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Maricopa County Animal Care And Control 2500 South 27th Avenue Phoenix, AZ 85009 (602) 506-7387 Tele. (602) 506-2739 Fax KENNEL PERMIT APPLICATION El New Renewal Permit # q- pat Name: kits1 e 4 .3—i) 01 ; f irg Kennel Name: V) V1 Q Mailing Address: 3 1---tkin) .Ctvpbe 11 (60 Kennel Location: L-1 LI sCA krtf be Li re—cf city GI, I bet+ , AZ ZP a? Li County Supervisorial District Home Phone: Kennel Phone: 7/ V— 37) 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 c 1. 1 1/We assume complete responsibility for the kennel at the premises for which I/we are making app ation 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. I/We certify that the kennel has been approved by the local zoning authority (if applicable) at the prer7es for which I/we are making application for a permit. \‘'T I/VVe certify that I/We have dogs and that the kennel meets the definition in statute. I/VVe certify that I/We 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. )t)0 I/We certify that all dogs over the age of three (3) months that are kept, harbored or maintained on the prerriises 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 maintaiRed on the premises for each dog. 6. ;:-)A) I /We certify that I/We are submitting a valid copy of the rabies vaccination certificate for each dog with this application. 7. 14-- `INVe 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. yik I/We understand that a person who fails to obtain a kennel permit under ARS 11-1009 is subject to a penaity,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. ".;\ k VI's 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) N./ 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 1-94 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/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 UWe have provided is true and accurate under penalty of law. Applicant Signature Date: Applicant Signature Date: 1.) 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: R13-184113 Receipt Date: 09/24/2013 Person ID: P0943291 Phone: 480 5583373 OLIVERA KENNELS 3440 E CAMPBELL RD 9/24/2013 5:53:47PM GILBERT, AZ 85234 Item: Animal ID: Reference No: Price: Each: Amount: KEN PERMIT A7777777 K14-000021 $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 munozd EBUSOFF Cr4.1-1.14.0 C. •4,-.1%-1 Animal Care & Control 2500 South 27th Avenue Phoenix, AZ 85009 Phone: (602) 506-7387 pets.maricopa.gov KENNEL PERMIT PREMISE INSPECTION APPLICANT 1,1 ,S STREET ADDRESS Coi-vp--4.