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Maricopa County
Animal Care And Control
2600 South 27th Avenue
Phoenix, AZ 85009
(602) 506-7387 Tele.
(602) 506-2739 Fax
KENNEL PERMIT APPLICATION
D New VRenewal Permit # \LI -
Name: ''") I \t f?)en ta-X Ittirr
Mailing Address: D I) • Kennel Location: igri D
City V-01._ , AZ ZIP 39 County Supervisorial District LI
Home Phone: (Gar 12) . - .3 - 3 2 ,u Kennel Phone: SiES t CCL)
(s0-2,-----1(2;2L1
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. l S IANe 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. 1/4'CS INVe 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. Q(').' I/We certify that INVe have J dogs and that the kennel meets the definition in statute.
4. I/We certify that I/VVe 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. -'.-(1..)1/VVe 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
mai tained on the premises for each dog.
6. /We certify that I/VVe are submitting a valid copy of the rabies vaccination certificate for each
dog with this application.
7. t-1-5-1/-1/We 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.
I/VVe 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.
c-E--/ 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. le,) Is this kennel permit being obtained for the purposes of operating a business 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.
11. e certify that the kennel permit is being used solely for the purpose of licensing my own multiple
companion dogs in my household.
I/We certify that all of the information VWe have provided is true and accurate under penalty of law.
)pjjp j
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: R13-199200 Receipt Date: 1011612013
Person ID: P0839309
Phone: 602 8851324
BENWAY KENNELS 10/16/2013 3:48:56P1I
1810 N 202ND AVE
BUCKEYE, AZ 85396
Item: Animal ID: Reference No: Price: Each: Amount:
KEN PERMIT A7777777 K14-000041 $328.00 1 $328.00
KEN PER LATE A7777777 25.00 1 $25.00
DONATION A7777777 OTC 29.67 1 $29.67
Total Fees Due: $382.67
Payments: Cash: $0.00
Check: $382.67
Credit Card: $0.00
Total Payments Received: $382.67
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
KJENSEN EBUSOFF
RABIES VACCINATION CERTIFICATE
Rabies Tag Number
NASPHV Form Si
Owner's Name 6 Address PRINT - use ballpoint pen or type
First M.1. Telephone 4 2,5
A5'3 -J.2.e 1-1
No. Street City State
..7112,AA
SPECIES: SEX: AGE: SIZE; PREDOMINANT BREEDt crd
Dog Male 0 3 mo, - 12 rms. Under 20 Ibs,i(1_
Cat Female 12 mo. or oldolVt, 20 • SO lbs,
Other Netitered Over 50 lb!, riRIAME1
Meese specify
f) 1-1I
DATE VACCINATED' VETERINARIAN)
PRODUCER'
Veterinarian's #:
-Month Day ' Year (First 3 letters
VACCINATION EXPIRES, 1 yr.Uc.1Vacdne 0 titadeSad
3 yr. Uc. /Vaccine pg. Veterinarlan's_SlInAW FOluIAGGED FRIENDS
d 41- 0
Renth DIY Year .2(17 9/1 Address; 3131 E. Thunderbird, #59
Vaccine Serie) (Lot) No. Phoenix, AZ B5032
RABIES VACCINATION CERTIFICATE
Owner's Name &Address NASPHV Farm 51 Rabies Tag Number
Last PRINT use ballpoint pan or type
Flier Mi. Telephone ajt:114 -
No, Street CII y
lqA:J 7 - (:57''-1)
SPECIES: SEX: AGO: SIZE:
Dog Male El 3 mo, - 12 ma L. Under 20 Ibair) PREDOMINANT Ac\f-J-07—A4..A ERIE
Cat r:1 0 Female 12 mo, or oldo> 1) 20 - SO lbs. 0
Other Ne;str,d ZZAI2g
Please specify Over SO lbs. 2J NAM"
DATE VACCINATED,
VETERINARIAN;
PRODUCER:
6— 1A1122—.
Month Day Year Veterinarian's #:
(First 3 letters) ILense No.
VACCINATION EXPIRES, 1 yr,L1c. /Vaccine
DLI 3 yr. Us. /Vaccine '10
veterinrettrtnGE11 FRIENDS
Month Day Year SSBS1 S SiC4r Addres2131 I. Thunderbird, 459
Vaccine Serial (Loo No. I pi monis, AZ 85032
RABIES VACCINATION CERTIFICATE
Owner's Name & Addrees NASPHV Farm Si Rabies Tag Number
PRINT - use ballpoint pull or type
LOF
k/O\Na, Fires M.I. Telephone UT.
