phone: (928) 782-1621
Ask About Our Low Cost Clinic Services! 928-247-9115
Vaccination Certificate
Vaccination information:
Vaccination ID HSOY
Vaccination Type RABIES
Effective Date 05-20-2014
Expiration Date 05-20-2015
Issued by CARNEY/ PERRY DVM
Drug administered:
Manufacturer PFIZER
Vaccine RABVAC 3
Lot ID 1312870
Serial ID 8309091
Pet Name CHARLES License None on record
Species DOG ID#: 134063 Vacc ID HSOY
Primary Breed CHIHUAHUA Microchip 982000361931857
Gender MALE/STERILIZED Registration None on record
Age ADULT
Size SMALL
Bites NO
Veterinarian Signature
Veterinarian ID # 720
goompoompoom
1
gle )811
Federal Tax ID 86-6053617
Printed using Shelter Pro

Humane Society of Yuma, Inc.
4050 SOUTH AVE 4 112E
YUMA, AZ 85365
Phone: (928) 782-1621
Ask About Our Low Cost Clinic Services! 928-247-9115
Spay/Neuter Certificate
Case ID 05-14-2014 58
Species DOG ID#: 134063
Pet Name CHARLES
Primary Breed CHIHUAHUA
CrOSSbreed MIXED BREED
Gender MALE/STERILIZED
Pickup Date
SPAY/NEUTER CERTIFICATE - This animal was sterilized at the Humane Society of Yuma Spay/Neuter Clinic.
Thank you for sterilizating your pet and saving lives.
Federal Tax ID 86 -6053617
Printed using Shelter Pro

RABIES VACCINATION CERTIFICATE Rabies Tag Number
NASPHV Form #50
Owner's Name & Address Prin.; - use ball point pen or Woe
PRINT - L
ml .-LIVW7-go?
110 10 Vagqkt. hit Cgiff ibeil- Ate 4R636g
Specte5(.. Sex: ge: Size: Predominant Breed:
Dog Male 3 mo. to 12 mo t.1 -4 nder 20 lbs.
Cat Female U 12 + or older U 20-50 lbs. 131 ; ht.itat“45L) --'169-jn il)rs:
Name ' vr-ro 1,r ilitwier U Ver 50 lbs. U
-AM" Vacc. Serial (lot) No.
Producer: 1 yr. Uc.Nacc.
(First 3 letters) U 3 yr. Lic.Nacc. Otherr /NMRAt/t1
For Licensing Agency Use DATE VACCINATED:
License No. Year 0(9 04 001 License No. \1N
Month Day Yed I Askew,my # 1672
Other VACCINATION EXPIRES: Wiltl's Place #737
Change U Add 1:3 D6 ot/ r 1459 S, Higley Rd #104
Control No. Gilbert, AZ 85296
Month Day Year
D4
16.7311LUICE" &Ma—swarms oary.cows..
480-279-NIKI (6454)
NEUTER CERTIFICATE
ISSUE/SURGERY DATE: Ra ct
PET OWNER: FRIENDS FOR LIFE
ADDRESS: 143 WEST VAUGHN AVENUE, GILBERT, AZ 85233
HOME/OFFICE #: 480-497-8296 CELL #:
PET NAME:C.9AUdi CANINE:,/ FELINE:
BREED:1% ftttFILtec—, MALE: V FEMALE:
CO? & MAR_KINGS:Lft:n oath__ D.O.B. /AGE: rrx,n+h3
V This is to certify that the animal described above has been surgically sterilized at
Niki's Place on the date listed above.
I have examined this pet and found evidence of sterilization done
elsewhere. Surgery was not performed at Mari Place.
ao-Plem) bdileu
J t°RikEitwabvm #1672

nitn.er's RABIES VACCINATION CERTIFICATE
PRIN & Address P.rint NASPHV :use ball oint Form en #50 or t
Ize: —
„Under 20 lbs.
20-50 lbs.
Over 50 Lbs. U a I
1 yr. Lic.Nacc.
For Licensing Agency Use DATE U 3 yr. Lic.Nacc.
License No. Year
Month ilitAskew, DX/Rif*16
Other 72
Control Change EJ Add Di Nikii%jrZe *737
1459 S, Highay Rd #104 14
Oilbert, AZ 85295
411PCP 411, ,
SPAY CERTIFICATE
O out 4
ISSUE/SURGERY DATE:
PET OWNER: FRIENDS FOR LIFE
ADDRESS: 143 WEST VAUGHN AVENUE, GILBERT, AZ 85233
HOME/OFFICE #: 480-497-8296 CELL #:
ryLbi4 COL_ CANINE: / FELINE:
PET NAME:
MALE: FEMALE: / _
BREED.
COLOR & MARKINGS: --r faNTh D.O.B. /AGE:ZzarrA_-__q4f1S-
This is to certify that the animal described above has been surgically sterilized at
Niki's Place on the date listed above.
I have examined this pet and found evidence of sterilization done
elsewhere. Surgery was not performed at N 's Placa.

