BURTNER KENNEL.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 EZ Renewal Permit # < - Li-- 03 4,
Name: EtA1+.1-Ie r Kennel Name: B ()lc A-- n.0
maiiingAddress:Isc \94 ctick--( Kennel Location: t 5'd Q. Cl L. kue_
Ci , AZ ZIP 33 CVis, County Supervisorial District LI
Home Phone:6_6a 2-1_& / "76 Kennel Phone& CS ,-;2, 9 cc 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 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 require individual licensing of each dog under the provisions of ARS
11-1008.
PLEASE ANSWER THE FOLLOWING QUESTIONS
Initial Each
1. 1 " _ INVe assume complete responsibility for the kennel at the premises for which I/we are making
apptçtion for a permit and understand that "kennel" means an enclosed, controlled area, inaccessible to
othe animals, in which a person keeps, harbors or maintains five or more dogs under controlled conditions
(ARS 11-1001).
INVe certify that the kennel has been approved by the local zoning authority (if applicable) at the
es for which I/we are making application for a permit.
INVe certify that 1/We have PiN,741,„;) / 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 1 910.01 (dog fighting), or any other state, county or municipal animal welfare law. (Violations of license
and leash laws DO NOT apply.)
5 ( imp I/VVe certify that all dogs over the age of three (3) months that are kept, harbored or maintained on the
Ifr
pre IS es of the a bove 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.

IfVVe understand that a dog remaining within the kennel is not required to be licensed individually under
ARS 1 1-1008. I/we also understand that a dog leaving the controlled kennel conditions shall be licensed under
ARS 1-1008 except if the dog is only being transported to another kennel which has a permit issued under this
section.
8. L I/VVe understand that a person who fails to obtain a kennel permit under ARS 11-1009 is subject to a
pen ty of twenty-five dollars in addition to the annual fee.
6. _V TA /We certify that 1/We are submitting a valid copy of the rabies vaccination certificate for each
dog kith this application.
9% ft I/We understand that a person who knowingly fails to obtain a kennel permit within thirty days after written
not'ration from the county enforcement agent is guilty of a class 2 misdemeanor.
10. Is this kennel permit being obtained for the purposes of operating a business including but not limited to
breed rs, groomers or boarding establishments? (Please check one) YES _1:1 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. I/We certify that the kennel permit is being used solely for the purpose of licensing my own multiple
companion dogs in my household.
l/We certify that all of the info rmrti n l/We have provided is true and accurate under penalty of law.
Applicant Signature Date. tz) 0? 2 1/
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

iviaricupa .ouiILy
Animal Care & Control A - 5g 69
2500 South 27th Avenue
Phoenix, AZ 85009
Phone: (602) 506-7387
pets.maricopa.gov
KENNEL PERMIT PREMISE INSPECTION
APPLICANT t A 6.4 i r + 111P
STREET ADDRESS 1 sn cNilq
CITY, STATE, ZIP
HOME PHONE (.)0(7)• BUSINESS PHONE
COUNTY DISTRICT KENNEL LICENSE # c)34., NUMBER OF DOGS 3.?
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
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?
,z
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 Agen\-1-11a/i # Date t_3/0 60 4.1

Maricopa County Animal Care and Control
2500 S. 27th Avenue
Phoenix, AZ 85009-6797
(602) 506-7387
http://pets.maricopa.dov
Receipt Number: R14-040371 Receipt Date: 02/2712014
Person ID: P1875830
Phone: 602 2953386
BURTNER KENNELS
1509 N 194TH AVE 2/27/2014 2:36:32PM
BUCKEYE, AZ 85396
Item: Animal ID: Reference No: Price: Each: Amount:
KEN PERMIT A7777777 K15-000036 $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 911411999, 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

Agua Fria Animal Hospital Client No. 21883
13330 W. Van Buren Burtner-Kennel, Judy
1509 N 194th Ave
Goodyear, AZ 85338 BUCKEYE, AZ 85396
Phone: (623) 932-3611 Phone: (602) 486-2928
Fax: (623) 932-3396
www.aguafriaah.com
Rabies Vaccination Certificate
NAME: JJ-Harris
SPECIES: CANINE WEIGHT: lbs Rabies Tag #:
BREED: BOSTON TERRIER ID #1:
GENDER: MI ID #2:
COLOR: black/whit Last Visit: 2/26/2014
BIRTHDAY: 2/26/2011
AGE: 3 yrs, 0 months
Item Description Given Due Date Lot # Manufacturer Exp. Date
2028 RABIES CANINE - 1 YEAR 2/26/2019 2/21/2015 1215380A BI 12/1/2015
I hereby certify that this animal has been vaccinated in accordance with the manufacturer's recommendation for the vaccine used on above date.
Date Issued 2/2612014
Scott Duston License: 3854
Agua Fria Animal Hospital Client No. 21883
13330 W. Van Buren Burtner-Kennel, Judy
1509 N 194th Ave
Goodyear, AZ 85338 BUCKEYE, AZ 85396
Phone: (623) 932-3611 Phone: (602) 486-2928
Fax: (623) 932-3396
www.aguafriaah.com
Rabies Vaccination Certificate
NAME: Feonia
SPECIES: CANINE WEIGHT: lbs Rabies Tag #:
BREED: PUG ID #1:
GENDER: Fl ID #2:
COLOR: TAN Last Visit: 2/25/2014
BIRTHDAY: 2/25/2011
AGE: 3 yrs, 0 months
Item Description Given Due Date Lot # Manufacturer Exp. Date
2028 RABIES CANINE - 1 YEAR 2/25/2014 2/20/2015 1215380A BI 12/1/2015
I hereby certify t this animal has been vaccinated in accordance with the manufacturer's recommendation for the vaccine used on above date.
Date Issued 2/25/2014