No. Street 1'3'7
Zip
SkciEs: bE AGE:
Dog Male )N3 3 ma, - 12 mo. 17:1 Under 20 lbs COi.QRS;
Car Female 0 12 mo. or o1,1021c) 20- SO ibs, -0
Other 0 Noutered Over 50 lbs. El
Please specify NAME,
DATE VACCINATED,
VETERINARIAN:
7&Z,' - PRODUCER,
Month Day Year Veterinarian's #:
(First 3 letters) Ucen e No:
VACCINATION EXPIRES; 1yr.t.ic. /Vaccine El 4 1
f7) /6, 3 yr.IA./Vaccine VererinarlaekAimu a
rvvri ri-FGGED FRIENDS
Month Day Year 177w\dse Aaron: 3131 E. Thunderbird, #59
NAM VACCINATION CORTIPICATI
WNW item SI
Owner's Name I Addrue PRINT use hull oint n or typo
Melo 0 $ MA. 11 ma,
Ponds CA 13 me, or older
Naomi('
I7ATU 2.., VACcINATPIti
C
_1
oink Day (Illrit 3 letter
1 yr. W./Yeti:Melt
3 yn 1.1c, Paulo,
RABIES VACCINATION CERTIFICATE
NASINV term SI Rabies tag Number
Owner's Name & Address PRINT • use ballpoint pen or type
Last Piro
I LA I
Mo. Street „..ejuoce, Sate Zip
1 (6 1 Li c) V)V4iity SaaLf
SPEcIrS: SEX: tirkt I -- —0 WANT WI l COLORS:
Dog J. Male $ 3 mo.- limo. [21 Under 20 lbs. 0 171Ict,o4.
Cat Li Female 0 12 MO. Or older 20 .50 lbs. 0 "A—.C.1"1( I
Other 0 Neutered El Over SO lbs. 0 NAM&
Please speedy
V— 0 \
DATE VACCINATIlth
PROCUCERt
?-7 n
Month bay Tear (First 3 letters
VACCINATION EMPIRES: I yr. Lie. /Vaccine 0
3 yr. Uc./Vactine yowl-it-1TM
fl 3111 E. Thunderbird, #59
Month Day Address: Phoenix, AZ 85032
;ZerfrigrArlic (Lot) No.
RADIO VACCINATION CIRTIPICAT jaw--r sti or—
NASPHV An Si
PRINT use ballpoint pen Or type
Nit 3 letters)
VACCINATION ORM& 1 yr. Us, /Voselnook
3 yr. Um /*seine
I '— 1 15
Month Clay I Tier •
lens 11-olgt No
RABIES VACCINATION CERTIFICATE Rabies Tag Number
NASPHV form 51
Owner's Name & Address PRINT - use b.:1Ipoint pen or type
Last 1 irst M.I.
\
No. Street State Zip
\?)\() • J1/41-' '1.41)04 e.14 Rt. 5S:56117
SPECIES; SEX; AGE; SIZE; I PREDOMINANT BREED: COLORS;
Dog pc Male 3 mo. - 12 mo. n Under 20 lbs. 0
Cat El Female 12 mo. or older 20 - 50 lbs. 0
Other 0 Neutered Over 50 lbs. 0
Please specly
DATE VACCINATED: VETERINARIAN:
PRODUCER: t4-0
Veterinari it'c 3i•
Moifil) Day Year Lice se No.
First 3 letters
ae,41_th
0/
VACCINATION EXPIRES: 1 yr. Wt. /Vaccine
3 yr. Lit. /Vaccine Veterinarian:A auir.• • treZt Pfen
Rd.
snlv Addres;i;i ; A E. Illunderbird
MoutilIV teal' r Cuite 59
Vaccine Serial (Lot) No.
RABIES VACCINATION CERTIFICATE Rabies Tag Number
NASPHY Farm 51
PRINT - use ballpoint pen or type Teleis ph
Owner's Name &Address First M .I.
Last o\A__
City
No.