RABIES VACCINATION CERTIFICATE Rabies Tag Number
NASPHV Form #50
Jwner'sNiardress Print - use ball point pen or type
;HINT - Last -r—
Fil ' 1 M I Lle6h6neli ql 9-NIKI (6454)
Street City
413..VC-1-; C qh tve 61
ipecles: Sex: Age: Size: Predominant Breed: r"le , ZS425 Colors: ENT FORM
Jog IS1 Male tif 3 mo. to 12 mo. U Under 20 lbs. 1-3
at U Female U 112 mo. or older NI 20-50 lbs. a bco\o)u-
Jame c.wxyv— Lou ed Over 50 lbs. 1:1
roducer: i1 Vacc, Serial (lot) No. ZIP: 11')-(.'4/
yr. Lic.Nacc. 3ZZLiri
(First 3 letters) LI 3 yr. Lic.Nacc. Other
or Licensing Agency Use DATE VACCINATED:
.icense No. Year Veten7rd ./
LIcen e No/1 _Neutered 1.1 Female Spayed
Month Day Year
)ther VACCINATION EXPIRES: C -Na4o_iii9y,DVil #5033 Age: -7\-1 V -
;flange la Add C:)I 7,61 t d r Mktg risee #737
.:ontrol No. e s 1459 S, Higiey'Rri #1D4 _ DENTAL OTHER
Month Day Year S Gilbert, AZ 85/96
ES, WE CAN NOT DO SURGERY TODAY)
Yes No Is your pet allergic to any drugs? If yes explain:
Yes No is your pet on any medications? If yes explain:
Please check all the ones you would like for your pet today. $ Save money and get one of our Vaccine Packages $
DOGS: Weight: (._, I - I CATS: Weight: ESTIMATED COST (Dr. to fill out)
)(Rabies VacciW-F" $30 _Rabies Vaccine $30 SURGERY COST: $
____Distemper/Parvo Vaccine $30 FVRCP Vaccine $30 VACCINE COST: $ - 7_0
_Bordetella Vaccine $30 FELV (Leukemia) Vaccine $30 PAIN MEDS COST: $
___Hearfworm Test $35 Combo Leukemia/F1V test $40 DENTAL COST: $
___Take Home Pain Medication $15 Take Home Pain Medication $15 &COLLAR: $
___Blood Work $95 Blood Work $95 OTHER: $
_ Dental Cleaning $100 to $250 _Declaw $175 to $350 OTHER: $
_E-Collar _ $10 _ Dental Cleaning $100 to $250 OTHER: $._.,_
_Microchip - $45 Microchip $45 TOTAL COST: $ ,r-D
ADDITIONAL CHARGES — Your pet will be weighed, their temperature, pulse and respiration will be noted. Our veterinarian will perform a
pre surgical physical exam on your pet, she will exam their eyes, ears, mouth, teeth, skin condition, coat, and abdomen. She will listen to your
pet's heart & lungs. If your pet is an acceptable surgical candidate, sterilization procedures will be performed. Additional charges ($10 to
$100) can and will occur if your pet is overweight, currently in heat, currently pregnant, or if your pet is a male and both his testis are
not in the scrotum (Crypt orchid). You will be informed of any additional charges prior to leaving the pet with us.
Please read and initial each of the following:
It is required by law that dogs ages 3 months & older have a current Rabies vaccination. Please provide proof of a current rabieseine or
if unable to provide proof of an up-to-date rabies vaccine one will be given today at a charge of $20. Initial
I certify that I own/or assume financial responsibility for the above pet and grant NIKI'S PLACE and its staff members or agents my consent
to perform sterilization surgery and/or vaccinations upon the animal named above. I understand that modern techniques and trained staff will
be used to care for all animals, and reasonable precautions will be used against injury, escape or destruction of the animal. It is ,thoroughly
understood that NIKI'S PLACE, its staff, and agents will not be held liable or responsible in any manner, and I assume all risks.
I understand that payment in full is required at the time of discharge from NIKI'S PLACE.
We accept Cash, Debit, Visa, MasterCard, Discover and American Express. (WE DO NOT ACCEPT CHECKS) Initial
Your pet will be ready for discharge between 12:00 p.m. and 3:00 p.m. You will receive a phone call after their surgery is completed
with the actual time of pickup. Please provide a phone number where you can be reached.
Sitinatirrp. nf ismariReanrinskle-Areft; Date:
6 FilEr 77:771 ..4.. cr IF- 5 sa:VNt v ez• ie le
'..= sTi -1
w P P e. lot l' ne CI Cr3
Plij P i ; ° ry — Veterinarian Signature:
Dr. Nichols Ray,DC1M- #503i