Agua Fria Animal Hospital Client No. 21883
Burtner-Kennel, Judy
13330W. Van Buren 1509 N 194th Ave
Goodyear, AZ 85338 BUCKEYE, AZ 85396
Phone: (623) 932-3611 Phone: (602) 486-2928
Fax: (623) 932-3396
www.aguafriaah.com
Rabies Vaccination Certificate
NAME: vviggys
SPECIES: CANINE WEIGHT: lbs Rabies Tag #:
BREED: BOSTON TERRIER ID #1:
GENDER: Fl ID #2:
COLOR: black/whit Last Visit: 2/26/2014
BIRTHDAY: 8/26/2012
AGE: 1 yr, 6 months
Item Description Given Due Date Lot # Manufacturer Exp. Date
2028 RABIES CANINE - 1 YEAR 2/26/2014 2/21/2015 1215380A BI 12/1/2015
I hereby certify that this animal has been vaccinated in accordance with the manufacturer's recommendation for the vaccine used on above date.
von
Date Issued 2/2612014
Scott Duston License: 3854
Agua Fria Animal Hospital Client No. 21883
13330 W. Van Buren Burtner-Kennel, Judy
1509 N 194th Ave
Goodyear, AZ 85338 BUCKEYE, AZ 85396
Phone: (623) 932-3611 Phone: (602) 486-2928
Fax: (623) 932-3396
www.aguafriaah.com
Rabies Vaccination Certificate
NAME: Jill
SPECIES: CANINE WEIGHT: lbs Rabies Tag #:
BREED: PUG ID #1:
GENDER: Fl ID #2:
COLOR: FAWN Last Visit: 2/26/2014
BIRTHDAY: 8/26/2012
AGE: 1 yr, 6 months
Item Description Given Due Date Lot # Manufacturer Exp. Date
2028 RABIES CANINE - 1 YEAR 2/26/2014 2/21/2015 1215380A BI 12/1/2015
I hereby certify that this animal has been vaccinated in accordance with the manufacturer's recommendation for the vaccine used on above date.
St4O--,120P1 Date Issued 2/26/2014

Agua Fria Animal Hospital Client No. 21883
13330 W. Van Buren Burtner-Kennel, Judy
1509 N 194th Ave
Goodyear, AZ 85338 BUCKEYE, AZ 85396
Phone: (623) 932-3611 Phone: (602) 486-2928
ea, !AL Fax: (623) 932-3396
www.aguafriaah.com
Rabies Vaccination Certificate
NAME: Benny
SPECIES: CANINE WEIGHT: lbs Rabies Tag #:
BREED: POODLE ID #1:
GENDER: MI ID #2:
COLOR: BLACK Last Visit: 2/25/2014
BIRTHDAY: 2/25/2009
AGE: 5 yrs, 0 months
Item Description Given ' Due Date Lot # Manufacturer Exp. Date
2028 RABIES CANINE - 1 YEAR 2/25/2014 2/20/2015 1215380A BI 12/1/2015
I hereby certify that this animal has been vaccinated in accordance with the manufacturer's recommendation for the vaccine used on above date.
Date Issued 2/25/2014
Mjc IJIPI044 e . 31
Agua Fria Animal Hospital Client No. 21883
13330 W. Van Buren Burtner-Kennel, Judy
1509 N 194th Ave
Goodyear, AZ 85338 BUCKEYE, AZ 85396
Phone: (623) 932-3611 Phone: (602) 486-2928
•III Fax: (623) 932-3396
www.aguafriaah.com
Rabies Vaccination Certificate
NAME: Buggie
SPECIES: CANINE WEIGHT: lbs Rabies Tag #:
BREED: YORKIE POO ID #1:
GENDER: Fl ID #2:
COLOR: brown/blac Last Visit: 2/25/2014
BIRTHDAY: 2/25/2012
AGE: 2 yrs, 0 months
Item Description Given Due Date Lot # Manufacturer Exp. Date
2028 RABIES CANINE - 1 YEAR 2/25/2014 2/20/2015 1215380A BI 12/1/2015
hat this animal has been vaccinated in accordance with the manufacturer's recommendation for the vaccine used on above date.
Date Issued 2/2512014
rsr II.I k'illi.n I I .44

Agua Fria Animal Hospital Client No. 21883
13330W. Van Buren Burtner-Kennel, Judy
1509 N 194th Ave
Goodyear, AZ 85338 BUCKEYE, AZ 85396
Phone: (623) 932-3611 Phone: (602) 486-2928
Fax: (623) 932-3396
www.aguafriaah.com
Rabies Vaccination Certificate
NAME: Scoter Bruiser
SPECIES: CANINE WEIGHT: 7.70 lbs Rabies Tag #:
BREED: YORKSHIRE TERRIER ID #1:
GENDER: MI ID #2:
COLOR: brown/blac Last Visit: 2/24/2014
BIRTHDAY: 2/24/2012
AGE: 2 yrs, 0 months
Item Description Given Due Date Lot # Manufacturer Exp. Date
2028 RABIES CANINE - 1 YEAR 2/24/2014 2/19/2015 1215380A BI 12/1/2015
I hereby certify that this animal has been vaccinated in accordance with the manufacturer's recommendation for the vaccine used on above date.
Date Issued 2/24/2014
Agua Fria Animal Hospital Client No. 21883
13330 W. Van Buren Burtner-Kennel, Judy
1509 N 194th Ave
Goodyear, AZ 85338 BUCKEYE, AZ 85396
Phone: (623) 932-3611 Phone: (602) 486-2928
Fax: (623) 932-3396
www.aguafriaah.com
Rabies Vaccination Certificate
NAME: Bear Lizer
SPECIES: CANINE WEIGHT: lbs Rabies Tag #:
BREED: BOSTON TERRIER ID #1:
GENDER: MI ID #2: ,
COLOR: black/whit Last Visit: 2/26/2014
BIRTHDAY: 2/26/2011
AGE: 3 yrs, 0 months
Item Description Given Due Date Lot # Manufacturer Exp. Date
2028 RABIES CANINE - 1 YEAR 2/26/2014 2/21/2015 1215380A RI 12/1/2015
I hereby certify that this animal has been vaccinated in accordance with the manufacturer's recommendation for the vaccine used on above date.
Date Issued 2/26/2014