MC) SIZE:
SPECII:St SEX; 3 nto.- 12 ma. Under 20 llt
Dog Male 12 ilia or oldetN - 20 - 50 lbs. 0
Cat 0 Female 0 Over 50 lbs. 0
Other 0 Neutered El
Please specify
VETERINARIAN;
DATE VACCINATED: e_
PRODUCER: Veterinarian's di
4:i .:ce2dg
Month pay Year (First 3 letters) V& eii4-.%a
1 yr. Lic. /Vaccine 0 --7,7111=51011 vim. 0 _
VACCINATION EXPIRES; 3 yr. Lic. /Vaccine 51 91.01, fikunderbIrd Rd.
0` ').(1 / 5-- 5/7 7 r•2 Address: Stilts 59 aeosa
Motel) Pay Year (Lot) No. Phoedts AZ
Vaccine Serial
-.MOM
RABIES VACCINATION CERTIFICATE
NASPHV Form 51 Rabies Mg Number
jaxAIL L,„ Owner's Name *Address PRINT • use ballpoint pen or type
First
tVo. 'Street City
`L.-11,04
SPECIES; SEX: AGLi: SIZE:
Dog Male CI 3 ma.- 12 nuo, Li Under 20 lb
Cat 0 Female Sit - 12 mo. or olderti4. 20 - 50
Other 0 Neutet ed Over SObi. 0
Please specify
DATE VACCINATED: VD
liPZ PRODUCER;
Month Day Year
(First] letters)
VACCINATION EXPIRES: I yr. Wt. /Vaccine El
3 yr. tic. /Vaccine,,, Veterinarian's SIgnatrio 4
cw /10 rnUR LEOriED FRIENDS
Month Day Year Address: 3131 E. Thunderbird, #59
(1-1#.07M4-Ce--
vaccine aerial (Lot) No. Phoenix, AZ 85032
RABIES VACCINATION CERTIFICATE
NASPHV Form 51 Rabies Tag Number
Owner's Name & Address PRINT - use ballpoint pen or type
Last V,tovtiI
No., Street( _
‘‘611) `X15 1"1
SPECIES: SEX: AGE:
Dog Male Ei 3 mo.- 12 mo.
Cat 111 Female 12 mo or older
Other 0 Neutered 111
Please specify
DATE VACCINATED:
6 0- PRODUCER:
VeterInari40-#'
TI-ont-11 Day 1 Year
(First 3 letters
VACCINATION EXPIRES: 1 yr. Lic. /Vaccine 0
3 yr. Lit. /Vaccine VaterInari
ThUnderbird Rd.
,S1/11 Address: Suite Be
Vaccine Sea (Lot) No. Phoenix. AZ 8110112
RABIES VACCINATION CERTIFICATE
Rabies Tag Number
NASPHV Form 51
Owner Name & Address PRINT - use ballpoint pen or type
Last First
Ke4s64-4.1
Street State
Rtgi"Ct-ii e. Al-
SPECIES: AGE; SIZE:
Dog g Male 0: 3 mo.- 12 mo. 11 Under 20 lbsig..
Cat 0 Female 0 12 mo. or °Nellie 20 - 50 lbs. 0
Other 0 Neutered 0 I Over 50 lbs. 0
Please specify
DATE VACCINATED: VETERINARIAN:
tg3 12- PRODUCER; 124
Veterinarian's #:
Month Day Year ense No.
First 3 letters
VACCINATION EXPIRES: I yr. Lic. /Vaccine 0 rA
q 3 yr. Lic. /Vaccine giC,, Veterinarian's Signature. ,r.ocil
)3 Four 1-kftod
Month Day 1 Year Address: 031 E. Tevattuanedccbird
Vaccine Serial (Lot) No. u!_ A
RABIES VACCINATION CERTIFICATE Rabies Tag Number
NASPHV Form S I
Owner's Name & Address PRINT - use ballpoint pen or type
Last First M.I. Telephone
1(erly)6/ t/i 10-1 0-5 IMV
No. Street it y State Zip
„4,), „LA-44 ewe. AZ. ir5-19/,
SPECIES: SEX: AGE: SIZE: INIEDOMINANT BREED: COLORS:
Dog Male ig 3 mo.- 12 mo. n Under 20 114154_
Cat 0 I Female 0 12 mo. or older 20 - 50 lbs. Li P#S4 1\ 5/Writ).
Other n Ltsred D Over 50 lbs.