Humane Society of Yuma, Inc.
4050 SOUTH AVE 4 112E
YUMA, AZ 85365
Phone: (928) 782-1621
Ask About Our Low Cost Clinic Services! 928-247-9115
Vaccination Certificate
Vaccination information:
Vaccination ID HSOY
Vaccination Type RABIES
Effective Date 05-01-2014
Expiration Date 05-01-2015
Issued by PAUL CARNEY DVM
Drug administered:
Manufacturer PFIZER
Vaccine RABVAC 3
Lot ID 1312870
Serial ID S309091
Pet Name KERMIT License None on record
Species DOG ID#: 131618 Vacc ID HSOY
Primary Breed CHIHUAHUA Microchip None on record
Gender MALE/STERILIZED Registration None on record
Age ADULT
Size SMALL
Bites NO
Veterinarian Signatur&—
Veterinarian ID # 720
Federal Tax ID 86-6053617
Printed using Shelter Pro

Humane Society of Yurna Inc.
4050 SOUTH AVE 4 112E
VU MA, AZ 85365
Phone (928) 782-1621
Ask About Our Low Cost Clinic Services! 928-247-9116
Spay/Neuter Certificate
Case ID 03-24-2014 14
Species DOG IDif: 131618
Pet Name KERMIT
Primary Breed CHIHUAHUA
Crossbreed
Gender MALE/STERILIZED
Pickup Date
SPAY/NEUTER CERTIFICATE - This animal %rya§ sterilized at the Flumane SOciety of Yuma Spay/Neuter Clinic.
Thank you for Sterilizatirig your Pet and Saving lives.
Federal Tax ID 88 -6053617
Printed using Shelter Pro

RABIES VACCINATION CERTIFICATE Rabies Tag Number
NASPI-IV Form le)
Owner:elf.tiito 3. Address Print - use ballpoint pen or type
• pram- - last— Ft M.I. ittyntiejlnw7
1.146 I Arfax,t. end Aosix 15-d
Sex: A4: Size: Gir ,Predominant Breed: )
Dog fAtt4re Or 3 MO. ID rno. 1 Under 20 5bs. U LIU) -7-7-17—
Cal I Female 12 Mu. or otho r: ii 1 20-50 the.
Peale t , 1 Over 50 ths. re-• Upl U2-1(.614
Vacc. Serial (lot) No.
yr.LiciVece.
(First S letters) r.:1 3 yr. Lic./Vacc. Other
For Licensing Agency Use DATE VACCINATED: ey--1 e to JARMO A A
ik.epara t‘to._ Yesi „I t
45.talts Oatr Year ti 11441-672
Other VACCINATION EXPIRES: /4 MI6 1OC #737
Change ID Add LI r 14S9 G. Higley Rd #104
Control No. -4 IZt 1t55SS
Month Day Year )4
NAN:. "64s4)
NEUTER CERTIFICATE
Kr.
'SSE rE/SURIIERY DATE: 1
I
PET OWNER: FRIENDS FOR LIFE
VmTSCI: 143 WEST VAUGHN AVENUE. 04,13ERT. AZ ,85233
HOME/01rFICE #: 480-497-8296 CELLS:
PET NAME: CANINE: FELINE:
BREED: A41,U iia e „
,
COLOR &MARKINGS: 4—Tar-ttTh D.O. B. /AGE: it/ • 4i. -
V This is to certify that the animal described above has been surgically sterilized at
Place rai the date listed above.
I have exv-minea .11'14 pet fdde -ee -41-ion 1 ndne
elsewhere. Surgery was not performed at Nan Place.
av-JheAid bdieen, 1.
(„
ql-p 1 I I t.-
Nk tfialt,,X Date. Signed

Control Change Other License For Producer: Name Cat Dog Species: No. PRINT Owner's
Licensing Zi -
No. DI No. Last Name
Add Agency Female Male Sex: &
UI (First Address
Year Use 3 t:11
letters) 3 sStsreeUatA_st.s
12 mo. Age:
Month Month DATE mo. or to RABIES
VACCINATION older 12
3 Tyr. mo.r.) Print
VACCINATED: yr. . First -
use
Day Int EXTIES: Day Lic.Nacc. LicJVacc. Over 20-50 Under Size: ball NASPI-11/ VACCINATION
50 lbs. lbs. 20 point
lbs. r Form
Year Year e pen
CI 'W Zi or #50
ye Other type CERTIFICATE
I
Dr. Predominant FIK?
1459
Plikres # :
Gilbert, S, Jt Breed: M.1.
AZ Higley Moe NichoVVR,VM Vacc. State _ite
ic -3 Serial IS Rabies
852u6 Rd 0737 (lot) Zi Tag
#104 0-DaiA No. ors mai_
#5033 S7,233 Number
tazite
7;2)