-at II 'Pd CITY, STATE, ZIP Fs-a3q HOME PHONE1 t 5D9 -11--N BUSINESS PHONE") \ - SO c( 6 b COUNTY DISTRICT KENNEL LICENSE #1/114- Os). NUMBER OF DOGS_ata 1. Are all dogs over the age of three months properly vaccinated for rabies and in possession of a valid rabies vaccination certificate? Yes i 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 CORRECT WE ACTION NEEDED FOR COMPLIANCE AND DAYS GIVEN BEFORE REINSPECTION. (Note: There will be $49 re-inspect fee payable to the Inspector by check upon each return visit.) Deputy Enforcement Agent Rabies Certificate 11/01/2012 Name: SE1MOUR Date of Birth: 02/09/2009 Sex : M Age: 4 Years 7 Months Species: CAN Color: White Breed: dumber Weight: 0.00 Procedure Performed: 3 Yr Rabies Vacc. Owned By: Susie & Jorge Olivera 3440 E Campbell Gilbert, AZ 85234 Home Phone: (480) 558-3373 Work: (480) 497-8223 Microchip # 1 year Lic/Vacc Vacc. Serial # Producer: Pfizer )( 3 year Lic/vacc (r)5.3,1-)61) For Licensing Date Vaccinated Agency Use Veterinarian #(_ ;-;73 0 1 12_ Month Day Year Clinic: Squaw Peak Animal Hosp Other Vaccine Expires 3165 E Lincoln Dr #115 Change Add Phoenix AZ 85016 Control # II Office 602-553-8855 Month Day Year Fax 602-553-0188 Signed D.V.M. Squaw Peak Animal Hospital 3165 E Lincoln Dr #115 Phoenix, AZ 85016 (602) 553-8855 Rabies Certificate 08/27/2012 Name: BANK$ Date of Birth: 07/21/2010 Sex : M Age: 3 Years 1 Months Species: CAN Color: Salt & pepper Breed: SCHN Weight: 0.00 Procedure Performed: 3 Yr Rabies Vacc. Owned By: Marilyn Lande 1829 N 29th P1 c)(9 Mesa, AZ 85213 Home Phone: (480) 396-6933 Microchip # 1 year Lic/Vacc Vacc. Serial # Producer: Pfizer 7( 3 year Lic/Vacc 4,2-8-59-56e - 14 For Licensing Date Vaccinated Agency Use Veterinarian #3(.1)73 Month Day Year Clinic: Squaw Peak Animal Hosp Other Vaccine Expires 3165 E Lincoln Dr #115 Change Add -' AZ 85016 Control # 2 1 Office 602-553-8855 Month Day Year Fax 602-553-0188 Signed 4440t D.V.M. Squaw Peak Animal Hospital 3165 E Lincoln Dr #115 Phoenix, AZ 85016 (602) 553-8855 Rabies Certificate 08/07/2013 Name: DREAM Date of Birth: 08/08/2011 Sex : F Age: 2 Years 0 Months Species: CAN Color: Tri Color Breed: AKI Weight: 0.00 Procedure Performed: 3 Yr Rabies Vacc. Owned By: Susie & Jorge Olivera 3440 E Campbell Gilbert, AZ 85234 Home Phone: (480) 558-3373 Work: (480) 497-8223 Microchip # 1 year Lic/Vacc Vacc. Serial # Producer: Pfizer 1/3 year Lic/Vacc S285956C For Licensing Date Vaccinated 3 (41 Agency Use Veterinarian # qr -7 1 3 Month Day Year Clinic: Squaw Peak Animal Hosp Other Vaccine Expires 3165 E Lincoln Dr #115 Change Add Phoenix AZ 85016 Control # '7 i& Office 602-553-8855 Month Day Year Fax 602-553-0188 Oa:4 Signed D .V.M. Squaw Peak Animal Hospital 3165 E Lincoln Dr #115 Phoenix, AZ 85016 (602) 553-8855 Rabies Certificate 08/09/2012 Name: PANDA Date of Birth: 08/10/2009 Sex : F Age: 4 Years 1 Months Species: CAN Color: black & white Breed: BEARDIE Weight: 0.00 Procedure Performed: 3 Yr Rabies Vacc. Owned By: Susie & Jorge Olivera 3440 E Campbell Gilbert, AZ 85234 Home Phone: (480) 558-3373 Work: (480) 497-8223 Microchip # 1 year Lic/Vacc Vacc. Serial # Producer: Pfizer / 3 year Lic/Vacc i 51 3Utir For Licensing Date Vaccinated Agency Use Veterinarian # 30.3 1 2- Month Day Year Clinic: Squaw Peak Animal Hosp Other Vaccine Expires 3165 E Lincoln Dr #115 Change Add Phoenix AZ 85016 Control # ) 1c5 Office 602-553-8855 Month Day Year Fax 602-553-0188 Signed 177 b/..