Agua Fria Animal Hospital Client No. 21883
13330 W. Van Buren Burtner-Kennel, Judy
1509 N 194th Ave
Goodyear, AZ 85338 - BUCKEYE, AZ 85396
Phone: (623) 932-3611 Phone: (602) 486-2928
Fax: (623) 932-3396
www.aguafriaah.com
Rabies Vaccination Certificate
NAME: DeIlia
SPECIES: CANINE WEIGHT: lbs Rabies Tag #:
BREED: BOSTON TERRIER ID #1:
GENDER: Fl ID #2:
COLOR: black/whit Last Visit: 2/26/2014
BIRTHDAY: 2/26/2011
AGE: 3 yrs, 0 months
Item Description Given Due Date Lot # Manufacturer Exp. Date
2028 RABIES CANINE - I YEAR 2/26/2014 2/21/2015 1215380A SI 12/1/2015
I hereby certify that this animal has been vaccinated in accordance with the manufacturers recommendation for the vaccine used on above date.
c.
Date Issued 212612014
Scott Duston License: 3854
Agua Fria Animal Hospital Client No. 21883
13330 W. Van Buren Burtner-Kennel, Judy
Goodyear, AZ 85338 1509 N 194th Ave
BUCKEYE, AZ 85396
Phone: (623) 932-3611 Phone: (602) 486-2928
Fax: (623) 9324396
www.aguafriaah.com
Rabies Vaccination Certificate
NAME: Ziggie
SPECIES: CANINE WEIGHT: 15.40 lbs Rabies Tag #:
BREED: PUG Mixed ID #1:
GENDER: MI ID #2:
COLOR: BRINDEL Last Visit: 2/24/2014
BIRTHDAY: 2/24/2012
AGE: 2 yrs, 0 months
Item Description Given Due Date Lot # Manufacturer Exp. Date
2028 RABIES CANINE - 1 YEAR 2/24/2014 2/19/2015 . 1215380A BI 12/1/2015
I hereby certify that this animal has been vaccinated in accordance with the manufacturers recommendation for the vaccine used on above date.
Date Issued 2/24/2014

Agua Fria Animal Hospital Client No. 21883
13330 W. Van Buren Burtner-Kennel, Judy
1509 N 194th Ave
Goodyear, AZ 85338 BUCKEYE, AZ 85396
Phone: (623) 932-3611 Phone: (602) 486-2928
Fax: (623) 932-3396
www.aguafriaah.com
Rabies Vaccination Certificate
NAME: Muncho
SPECIES: CANINE WEIGHT: lbs Rabies Tag #:
BREED: PUG ID #1:
GENDER: MI ID #2:
COLOR: TAN Last Visit: 2126/2014
BIRTHDAY: 2/25/2012
AGE: 2 yrs, 0 months
Item Description Given Due Date Lot Manufacturer Exp. Date
2028 RABIES CANINE - 1 YEAR 2/25/2014 2/20/2015 1215380A RI 12/1/2015
I hereby certify this animal has been vaccinated in accordance with the manufacturers recommendation for the vaccine used on above date.
Date Issued 2/25/2014
Dr. Miles Killian License: 1431
Agua Fria Animal Hospital Client No. 21883
13330W. Van Buren Burtner-Kennel, Judy
Goodyear, AZ 85338 1509 N 194th Ave
BUCKEYE, AZ 85396
Phone: (623) 932-3611 Phone: (602) 486-2928
Fax: (623) 932-3396
www.aguafriaah.com
Rabies Vaccination Certificate
NAME: Chica
SPECIES: CANINE WEIGHT: 6.00 lbs Rabies Tag #:
BREED: CHIHUAHUA CROSS Mixed ID #1:
GENDER: Fl ID #2:
COLOR: RED/TAN Last Visit: 2/24/2014
BIRTHDAY: 2/24/2012
AGE: 2 yrs, 0 months
Item Description Given Due Date Lot 4 Manufacturer Exp. Date
2028 RABIES CANINE - 1 YEAR 2/24/2014 2/19/2015 1215380A BI 12/1/2015
I hereby certify that this animal has been vaccinated in accordance with the manufacturers recommendation for the vaccine used on above date.
Date Issued 2/24/2014

Agua Fria Animal Hospital Client No. 21883
13330 W. Van Buren Burtner-Kennel, Judy
1509 N 194th Ave
Goodyear, AZ 85338 BUCKEYE, AZ 85396
Phone: (623) 932-3611 Phone: (602)486-2928
Fax: (623) 932-3396
www.aguafriaah.com
Rabies Vaccination Certificate
NAME: Barbara Jean
SPECIES: CANINE WEIGHT: 4.80 lbs Rabies Tag #:
BREED: CHIHUAHUA CROSS Mixed ID #1:
GENDER: Fl ID #2:
COLOR: CREAM Last Visit: 2/24/2014
BIRTHDAY: 2/24/2012
AGE: 2 yrs, 0 months
Item Description Given Due Date Lot # Manufacturer Exp. Date
2028 RABIES CANINE - 1 YEAR 2/24/2014 2/19/2015 1215380A BI 12/1/2015
I hereby certify that this animal has been vaccinated in accordance with the manufacturer's recommendation for the vaccine used on above date.
Date Issued 2/24/2014
Jeovanny Toribio License: 6272
Agua Fria Animal Hospital Client No. 21883
13330 W. Van Buren Burtnor-Kennol, Judy
1509 N 194th Ave
Goodyear, AZ 85338 BUCKEYE, AZ 85396
Phone: (623) 932-3611 Phone: (602) 486-2928
Fax: (623) 932-3396
www.aguafflaah.com
Rabies Vaccination Certificate
NAME: Moo Boo
SPECIES: CANINE WEIGHT: 7.30 lbs Rabies Tag #:
BREED: POMERANIAN ID #1:
GENDER: Fl ID #2:
COLOR: RED Last Visit: 2/24/2014
BIRTHDAY: 2/24/2012
AGE: 2 yrs, 0 months
Item Description Given Due Date Lot # Manufacturer Exp. Date
2028 RABIES CANINE - 1 YEAR 2/24/2014 2/19/2015 1215380A BI 12/1/2015
I hereby certify that this animal has been vaccinated in accordance with the manufacturer's recommendation for the vaccine used on above date.
Date Issued 2/25/2014
cn-p,