Other License For Name Cat Dog Species: PRINT Owner's
Control Change -
No. No. Licensing I X Last Name
0 &
Add Agency Female Male Sex: wsl cf.. \ Address
(First
Year Use 3 a 1.3
letters) 12 3 Ag4: clr,
mo. mo. to hn
Month _1- Month DATE or 12 coy RABIES
VACCINATION older mo.1:11 Print
VACCINATED: 3 yr. 1 yr. -
Lic.Nacc. Lic.Nacc. Over 20-50 Under Size: tidtIst.,_f use ball NASPHI/ VACCINATION
Day EXPIRES: Day 50 lbs. 20 City
lbs. lbs. point Form
Year 15 Year *I 0 t0 pen or #50
1 Other type CERTIFICATE
eteri u\11 Omer', Predominant
an'st 003
coon Breed: M.I.
11.13Z
Gilbert, Vacc. PT2
Rabies
AZ Serial rretSlegrq7
v (lot) Tag
85296 di No. Ztsz5.3 Number
ti--i-t .
sz%
0

RABIES VACCINATION CERTIFICATE Rabies Tag Number
NASPHV Form #50
OwrIer'e,Name & Address Print-use ball point pen or type Ml.Who e97
PRINT - •+F
Species: Sex: A Size: re. omlnant Breed:
Dog ›er Male 3 mo. to 12 rrio.; Under 20 lbs.
Cat Female 12 mo. or ol er 20-50 lbs.
Name Over 50 lbs.
Vacc. Serial (lot) NO.
Producer: 51,J, yr. Lic.Nacc.
(First 3 letters) 3 yr. Lic.Nacc. Othtir rrt_.
For Licensing Agency Use DATE VACCINATED: eterinarian's:
License No. Year 00 V/ aati DVMen# i°672
Askew,
Month Day
Nikenti6 #737
Other VACCINATION EXPIRES: 1459 S, Higley Rd #104
Change 0 Add Up 0 ,6 Gilbert, AZ 85296
Control No. Month Day Year
winerit, Arizona 85296
480-279-NIKI (6454)
SPAY CERTIFICATE
ISSUE/SURGERY DATE:
PET OWNER: FRIENDS FOR LIFE
ADDRESS: 143 WEST VAUGHN AVENUE, GILBERT, AZ 85233
HOME/OFFICE #: 480-497-8296 CELL #:
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PET NAME: 1 e_..., CANINE: \./ FELINE:
BREEQ [carpel / 1,0h; tope..+- MALE: FEMALE: \/
COLOR & MARKINGS: apkii----e 6:71-0GDA, D.O.B. /AGES 1/1..071.701.5
This is to certify that the animal described above has been surgically sterilized at
_Niki's ve P1 on the date listed above.
I have examined this pet and found evidence of sterilization done
asewhere. Surgery was nit performed at Mars Place.

Humane Society of Yuma, Inc.
4G60 SOUTH AVE 4 1/2E
YUMA, AZ 85365
Phone: (928) 782-1621
Ask About Our Low Cost Clinic Services! 928-247-9115
Vaccination Certificate
Vaccination information:
Vaccination ID HSOY
Vaccination Type RABIES
Effective Date 05-06-2014
Expiration Date 05-06-2015
Issued by CARNEY/ PERRY DVM
Drug administered:
Manufacturer PFIZER
Vaccine RABVAC 3
Lot ID 1312870
A r zsz_ Serial ID S309091
Pet Name -PENNY- tOPE- License None on record
Species DOG ID#: 133166 Vacc ID HSOY
Primary Breed CHIHUAHUA Microchip 982000363471596
Gender FEMALE/STERILIZED Registration None on record
Age ADULT
Size SMALL
Bites NO
Veterinarian Signature
Veterinarian ID # 720
Federal Tax ID 86-6053617
Printed using Shelter Pro

Humane Society of Yuma, Inc.
4050 SOUTH AVE 4 1/2E
YUMA, AZ 85365
Phone: (928) 782-1621
Ask About Our Low Cost Clinic Services! 928-247-9115
Spay/Neuter Certificate
Case ID 04-26-2014 22
Species DOG ID#: 133166
Pet Name PENNY-LOPE
Primary Breed CHIHUAHUA
Crossbreed
Gender FEMALE/STERILIZED
Pickup Date
SPAY/NEUTER CERTIFICATE - This animal was sterilized at the Humane Society of Yuma Spay/Neuter Clinic.
Thank you for sterilizating your pet and saving lives.
1196
9j 0 L63L7
Federal Tax ID 86-6053617
Printed using Shelter Pro