-41at. / .441-% D.V.M. Squaw Peak Animal Hospital 3165 E Lincoln Dr #115 Phoenix, AZ 85016 (602) 553-8855 Sep 16 13 12:14p Rene Kiel 760-739-1450 p.1 Date of Rabies Vaccination: 05-15-13 Certificate No: 0 Next Rabies Vaccination 011: Previous Rabies Vaccination: VETERINARY CLINIC OWNER OF ANIMAL .\( Murrieta Oaks Veterinary Hospital 40414 California Oaks Murrieta, CA 92562 WIN IF CA 92596 951-677-7007 County: This is to certify... THAT I HAVE VACCINATED AGAINST RABIES THE ANIMAL DESCRIBED BELOW. MICROCHIP# TAG NO: 200642 WEIGHT: 102.00 AGE: 3 years Color and markings... Grey Signed ANYDOCTOR License: Rabies Vaccine Information... BRAND: <vacc> MFG BY: FTDOD SER.NO: 1215363A LOT EXP: 13FEB14 ADM: SQ Rabies Certificate 02/10/2011 Name: CAMERON Date of Birth: 07/01/2009 Sex : F Age: 4 Years 2 Months Species: CAN Color: black & white Breed: SMOOTH FOX Weight: 0.00 Procedure Performed: 3 Yr Rabies Vacc. Owned By: Susie & Jorge Olivera 3440 E Campbell Gilbert, AZ 85234 Home Phone: (480) 558-3373 Work: (480) (480) 497-8223 Microchip # 1 year Lic/Vacc Vacc. Serial # Producer: Pfizer 3 year Lic/Vacc For Licensing Date Vaccinated Agency Use Veterinarian itc 3(67:2- , 4 a ID II Month Day Year Clinic: Squaw Peak Animal Hosp Other Vaccine Expires 3165 E Lincoln Dr #115 Change Add Phoenix AZ 85016 Control # • r, Office 602-553-8855 Month Day Year Fax 602-553-0188 Signed D.V.M. Squaw Peak Animal Hospital 3165 E Lincoln Dr #115 Phoenix, AZ 85016 (602) 553-8855 VACCINATION CERTIFICATE Account #: 2178 Animal: CHASE Owner: MARILYN LANDE Species: Canine Address: 1829 N. 29TH PL. Breed: Miniature Schnauzer MESA, AZ 85213 Color: Salt & Pepper Gender: Male Phone: (480)396-6933 Birthdate: 8/3/2012 (480)396-6933 Age: 5 months 27 days Weight: 12.10 Chip #: 0(° Manufacturer Serial # Type Tag # Due on PlEgIAL / 133d //a. g/iy Mesa NE. Animal Hospital 1927 N. Gilbert Rd., Ste 2 Mesa, AZ 85203 (480) 835-0117 Dennis Nowicki, DVM 01/28/2013 FAX: (480) 833-8526 mesaneah@aolcorn Rabies Certificate 08/07/2013 Name: FRASER Date of Birth: 08/08/2009 Sex : M Age: 4 Years 0 Months Species: CAN Color: Tri Color Breed: AKI Weight: 0.00 Procedure Performed: 3 Yr Rabies Vacc. Owned By: Susie & Jorge Olivera cyP 3440 E Campbell Gilbert, AZ 85234 Home Phone: (480) 558-3373 Work: (480) 497-8223 Microchip # 1 year Lic/Vacc Vacc. Serial # Producer: Pfizer 3 year Lic/Vacc S285956C For Licensing Date Vaccinated Agency Use Veterinarian 00 25 Month Day Year Clinic: Squaw Peak Animal Hosp Other Vaccine Expires 3165 E Lincoln Dr #115 Change Add Phoenix AZ 85016 Control # q -7 Office 602-553-8855 Month Day Year Fax 602-553-0188 0a;ta, /5/,tee‘t ,04-nt Signed D.V.M. Squaw Peak Animal Hospital 3165 E Lincoln Dr #115 Phoenix, AZ 85016 (602) 553-8855 Rabies Certificate 