Agua Fria Animal Hospital Client No. 21883
13330 W. Van Buren Burtner-Kennel, Judy
1509 N 194th Ave
Goodyear, AZ 85338 BUCKEYE, AZ 85396
Phone: (623) 932-3611 Phone: (602) 486-2928
Fax: (623) 932-3396
www.aguafriaah.com
Rabies Vaccination Certificate
NAME: Blazer
SPECIES: CANINE WEIGHT: 5.10 lbs Rabies Tag #:
BREED: POMERANIAN ID #1:
GENDER: MI ID #2:
COLOR: WHITE Last Visit: 2/24/2014
BIRTHDAY: 2/24/2012
AGE: 2 yrs, 0 months
Item Description Given Due Date Lot # Manufacturer Exp. Date
2028 RABIES CANINE - 1 YEAR 2/24/2014 2/19/2015 1215380A BI 12/1/2015
I hereby certify that this animal has been vaccinated in accordance with the manufacturer's recommendation for the vaccine used on above date.
Date Issued 2/24/2014
Jeovanny Todbio License: 6272
Agua Fria Animal Hospital Client No. 21883
Burtner-Kennel, Judy
13330 W. Van Buren 1509 N 194th Ave
Goodyear, AZ 85338 BUCKEYE, AZ 85396
Phone: (623) 932-3611 Phone: (602) 486-2928
Fax: (623) 932-3396
www.aguafriaah.com
Rabies Vaccination Certificate
NAME: Jack
SPECIES: CANINE WEIGHT: lbs Rabies Tag #:
BREED: PUG ID #1:
GENDER: MI ID #2:
COLOR: TAN Last Visit: 2/25/2014
BIRTHDAY: 8/25/2012
AGE: 1 yr, 6 months
Given Due Date Lot # Manufacturer Exp. Date
Item Description
2028 RABIES CANINE - 1 YEAR 2/25/2014 2/20/2015 1215380A RI 12/1/2015
I hereby certifyrthat this animal has been vaccinated in accordance with the manufacturer's recommendation for the vaccine used on above date.
Date Issued 2/25/2014
hAillac I irsencta• 1411

Agua Fria Animal Hospital Client No, 21883
Burtner-Kennel, Judy
13330 W. Van Buren 1509 N 194th Ave
Goodyear, AZ 85338 BUCKEYE, AZ 85396
Phone: (623) 932-3611 Phone: (802)486-2928
Fax: (623) 932-3396
wwvr.aguafriaah.com
Rabies Vaccination Certificate
NAME: Coco
SPECIES: CANINE WEIGHT: 9.40 lbs Rabies Tag #:
BREED: POODLE ID #1.
GENDER: Fl ID #2.
COLOR: BROWN Last Visit: 3/542014
BIRTHDAY: 10/5/2010
AGE: 3 yrs, S months
Item Detscription Given Due Date Let Manufacturer Esp. Date
Z029 RADIEs CANINE - 1 YEAR 3/5/2(,14, 2/28/2015 :2I53UCA BI 12/1/2015
hereby certify that this animal has been vaccinated in accordance with the manufacturers recommendation for the vaccine used on above date.
jear a. ..940 Potet Date Issued 3/612014
Scott Duston License: 3854
Agua Fria Animal Hospital Client No. 21883
Burtner-Kennel, Judy
—.1 13330W. Van Buren 1509 N 194th Ave
Goodyear, AZ 65338 BUCKEYE, A2 85396
Phone: (623) 932-3611 Phone: (602) 486-2928
Fax: (623) 932-3396
wvm.aguafriaah.com
Rabies Vaccination Certificate
NAME . Witcha
SPECIES. CANINE WEIGHT. ibs Rabies Tag #.
BREED. BICHON FRISE ID #1:
GENDER: Fl ID #2:
COLOR: WHITE Last Visit 2/26)2014
BIRTHDAY: 2/25/2010
AGE: 4 yrs, 0 months
Given Due Date Lot Manufacturer Exp. Data
Item Description
2028 RABIES CANINE - I YEAR 2/26/2214 2/21/2015 1215310A 11 12/1/2015
I hereby certify that this animal has been vaccinated in accordance with the manufacturer's recommendation for the vaccine used on above date.
Date Issued 31412014
Scott Duston License: 3854

. RABIES VACCINATION CERTIFICATE
Owner's Name and Address NASPHV Form #51 Rabies Tag Number
PRINT - Last Print - use ball point pen or type
First , M.I. Telephone
3-/1-' Street \- Y I Cr. - I..) 6 I (.^0 1 - e‘-01-1 Cf9i7
City L., ;01 ,1-4— State Zi
Species: Sex: Age: Size: Ift36/
Dog Male • 3 mo to 12 mo 0 Under 20 lbs. Predominant Breed: Colors:
Cat El Female Female ig° 12 mo or older • 20 - 50 lbs. poor)
Other: 0 Neutered 0 Actual Aget f.x- Over 50 lbs. Cl]
(Specify)
Actual lbs. Name:
C C
DATE VACCINATED: ! 1 • I 1
Producer: te [ 1-: % I Veterinarian's: * P‘ 1 , lli c\
_Icense No.)
(f. 1 5 tl (First 3 letters)
Month Day Year
CI 1 yr. Lic./Vacc. (Signature 4. 7P-ro'd
VACCINATION EXPIRED: yr. Lic./Vacc. Address:
Other
Co 15 1 s
Month Day Year Vacc. Serial (lot) no. , —
' A-