Please specify
DATE VACCINATED:
PRODUCER
--q--23 12-
Month Day Year
VACCINATION EXPIRES: 1 yr. Lic. /Vaccine El
3 yr. Lit. /Vaccine'. Vetrli-tarla SI natur - -0 rrrietiln
•0
Month Day Year 5) ki' LlhiS" R Address: 3131 E. •(hunderbIrd
Vaccine Serial (Lot) No. Selto
RABIES VACCINATION CERTIFICATE
Rabies Tag Number
NASPHV FOrM 5
Owner's Name Is Address PRINT- use ballpoint pen or type
Last First
Street CI State
SPECIES: SEX; SIZE; PREDOMINAN OREM COLORS;
Dog jtie. Male /IND 3 Mo.- 12 rno,, P Under 20 lbs.1§10 Vet)
Cat El Female 11 mix or oldo 20 50 lin, 0 22t1L 1\\b
Other 1:1 Neutered I Over 50 OW 0 NAME;
Please specify
DATE VACCINATED; VIITERIMARIANI
4)7 od /3 PRODUCER;
Vete rine rift nb #:
Month Day Year OtIrst 3 letters)
VACCINATION WIRES, 1 yr. LIc. /VsecineA
9 7 y 3 yr. Wet/Vaccine. Veterinarianb Thunderhird,.#5P
2;
Month Pay Year ,r c9,5 -fs-4,) Address; Phoenix, AZ 85032
Vaccine Serial (Lot) No.
RABIES VACCINATION CERTIFICATE Rabies Tag Number
NASPHif Form 51
Owner's Name & Address PRINT • use ballpoint pen or type —
Last First MI. Whinn-7.3S3
.11 "(v (-4
Street cItY State ZIP
t) -ZU-L leicA aI‘I 6eq-e. €06341.
SPECIES: SEX; AGE: SIZEs PREDOMINANT BREED; COLORS;
Dog mai§ I?. 3 ma. 12 mo. I:1 Under 10 lbs. tip cain (A in d
Cat 0 Female 0 11 ma. or olds* 20 ov -050501bilbs..
Other El Neutered NA;n6it
Please specify
ELH
DATE VACCINATEDs VETERINARIAN:
PRODUCER;
D 'Ye) Vaterharlani
Month Day Year (First 3 letters)
VACCINATION EXPIRES; 1yr. LIc. /Vaccine 0
3 yr. LIc. /Vaccine CI veterinarAvour Logged Friends
tf,)_ /7,3 LE 1114)1 E. Thunderbird Rd,
Month Day Year -, 1 I,0(A91 §4 Address: Suite 59
Vaccine Serial (Lot) No, Phoenix, AZ- 85032—
RABIES VACCINATION CERTIFICATE
Owner's NMI) &Address PRINT . NASIIHY Form SI Rabin Tag Number
Lisst ballpoint pen or type
164,1 Fli st M.1.
No. 0 Straelts.i irgFcs-is2L
--6t4041, S.,.
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SPECIES: SEX: AGE: DRec:P21.T...LI:
Dog Male SIZE; VI DOMINANT
Cat 0 3m. 12 ma, E- 1,, Under 20 lbs. le<
Other IC) Female 0 12 me, or olclerX 20 - 50 lbs. 0 h6(66,14,A
Neutel nd 0
Please specifr Over 50 lb,. 0
1
DATE VACCINATED,
D\ ?-5' VETERINARIAN;
PRODUCERS fi
Month Day I Veer Veterinarian's
(First 3 letters) vit_ei Lice;
VACCINATION EXPIRES: 1 yr.Lic. /Vaccine
3 Yr. L1c. /Vaccine v.erinarit
Month Tar 7WOre* Thranderblid Rd,
Address: Suite 59
Vaccine Serial (Lot) No. Phoenix, AZ 85032
RABIES VACCINATION CERTIFICATE
NASPHV Farm SI Rabies Tag Number
Owner % Name &Addrees PRINT - use ba Fliltpsotint pen or type
Lan
TelephoneCa-
tIV A \
ktz-L.\
No Street ZIP
ViW) i ‘•I .7ZZY4\17
SPECIE I SEX: AGE; SIZE;
Dog ;,,RP Male r-iii4 3 ma- 12 mo. 0 Under 20
Cat rj Female 0 11 mo. or olde 20 • 50 Ilss.