02/27/2013 Name: SIMON Date of Birth: 10/12/2008 Sex : M Age: 4 Years 11 Months Species: CAN Color: Brindle/white Breed: Mini Bull Weight: 0.00 Procedure Performed: 3 Yr Rabies Vacc. Owned By: Marilyn L. Jacobs P.O. Box 1509 Travis AFB , CA 94535 Home Phone: (707) 280-3979 Work: (916) 321-4513 Microchip # 1 year Lic/Vacc Vacc. Serial # Producer: Pfizer / 3 year Lic/Vacc s2.85.9e 52s IQ 1(6 k For Licensing Date Vaccinated Agency Use Veterinarian #A.c,1? Month Day Year Clinic: Squaw Peak Animal Hosp Other Vaccine Expires 3165 E Lincoln Dr #115 Change Add Phoenix AZ 85016 Control # 1 40 Office 602-553-8855 Month Day Year Fax 602-553-0188 Signed D.V.M. Squaw Peak Animal Hospital 3165 E Lincoln Dr #115 Phoenix, AZ 85016 (602) 553-8855 Rabies Certificate 08/27/2012 Name: MAX Date of Birth: 08/09/2009 Sex : m Age: 4 Years 1 Months Species: CAN Color: Red Breed: CHOW Weight: 0.00 Procedure Performed: 3 Yr Rabies Vacc. Owned By: Susie & Jorge Olivera 3440 E Campbell Gilbert, AZ 85234 Home Phone: (480) 558-3373 Work: (480) 497-8223 Microchip # 1 year Lic/Vacc Vacc. Serial # Producer: Pfizer / 3 year Lic/Vacc S-245-95-6-&- f.2)1 .--15q For Licensing Date Vaccinated Agency Use Veterinarian #,?kin . 1 1 )2 Month Day Year Clinic: Squaw Peak Animal Hosp Other Vaccine Expires 3165 E Lincoln Dr #115 Change Add Phoenix AZ 85016 Control # 2:1 IS Office 602-553-8855 Month Day Year Fax 602-553-0188 %%eat , 104' 1 Signed D.V.M. Squaw Peak Animal Hospital 3165 E Lincoln Dr #115 Phoenix, AZ 85016 (602) 553-8855 CERTIFICATE OF VACCINATION Date of Rabies Vaccination: 12-22:J2 Next Rabies Vaccination Or;61-2:22-fg--- VETERINARY CLINIC OWNER OF ANIMAL Power Ranch Animal Hospital Gilbert Maw 18521 East Queen Creek Road #1 4276 E Carob Dr Queen Creek, AZ 85242 Gilbert, AZ 85297 480-988-6488 County: This is to certify... THAT I HAVE VACCINATED AGAINST RABIES THE ANIMAL DESCRIBED BELOW. Patient information... PATIE Microchip #: 4C1148106B SPECI WEIGHT: 19.40 SEX: Male AGE: 2Y Color and marki gs: White Breed: West Highland Terrier 4,44 Signed DVAA Steve Waldo, DVM License: 4305 Rabies Vaccine Information... MEG BY: PFIZE SER.NO: S171728 LOT EXP: 01/23/13 ADM: SQ Vaccinations done... 12-22-12 SW Rabies Canine, 3yr, #1176 12-22-15 12-22-12 SW Da2p 1yr 12-22-13 11-26-12 SW Injectable Bordetella 01-12-12 SW Rabies Canine, 1yr, #331 01-12-12 SW Da2p #4 12-22-11 SW Da2p #3 3wks 11-25-11 SW Da2p #2 3wks 10-28-11 SW Da2p #1 3wks Rabies Certificate 08/27/2012 Name: MILLIE Date of Birth: 09/12/2011 Sex : F Age: 2 Years 0 Months Species: CAN Color: White Breed: WESTIE Weight: 0.00 Procedure Performed: 3 Yr Rabies Vacc. Owned By: Susie & Jorge Olivera 3440 E Campbell Gilbert, AZ 85234 Home Phone: (480) 558-3373 Work: (480) 497-8223 Microchip # 1 year Lic/Vacc Vacc. Serial # Producer: Pfizer xi year Lic/Vacc S2359-C— Li 1 FSC1 4 For Licensing Date Vaccinated Agency Use Veterinarian # 2[1 ) 2_ Month Day Year Clinic: Squaw Peak Animal Hosp Other Vaccine Expires 3165 E Lincoln Dr #115 Change Add Phoenix AZ 85016 Control # Office 602-553-8855 Month Day Year Fax 602-553-0188 /4:-- ,a44.4z. 1/4.