• , ir r 1L ,3 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 ,
1K --. kve C So 0,\I 6.,c. 6d1.-91.17
No. a,cc, Street vv / City pt
zV:cr Pe.i k_ .,-Ni I-4-
Species: Sex: Age: Size: Predominant Breed: , Colors:
Dog Male ?Sf 3 mo to 12 mo 0 Under 20 lbs. 0
Cat 0 Female 0 12 mo or older yl 20 - 50 lbs. 0 v. t'"
Other: 0 Neutered 0 Actual Age Over 50 lbs.
(sPeciry) - Actual lbs Name:ige,--
( b 0 r
DATE VACCINATED: Producer: -1:-: I Veterinarian's: # Z II g Ci
i ((ense No.)
(r j' t 1 (Rirst 3 letters)
Month Day Year
ID 1 yr. Lic./Vacc.
)3 yr. LiciVacc. Address:
VACCINATION EXPIRED: E" - /erWrr
Other
_4_16 il
5 IAD S $ I ck 3 74-92e,4 -
Month Day Year Vacc. Serial (lot) no.
OWNER'S COPY RABIES VACCINATION CERTIFICATE
Owner's Name and Address NASPHV Form #51 Rabies Tag Number
Print - use ball point pen or type
PRINT - Last First
M.I. Telephone
T3‘)r-i- of r
Ng. wozo Street vl i,")uniety-- City State zIs 3 6 . 1
ray_ v.) i 1-1-
Species: Sex: Age: Size: Predominant Breed:
Dog 4 Male 0 3 mo to 12 mo 0 Under 20 lbs. 0 Colors:
Cat Female y 12 mo or older 0 20 - 50 lbs. 0 6 tAicio l 7;;;?Aa;E,
Other: 0 Neutered 0 Actual Age ci y Over 50 lbs. 7
(SPeciN)
i Actual lbs Name:
te h .1
DATE VACCINATED: Producer: p f_ I 1 I Veterinarian's: # A-- 2 1 I ie-c7
(License
ip 11 I I (First 3 letters) a
Month Day Year
0 1 yr. Lic./Vacc. (Signature)
5 2.3 yr. Lic./Vacc. Address:
VACCINATION EXPIRED:
Other
_k___ i 5 vit 32 5 e i 5 A '1 6+- '
)1(rl_c-}W ycl LI
Month Day Year Vacc. Serial (lot) no. —
/C r/Ae -14 5 t I.)

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
\ ‘c -,c Q Li b 1 6, ,& , 10 LN:
Street City State
)0 Ne--/ ZU4/1,..0 Q6)k \i•-; `ikk A-r----- V)5-3 4 i
Species: Sex: Age: Size: Predominant Breed: Colors:
Dr .g 4 1' Male 0 3 mo to 12 mo 0 Under 20 lbs.
Cat Female )yzr 12 mo or olderrf 20 - 50 lbs. 0 U Ce ' -2-)A-c ) V_ .
Other: 0 Neutered C3 Actual Age Over 50 lbs. 0
(Specify)
Actual lbs. Name:
60 1.A) 1 q
DATE VACCINATED: Producer: F. _ i 1 Veterinarian's: # t Z.- I 1 SP
cense No.)
(, 1$ I (First 3 letters)
Month Day Year C7 1 yr. Lic./Vacc. (Signature)
p4,3 yr. Lic./Vacc. Address:
VACCINATION EXPIRED: Other , 3.15-E 15->q ST
(9 I q () 16 5 \c\ \)
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.I. Telephone
joStreet ,,State 1
NQ' N,I1 VI) 0 V\ (•-f c ( *e ci r._ ‘d V A.A" tr/... 15-34, 1
Species: Sex: Age: Size: Predominant Breed: Colors:
Dog ' Male El 3 mo to 12 mo 0 Under 20 lbs. CI
Cat b Female jin 12 mo or older 'yr 20 - 50 lbs. 0 \Pl.:110.4n I to0
Other: CI Neutered El Actual Age Over 50 lbs.
)Specify ) Name:
Actual It
V
DATE VACCINATED: Producer • Veterinarian's: # A / 0. S c'\
• r- i (License No.),
(First 3 letters)
Month Day Year (Signature )
0 1 yr. Lic./Vacc.
r, 3 yr. Lic./Vacc. Address:
VACCINATION EXPIRED: Other 3.1,5- Es xf-ri s•
\A )\40 5 c'A ) u\ \)
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.I. Telephone
*UV) il;Od- 6 2 1 ‘Ilci ?
No. Street rjrn'er -City State ,v zi 536 i
'a korae, I, J \13..) il \Z.- 'e C i'toi, +Sr
Species: Sex: Age: Size: Predominant Breed: Colors:
Dog g Male 0 3 mo to 12 mo 0 Under 20 lbs. EX' c \4\ t
Cat Female r.;.g. 12 mo or older 0 20 - 50 lbs. 0
Other: 0 Neutered 0 Actual Age 1 1 Over 50 lbs. 0
(Specify) Actuallbs _ Name: \
\iv
DATE VACCINATED; Veterinarian's: a A7-- t kc. 1
Producer: .- 7 t se No.)
CI / 5 _ LI. (First 3 letters) a - 6),-3:-1 --6, /
Month Day Year E3 1 yr. LiciVacc. (Signature)
yil 3 yr. Lic./ Vacc. Address : g /57W 17::
VACCINATION EXPIRED: Other 1.)-5 -
le 1 5 t IA \ 5'4 lq L.3 7alyoei /4)-, (PS-49P)
Month Day Year Vacc. Serial (lot) no.
OWNER'S COPY RABIES VACCINATION CERTIFICATE Rabies Tag Number
NASPHV Form #51
Owner's Name and Address Print - use ball all pt pen or type
, First ‘ M.I. Telephone
- Last
• V,3 \) -\-- t" ( State
-No. Street V.a.:(-- V-1 1-\-i• 4)1_ ze53 61
°.- VD 9.0 kiI-) 'Cl) 0
Sex: Age: Size: Predominant Breed: Colors:
Species: Male 0 3 mo to 12 mo 0 Under 20 lbsik 1.-)1 1 j
Dog \?) AA)
Cat 0 Female FS 12 mo or older V- 20 - 50 lbs. 0 V
Other: 0 Neutered 0 Actual Age Over 50 lbs. 0 Narr 50.1...v. -.
(SPecttY) Actual _lbs
1 e.,
i # .ii -- -t_ 1 (? el
DATE VACCINATED: Producer: Veterinarian's: ibcense No)
1 S \ (First 3 letters)
(Signature)
Month Day Year 0 1 yr. Lic./Vacc. Address:
yr. Lic./Vacc. 3). 5- F-, lc4 Jr-
VACCINATION EXPIRED: Other
z__, ?/).1 )
Month Day Year Vacc. Serial (lot) no.

