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16549 characters
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 Ntig Renewal Permit # (33„,
Name: E Kennel Name: x
Mailing Address: p9 t r Kennel Location: cos ff's Lou Ilse Or
"
City Phue rioc , Az ZIP i? sD3, County Supervisorial District 3
Home Phone: //7))._, ,,98 , :9,4- 7_3 Kennel Phone:
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 kenner 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 "kenner 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. ‘-/ 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. , 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. I/We certify that INVe have dogs and that the kennel meets the definition in statute.
r.-.71/We certify that I/VVe have not been convicted of a violation of A.R.S. §§ 13-2910 (cruelty to animals)
4. 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. I, I/We certify that all dogs over the age of three (3) months that are kept, harbored or maintained on the
pr9fnises of the above named kennel have been property vaccinated against rabies by a veterinarian licensed to
practice in the state of Arizona and that a current vaccination certificate signed by a licensed veterinarian is
maintained on the premises for each dog.
6. k I /We certify that I/We are submitting a valid copy of the rabies vaccination certificate for each
do with this application.
7- \i -e 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. -\; v 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.
9. v, I/VVe understand that a person who knowingly fails to obtain a kennel permit within thirty days after
written riotification 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 n t 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. After September § 41-1080(A) 30, prOvides: 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. 7-5I/VVe certify that the kennel permit is being used solely for the purpose of licensing my own multiple
companion dogs in my household.
INVe certify that all of the information VWe have provided is true and accurate under penalty of law.
Applicant Signature ',,..Z..e,t_e_.. /77 ./.1-/- 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.dov
Receipt Number: R13-184856 Receipt Date: 09/25/2013
Person ID: P1152886
Phone: 602 4826975
NIX KENNELS
2505 E LOUISE DR 9/25/2013 12:25:56PM
PHOENIX, AZ 85032
Item: Animal ID: Reference No: Price: Each: Amount:
KEN PERMIT A7777777 K14-000032 $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
APODA CAP EBUSOFF
Month 9 Month DATE (Specify) Other: Cat Dog No. PRINT Month Month Cil DATE (Specify) Other: Cat Dog Species: 9 No. PRINT Owner's
cA Species: Owner's () VACCINATION -
Day 15 VACCINATION Day 0 0 A (Jnoi-D ,,... U - I:.rit Day Day RI 0 0 xii Last CIWNEK
IU VACCINATED: i Last Name i VACCINATED: Male Sex: 1 Name (
Year Year 0 Neutered Female Male Sex: „Street.. v and (;)r, Year Year )3 Neutered Female Street X and )1'),
ko, EXPIRED: EXPIRED:
0 KJ 0 Address 0 0 IX F Address
Vacc. Actual 12 3 Age: Vacc. 5 tgi 0 Producer: Actual mo 12 mo 3 Age:
NJ 0 Producer: mo mo RABIES 3 1 to RABIES
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