Other 3 Neutere,02> Over SO lbs,
Please specify
DATE VACCINATEDI VETERINARIAN;
PRODUCERilM
Month 6ay Year Vaterinarian'i&i
First 3 letters) License No
VACCINATION EXPIRES: 1 yr. Ws. /Vaccine
3 yr. Wt. /Vacate g Veterinarian% %nature
Sa43s1s-s- A. FOUR LEGGED FRIENDS
Add'3131 E. Thunderbird, #59
Vaccine Serial (Lot) No,
H inenix
• RABIES VACCINATION CERTIFICATE
NASPHV Form S I Rabies Tag Number
Owner's Name & Address PRINT - use ballpoint pen or type
Last. -pc 1(1- s t M.I. ideation
Street CA State
LS k.) late .W11 4_Zit.5-7C;11(i)
SPECIE SEX: AGE: SIZE; PREDOMI NT 1t COLORS;
Dog Male LI 3 mo.- 12 mo. El Under 20
Cat 0 Female 12 ma or oiderjA 20 50 lba. 0
Other 0 Neutered Over 5014 0
Please spetlfr
DATE VACCINATED; VETERINARIAN;
PRODUCER;
1 Veterinarian's t#:
antis Year
First 3 letter* License No
VACCINATION EXPIRES! 1 yr. Lis. /Vaccine , 1td
3 yr. Ws. /Vaccine Veterinarian .; emu' L
Q 3131 E. T underbIrd Rd.
Month Day Year Address: 59
Vaccine Serial (Lot) No. Phoenkn AZ 080$2
RABIES VACCINATION CERTIFICATE
NASPHV Form SI Rablaslits Number
Owner's Name & Address PRINT - Use ballpoint pen or type
Last
C1ty
SPECIE SEX; NOM SIZE;
Dog Male cl 3 ma. 12 mo, 1:3 Under 20 IN, 0
Cat ID Female 0 12 ma. or olde 20 - SO lbs. 0
Other Neutered 0 Over SO lbs NA.L..1;
Please specify
'rot
--t
DATE VACCINATED; VETERINARIAN:
LQ ci L PRODUCER; W
Month - Day Vor Veterinarian's #1 ILIkY
(First 3 letters) License NQ
VACCINATION EXPIRES; 1 yr. Uc. /Vaccine 0
to et 3 yr. Lis. /Vaccine Fr) Veterinarian's Four Logasdffroncis
Month Day Year US) Address: $101E, ThpnderbIrd Rd.
V4G.I hie Serial (Lot) No. Suite 80
PAWS client No. 870
20836 N Cave Creek Road, A-2 Moutons, Patricia
A Vi (`-' ) Phoenix, AZ 85024 1010 North 202nd Avenue
Phone: (002) 7984297 F3kickuvo, AZ 80306
Fax: (602) 324-0816 Phone: (714) 746.0724
azpawa.ora
Rabies Vaccination Certificate
NAN% Cooper
SPECIES: coin° WEIGHT: 0.14 lbs Robins
BREti p: ChIlittahtla MINOCI Tag #
GENfIRR: MN IP #1
COLOR: WIllte/fIrown ID #2
BIRTHDAY: 61312008 Last Visit 31312011
AGE: 2 Yr*, 10 months
Tlam Daaariptim aven DUO, Ilate hot II Manufacturer
V1:102 400ion VaccinoLion 3 1/3/201J 3/2/ Ill 1 ii4V,9002/1 Nap Date
TntiliveL V/1 1 ./2011
I liiirehy certify 7this thilmellos tion-vaccinulpakaccoliloce with the menufachirer's
recommendation for the vaccine used on above data.
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Date 'sailed 313/2011
Siiut Diskin, DVM Licunse: 37111
1-r1WWQ
VAVJ phoenig, 20038 tsi Cave Creek Road, A-2 Plant No, 070
Phone: (802) AZ 88024 Matitors, Patrici.1
Fax: (802) 788-7297 1010 North 20200 Avenue
3240018 lituctioyo, Az 011308
azpawa.org Phone; (714) 740-0734
Rabies
Vaccination Certificate
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GENDI R: MN Reblefi To #
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BIRTHIlAY: 113121100 ID 0
AGE: 2 yra, a months Last Visit 31312011
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