OWNER r3 r,,s,re RABIES VACCINATION CERTIFICATE Rabies Tag Number
NASPHV Form #51
Owner's Name and Address Print - use ball point pen or type
. First M.I. Telephone
PRINT - Last (oat
?)t)C\V)fr Ci Q C\ \Iv • i 1 State Zip
No. a \ _ _Street er).-
0 '40 l,ki_ _. kpt.41Y--.C( Veci
Size: Predominant Breed: Colors:
Species: pt Sex: 0 Age: 3 mo to 12 mo 0 Under 20 lbs. p- Foc (3 iA-c Y
Dog Male
Cat 0 Female p 12 mo or older 20 - 50 lbs. CI
Other: 0 Neutered El Actual Age Over 50 lbs. CI Name:
(Specify) Actual_lbs
14211
' Veterinarian's: # it Z-- CI
DATE VACCINATED: Producer \:2 \ (License No.)
(First 3 letters) , ,%•,7:.4i,ehAeJa/
(4e1 1 S \ \ (Signature)
Month Day Year 0 1 yr. Lic./Vacc. Address:
?(3 yr. Lic./Vacc. .3.11 r: / 5"W fr
VACCINATION EXPIRED: Other ,..._Fzi 41, er)
7
s g 1ci \3
Month Day Year Vacc. Serial (lot) no.
RABIES VACCINATION CERTIFICATE
'3 '.‘1 :•C!' 5 '''C'Y Rabies Tag Number
NASPHV Form #51
Owner's Name and Address Print - use ball point pen or type
PRINT Last First , M.I. Telephone
- Cf r - E c- ,) C\\ 1,161 431 - (0q 117
U City State zit 3101
No.1 JA L) a,a) Street \I>) llf-1 *,c- ''e,o,V, PVIfti- h 2
Species: Sex: Age: Size: Predominant Breed: Colors:
Dog 12' Male G/3 mo to 12 mo 0 Under 20 lbs. ge l'?) TO 6CQUJ f)
Cat 0 Female 0 12 mo or older 0 20 - 50 lbs. 0
Other: 0 Neutered 0 Actual Age NI Over 50 lbs. 0
(speedy) Actual_lbs Name:
\C\f\*e 1
p 'F.. • Veterinarian's: # kl , i C CI 7
DATE VACCINATED: Producer: 1 ,....." (Ucense t
6 (Fst ir3 le tters) 7
Month Day Year 0 1 yr. Lic./Vacc.
Address:
ESP yr. Lic./Vacc.
VACCINATION EXPIRED: Other
I0\\3 -15 G Is ‘ b- c-k- Tr 1 e
ki) 1 5 I L\ 5 \k I 5'3
Month Day Year Vacc. Serial (lot) no. s .i? t

1
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 - Last First M .I. Telephone on
&J, toy-i-)
No. A..N. _ reet _ rty .,--, yr_ S tat7ra_ 435 31,, I
0 \Ail
Species: Sex: Age: Size: . Predominant Breed: Colors:
Dog Male El 3 mo to 12 mo 0 Under 20 lbs.A *AO /0 itt k
Cat El Female 12 mo or older )4 20 - 50 lbs. li] I “ (1-R--• ‘
Other: CI Neutered 0 Actual Age Over 50 lbs. 0
PPacifY) Actual lbs Name: I--- 1 -1.--:
i r
, 1'5
DATE VACCINATED: Producer: Vetennanan's: # ,Lcenss # No ) 7
F \
c‘: i 1 I (First 3 letters) al" On.):' g`'-'124(f
Month Day Year CI 1 yr. Lic./Vacc.
Addresa:
yo 3 yr. Lic./Vacc.
VACCINATION EXPIRED: 3 wis E: i cd sT
Other
1,-ip?, A ), tri. 21 - f -1
Month Day Year Vacc. Serial (lot) no.
.::,NEH -: I ,.:1`i RABIES VACCINATION CERTIFICATE Rabies Tag Number
NASPHV Form #51
Owner's Name and Address Print - use ball point pen or type
i First M.I. Telephone
PRINT - Last &a:2 oi („41z-17
0 f # nt r ._ueti
c7) City State
No. Street b o rdecT P(ct R. Lk/L-i-d— 4-z_
VW 0: , NA /
Species: Sex: Age: Size: Predominant Breed: Colors:
Dog j4 Male 0 3 mo to 12 mo CI Under 20 lbs.
Cat El Female 0 12 moor older Eid 20 - 50 lbs. CI 13'
Other. CI Neutered Cl Actual Age Over 50 lbs. El Name:
(specify) Actual_lbs
SI' C '65 y
7
p / Veterinarian's: # #2 / (5
DATE VACCINATED: Producer: P (License No.)
i
15 (First 3 letters) 0/1 • t'( id,g,e
I I (Signature)
Month Day Year ED 1 yr. Lic./Vacc. Address:
yr3 yr. Lic./Vacc. 32 j.5-1-i j r-
VACCINATION EXPIRED: Other
1077;ce, A-2.r)
igrld
le_ ii i
Month Day Yearl Vacc. Serial (lot) no.