-t Signed D.V.M. Squaw Peak Animal Hospital 3165 E Lincoln Dr #115 Phoenix, AZ 85016 (602) 553-8855 VACCINATION CERTIFICATE Account #: 2178 Animal: SQUIRE Owner: MARILYN LANDE Species: Canine Address: 1829 N. 29TH PL. Breed: Miniature Schnauzer MESA, AZ 85213 Color: Salt & Pepper Gender: Male Phone: (480)396-6933 Birthdate: 813/2012 (480)396-6933 Age: 5 months 27 days Weight: 14.04 Chip #: Date LTRIMITIrtg Manufacturer Serial # Type Tag # Due on / s9153C. Mesa N.E. Animal Hospital 1927N. Gilbert Rd., Ste 2 Mesa, AZ 85203 01/28/2013 (480) 835-0117 Dennis Nowicki, DVM FAX: (480) 833-8526 mesaneah*ol.corn Rabies Certificate 09/11/2013 Name: GABBY Date of Birth: 09/12/2008 Sex : F Age: 5 Years 0 Months Species: CAN Color: GRAY/WHITE Breed: BEARDIE Weight: 0.00 Procedure Performed: 3 Yr Rabies Vacc. Owned By: Susie & Jorge Olivera 3440 E Campbell Gilbert, AZ 85234 Home Phone: (480) 558-3373 Work: (480) 497-8223 Microchip # _./1 year Lic/Vacc Vacc. Serial # Producer: Pfizer 1,/ 3 year Lic/Vacc S285956C For Licensing Date Vaccinated Agency Use Veterinarian # 434-2/ h t77) Month Day Year Clinic: Squaw Peak Animal Hosp Other Vaccine Expires 3165 E Lincoln Dr #115 Change Add Phoenix AZ 85016 Control # Office 602-553-8855 Month Day Year Fax 602-553-0188 t;aeeet ,Res-% Signed D.V.M. Squaw Peak Animal Hospital 3165 E Lincoln Dr #115 Phoenix, AZ 85016 (602) 553-8855 VACCINATION CERTIFICATE Account #: 2178 Animal: ANNIE Owner: MARILYN LANDE Species: Canine Address: 1829 N. 29TH PL Breed: Miniature Schnauzer MESA, AZ 85213 Color: Salt & Pepper Gender: Female Phone: (480)396-6933 Birthdate: 8/3/2012 os (480)396-6933 Age: 5 months 27 days Weight: 13.12 Chip #: Manufacturer Serial # Type 11.W---VAL /81V3e- Mesa N.E. Animal Hospital v\-_,, 1927 N. Gilbert Rd., Ste 2 Mesa, AZ 85203 (480) 835-0117 Dennis Nowicki, DVM 01/28/2013 FAX: (480) 833-8526 mesaneah@aol.com CERTIFICATE OF VACCINATION Date of Rabies Certificate Printed: 09-13-13 VETERINARY CLINIC OWNER OF ANIMAL Pearson-Nespor Animal Hospital Elois Veltman 1903 W San Marcos Blvd.-Suite 140 PO Box 2170 San Marcos, CA 92069 Fal[brook, CA 92028 760-598-2512 County: This is to certify... THAT I HAVE VACCINATED AGAINST RABIES THE ANIMAL DESCRIBED BELOW. Patient information... PATIENT: The Kid TAG NO: SPECIES: Canine BREED: Pug WEIGHT: 18.00 SEX: Male AGE: 18M Color and markings: Fawn Signed , Dr. Dorota Pearson License: 12504 Vaccinations done... 09-13-13 DP Rabies 1-Year Vaccine (Canine) 09-13-14 Rabies Vaccine Information... MFG Boehringer Inge[helm LOT. NO: 1215379A EXP: 02-01-2015 ADM: SQ — Rabvac3 Rabies Certificate 08/01/2012 Name: ADMIRAL Date of Birth: 09/02/2007 Sex : M Age: 6 Years 0 Months Species: CAN Color: Black Breed: BOU Weight: 0.00 