. 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 /0 641 (,Lici--)
0 -,1
• \-.3A'-'-- AVer- __1_ \-2/ _ct (\\I \ci
No. .ø(.„ Slreet Zip
4\0 -Jo \-3.; CiSvil 1C-ec '63(01
Species: Sex: Age: Size: Predominant Breed: Colors:
Dog Male 3 mo to 12 mo El Under 20 lbs. n. c 3 i G 1
Cat D Female 12 mo or older 20 - 50 lbs.
Other: El Neutered 0 Actual Age Over 50 lbs. D -
(speedy) Actual Ibs Name:
DATE VACCINATED: Producer: V Veterinarian's: # (Li cense A- 7.... No.) I
LI IS I \ (First 3 letters) /al r\.)./ adA-'\12-'17/
Month Day Year El 1 yr. Lic./Vacc. (Signature)
Address:
7r-3 yr. Lic./Vacc.
VACCINATION EXPIRED: Other ).7-5E irt/si
s\ c, -)(g I(-,\ n A-7 4 fr i : 2 4 F )
ir___ 1Laj
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.I. Telephone
13uf--i—of r 0A \I &Col 1.0. 61/117
No .aty State z15361
0,toa vstreetW ZtAl Y,:e ( I ()CA 11— te0 114-- /sr2,_
Species: Sex: Age: Size: Predominant Breed: Colors:
Dog ' "6 Male El 3 mo to 12 mo El Under 20 lbs. El ,-. , --
Cat Female 12 mo or old/ El 20 - 50 ibs. g 15405N6 P . ttrr (3/ IA)
Other: 0 Neutered Actual Age el. 1/ Over 50 lbs.
(SPecify) 1 Actual_lbs Name:
FA, q
DATE VACCINATED: Producer: p F 1 Veterinarian's: # PV- Z. 11 4e S .4,1
1 ,i.License No.)
Sp / 5 _ d_ (Fast 3 letters)
onth Day Year (s,gnaturo 04.' iClirtIN''
El 1 yr. LicJVacc.
Address:
7r'''3 yr. Lic./Vacc.
VACCINATION EXPIRED:
Other
15 0
Month Day Year Vacc. Serial (lot) no.
/-e-,yze if-z, g6Dg 1

...it EH . • RABIES VACCINATION CERTIFICATE
. NASPHV Form #51 Rabies Tag Number
Owner's Name and Address Print - use ball point pen or type
PRINT - Last First Ml. Telephone
No. Street City I ,tiv, a+ /tp.t_at Zip
.. vzac Si 3 00 1<fr eeol s 5 ?/‘ 1
Species: Sex: Age: Size: Predominant Breed: Colors:
Dog cia Male CI 3 mo to 12 mo El Under 20 lbs. 0 ,f-7 u) di f3r ;r4k .
Cat 0 Female lia 12 mo or older pi, 20 - 50 lbs. 0 I
Other: O . Neutered 0 Actual Age Over 50 lbs. 0 AiilAk
(Specify) Actual_lbs Name:
Cf)°Ki'es
DATE VACCINATED: Producer: p y.... ) t Veterinarian's: # .kZ___B_Er_______
(License No
& _151j (First 3 letters)
Month Day Year 0 1 yr. Lic./Vacc. (Signature)
Address:
CC/3 yr. Lic./Vacc.
VACCINATION EXPIRED: Other
-1-5 ii ] s v i,s,
Month Day Yea Vacc. Serial (lot) no. /17, 1e5)32)
' • q • ' °' RABIES VACCINATION CERTIFICATE
NASPHV Form #51 Rabies Tag Number
Owner's Name and Address Print - use ball point pen or t ype
PRINT- Last ‘ First M.I. Telephone
t•l(- \-`(\"e( .N 0 ck 1/41,26 P i teliii -;
No. ao rceyet ‘.0 k-er oe. sr-z. liP 1
Cutel
Species: Sex: Age: Size: Predominant Breed: Colors:
Dog . ig Male 0 3 mo to 12 mo 0 Under 20 lbs. Ijg) -c 1„ If c
Cat Female 0 12 mo or old older 0 20 - 50 lbs. 0 —3 l
Other 0 Neutered 0 Actual Age .i_-_1__ Over 50 lbs. CI
(Specify) Actual_lbs. Name* '
1-1 AA- VC ci 1 .i.
DATE VACCINATED: Producer:: ro 1) i Veterinarian's: # IV -Z_ I t % t'l
(License No.)1Atede,
F—)
(First 3 letters)
IP-- _La _a 162.4
Month Day Year 0 1 yr. Lic./Vacc. (Signature) re
p6 yr. LiciVacc. Addle's:
VACCINATION EXPIRED: 3.2 r E )5."*.l.r-3
Other
(p 15 14 I..6‘ ,-5 i,,,,,„,,Ais-;?)
Month Day Year Vacc. Serial (lot) no.