Procedure Performed: 3 Yr Rabies Vacc. Owned By: Susie & Jorge Olivera 3440 E Campbell Gilbert, AZ 85234 Home Phone: (480) 558-3373 Work: (480) 497-8223 Microchip # 1 year Lic/Vacc Vacc. Serial # Producer: Pfizer ,/ 3 year Lic/Vacc 6.2.44444G- ':‘' ' • f-(Ti For Licensing Date Vaccinated Agency Use Veterinarian # 17-- Month Day Year Clinic: Squaw Peak Animal Hosp Other Vaccine Expires 3165 E Lincoln Dr #115 Change Add “--, Phoenix AZ 85016 Control # ,,;) i •--' Office 602-553-8855 Month Day Year Fax 602-553-0188 Signed f;ieeett 1 0-1-% D.V.M. Squaw Peak Animal Hospital 3165 E Lincoln Dr #115 Phoenix, AZ 85016 (602) 553-8855 Rabies Certificate 08/01/2012 Name: TASER Date of Birth: 01/01/2004 Sex : M Age: 9 Years 8 Months Species: CAN Color: Black Breed: Affenpinsc Weight: 0.00 Procedure Performed: 3 Yr Rabies Vacc. Owned By: Susie & Jorge Olivera 3440 E Campbell Gilbert, AZ 85234 Home Phone: (480) 558-3373 Work: (480) 497-8223 Microchip # 1 year Lic/Vacc Vacc. Serial # Producer: Pfizer / 3 year Lic/Vacc s2e5-55-6-e- Q C 1 For Licensing Date Vaccinated Agency Use Veterinarian # lapLa c4 12. Month Day Year Clinic: Squaw Peak Animal Hosp Other Vaccine Expires 3165 E Lincoln Dr #115 Change Add Phoenix AZ 85016 Control # Office 602-553-8855 Month Day Year Fax 602-553-0188 • Signed 1 • 1.1.1,0. i411.1 / D .V.M. Squaw Peak Animal Hospital 3165 E Lincoln Dr #115 Phoenix, AZ 85016 (602) 553-8855 Rabies Certificate 08/09/2012 Name: XL Date of Birth: 08/10/2009 Sex : F Age: 3 Years 0 Months Species: CAN Color: black & white Breed: BEARDIE Weight: 0.00 Procedure Performed: 3 Yr Rabies Vacc. Owned By: Susie & Jorge Olivera 3440 E Campbell Gilbert, AZ 85234 Home Phone: (480) 558-3373 Work: (480) 497-8223 1 year Lic/Vacc Vacc. Serial # Producer: Pfizer -Tz's 3 year Lic/Vacc S175963H For Licensing Date Vaccinated Agency Use Veterinarian # V7.3 4Ec 1 I Month Day Year Clinic: Squaw Peak Animal Hosp Other Vaccine Expires 165 E Lincoln Dr #115 Change Add Phoenix AZ 85016 Control # Office 602-553-8855 Month Day Year Fax 602-553-0188 Signed 97o2t, 4"tee-e4 , D.V.M. Squaw Peak Animal Hospital 3165 E Lincoln Dr #115 Phoenix, AZ 85016 (602) 553-8855 Rabies Certificate 08/13/2012 Name: CHET Date of Birth: 06/09/2009 Sex : M Age: 4 Years 3 Months Species: CAN Color: Tri Color Breed: harrier Weight: 0.00 Procedure Performed: 3 Yr Rabies Vacc. Owned By: Susie & Jorge Olivera 3440 E Campbell Gilbert, AZ 85234 Home Phone: (480) 558-3373 Work: (480) 497-8223 Microchip # 1 year Lic/Vacc Vacc. Serial # Producer: Pfizer / 3 year Lic/Vacc , [ For Licensing Date Vaccinated Agency Use Veterinarian #k_1? 1:3 17 Month Day Year Clinic: Squaw Peak Animal Hosp Other Vaccine Expires 3165 E Lincoln Dr #115 Change Add Phoenix AZ 85016 Control # Office 602-553-8855 Month Day Year Fax 602-553-0188 Signed .I e# 1,9 41,4" D.V.M. Squaw Peak Animal Hospital 3165 E Lincoln Dr #115 Phoenix, AZ 85016 (602) 553-8855