OWNERS 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 k M.I. Telephone
\-3 OC ke- -(- c-- 0 C\ Ccia — OA &Litt
No. wliyr RIV.,_ \A) .,-\--- stailev-7 7/ 5 3 (c I
Z Of\ Y feitY
Species: Sex: Age: Size: Predominant Breed: Colors:
Dog Male 0 3 mo to 12 mo r CI Under 20 lbs. El 0 i 14/
Cat Female X. 12 mo or older 20 - 50 lbs. yl. \.011c1c)
Other: DI Neutered 1:1 Actual Age Over 50 lbs. 0
(Specify) Actual lbs Name:
DATE VACCINATED: p v. 1 I Veterinarian's: # A Z. I 6 Ci
Producer: (License No.)
(P 0 1 \ (First 3 letters) /1? I--
Month Day Year (Signature)
0 1 yr. Lic./Vacc.
Address:
3 yr. Lic./Vacc. it
VACCINATION EXPIRED: Other -1 E A5V
\ P,SS VA
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 Fir0 M.I. Telephone
C\\1 Z.76'1). i'llN 6 3/ 2
Noyi \ 0 Street ci f 6 ‘4... wv_sr l State ZIT I
Species: Sex: Age: Size: Predominant Breed: Colors:
Dog ' NrMale El 3 mo to 12 mo ID Under 20 lbs. le n fan
Cat CI Female 12 moor or older 20 - 50 lbs. El tj0 rft
Other: CI Neutered El Actual Age Over 50 lbs. ID
(spoor) Actual lbs Name:
#\i
DATE VACCINATED: _1 r V Veterinarian's: an 151/- Z- I ( ° I
Producer: )1-1 (2e, ,,,,,,7_,5„. (License No.) i I 41 C\
Cil ii (First 3 letters)
i$
Month Day Year 0 1 yr. Lic./ Vacc. (Signature)
Address:
-yt3 yr. Lic./Vacc.
VACCINATION EXPIRED: Other
5 -,..,-,
(e I 19 5 ‘. -4. 553 tC\ t 3 35 t I _5 3c
Month Day Year Vacc. Serial (lot) no. 7-ep-9e 4z f5247

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 Fiet M.I. Telephone
No. Street State
IA; Cl.).(A1-,t ç c)C‘Z 4f 1:5 '3 iz. k
Species: Sex: Age: Size: Predominant Breed: Colors:
Dog (Id Male CI 3 mo to 12 mo 0 Under 20 lbs. g ,-, 3) LA-7
Cat 0 Female 12 mo or older 20 - 50 lbs. \e0SA40 A)
Other 0 Neutered 0 Actual Age Over 50 lbs. CI
(spoor) Actual lbs Name:
_ O I tc)
DATE VACCINATED: Producer: V Veterinarian's: # l\----7 \. \8c't
(License No.)
\ \ \ (First 3 letters) —idrITI‘L,
Month Day Ye r (Signature)
El 1 yr. Lic./Vacc.
7(3 yr. LicJVacc. Address: 315- E /5-t13t;
VACCINATION EXPIRED:
Other
.____ _13 ILA sk.osiA Ic3 7,-,20e
Month Day Year Vacc. Serial (lot) no.
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 - Last Fir* M.I. Telephone
LIJ--31 64#7
V) k_50- CVCC 0 A 4_ st tez_ i? 34?)
No. -3 o'n1/.-e( City .,, • i ..
. W.I. •
Species: Sex: Age: Size: Predominant Breed: CoVars:
Dog male rx 3 mo to 12 mo 0 Under 20 lbs. 0
Cat g Female 0 12 mo or older 0 20 - 50 lbs.
til
Other: 0 Neutered 7 Actual Age Over 50 lbs. 0
(sixidly) Actual_lbs Nam e:
Ke A
DATE VACCINATED: p F 1 1 Veterinarian s: #
Producer: i ense No.
& 1 5 I I (First 3 letters)
Month Day Year O (Sigrtatu '
0 1 yr. Lic./Vacc. Address: ,
l;g3 yr. Lic./Vacc.
VACCINATION EXPIRED: Other e / 5 HI -5-f-
cp 13 ILI ,,e)g
W.1),]
Month Day Year acc. Serial (lot) no. 7- --c- -)-- /i-'2__ f-5X . /

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
First
PRINT - Last
Ci State iPtol
No. ,_, Street I ViJVil V.,:er K+et 1 V.: I AA" Ill
. .I.V.110 VI Predominant Breed: Colors:
Species: ,,. Sex: Age: Size: Under 20 lbs. 0 1-2 \ I
DogKr Male 0 3 mo to 12 mo 0
0 Female recyg 12 mo or older. 20 - 50 lbs. 0
Cat Actual Age Over 50 lbs. Lg
Other 0 Neute Actual_ lbs Name: clt ‘
(SWAY) C5an
I Veterinarian's: # /r1._ /r1._ MSC)
DATE VACCINATED: Producer: V % • (License No.) .." - ,e'
-
(First 3 fetters) . / 4.I 0/1 • .._,A,—. -1
____ (5 11- !nature)
Month Day Year 0 1 yr. Lic./Vacc. Address:
3 yr. Lic./Vacc.
VACCINATION EXPIRED: Other
0,70e, A x, (14T/
1 Lt S 1 tie '4, 1 CI \ "5
Month (e Day Year Vacc. Serial (lot) no.
OWNER'S COPY RABIES VACCINATION CERTIFI A
Rabies Tag Number
NASPHV Form #51
Owner's Name and Address Print - use ball point pen or type
PRINT - Last Firit M.I. Telephone
V)(- -‘.. (- r -- U CA ci , Statti Do
-')-* \ 0 a b .1,. ) ori Vf r e Vti iii• gs-31, 1
No. Size: Predominant Breed: Colors:
Species: Sax: Age:
Dog X Male ,i'S 3 mo to 12 mo 0 Under 20 lbs. 0 vz ( /1C )0 , k: ) r
Cat 0 Female 0 12 mo or older y 20 - 50 lbs. g
Other 0 Neutered 1:1 Actual Age Over 50 lbs. A tab
(Specify) Actual_lbs Name:
Odd
d3
— Veterinarian's: # , I t W/
DATE VACCINATED: Producer: p , /...._ i (ucenser?-1.) '
(t, 1 5 I. I (First 3 lettefs) CI-4 ''
Month Day Day Year 0 1 yr. LiciVacc. (Signature)
Address:
3 yr. Lic./Vacc. e
VACCINATION EXPIRED: Other z - —'
Z).,,oa A 2.. '1)i)
(ti 1. / 4 -Tao k Cjk\ 3
Month Day Year Vacc. Serial (lot) no. c/ 1