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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 >4 Renewal Permit # l - 00 1- Name: -SPCIt (\e-V) Kennel Name: S Mailing Address: ..-3t-‘ tA S Kennel Location: b City O.( , AZ ZIP g508- County Supervisorial District Home Phone: IOC ?to Kennel Phone: (1)0 79- 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. IANe assume complete responsibility for the kennel at the premises for which I/we are making appO`oation 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/VVe certify that the kennel has been approved by the local zoning authority (if applicable) at the .preises for which I/we are making application for a permit. I/VVe certify that INVe have dogs and that the kennel meets the definition in statute. I/We certify that I/We have not been convicted of a violation of A.R.S. §§ 13-2910 (cruelty to animals) -2910.01 (dog fighting), or any other state, county or municipal animal welfare law. (Violations of license leash laws DO NOT apply.) 5- I/VVe certify that all dogs over the age of three (3) months that are kept, harbored or maintained on the Ore 'ses 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. 6r_ , I /We certify that I/We are submitting a valid copy of the rabies vaccination certificate for each doglkith this application. 7. I/We understand that a dog remaining within the kennel is not required to be licensed individually under ARO 1-1008. 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. INVe 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. . K. . 4 I/VVe understand that a person who knowingly fails to obtain a kennel permit within thirty days after WrittO 'fiPotification from the county enforcement agent is guilty of a class 2 misdemeanor. 10.)(p"-)Is this kennel permit being obtained for the purposes of operating a business including but not limited to lol-eeders, groomers or boarding establishments? (Please check one) 1../ 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. I/VVe 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 I/We have provided is true and accurate under penalty of law. Applicant Signature oSe 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 VJUL) it±iNns °LAD- resr• -ynn-r , 00 / http://pets.maricopa.dov Receipt Number: R13-175344 Receipt Date: 09/10/2013 Person ID: P0999286 Phone: 480 4881780 SPRINGBROOK KENNELS 36614 N 23RD ST 9/10/2013 2:52:43PM CAVE CREEK, AZ 85331 Item: Animal ID: Reference No: Price: Each: Amount: KEN PERMIT A7777777 K14-000004 $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 shawcrof EBUSOFF IV CO, la 460 l."1-7 0-/klt.4A.L cy Animal Care & Control 2500 South 27th Avenue Phoenix, AZ 85009 Phone: (602) 506-7387 pets.maricopa.gov KENNEL PERMIT PREMISE INSPECTION APPLICANT STREET ADDRESS 6 1 9 a3r4 s+ CITY, STATE, zip IAuen z gs-D8=-6 HOlVIE PHONE 1---k0 ' WO BUSINESS PHONE • 5711- SaC2D COUNTY DISTRICT /3 KENNEL LICENSE #V\It.1-001 NUMBER OF DOGS -1 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? 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 tkuLA.Challe; # 42 Date 09/09/2013 9:12AM FAX 14805951640 CVMC a0001/0001 Rabies Vaccination Certificate Based on NASPHV form 50 Owners Name & Address Last First Telephone Brooks Lue Jeane 602-579-8200 No. & Street City State Zip 36614 . . .. N. .. 23rd .. f ____ St .. .. Desert Hills AZ 85086 Species Sex Age Weight Breed Colors Canine Male 7 mo 31.4 Lbs English Springei Black and Wh .r`lartl . Bentley ' Chip: Producer. imrab 3 Duration:1 Year 12559 vacc. serial (lot) No. For Licensing Agency Use Date Vaccinated: t #:4 License No. Year Sat, May 18, 2013 111 .01f: ' A 2013 20 Rabies Tag #: Dr. ychael J. Keller 20 Vaccine due again: Ch.. 1, arral Veterinary Medical Cent Other 32100 N. Cave Creek Rd. Sun, May 18, 2014 Cave Creek. AZ 85331 Change 0 Add 0 Fax: 480-595-1640 Control: Tel: 480-595-8600 UCENSE FEE S TPE7 T,/-1: HOME PHONE - OWNER WORK PHONE PHYSICAL ADDRESS e ,A0 MAIUNG ADDRESS VIrCI °F NA TION -5//6 Pc 0 UN - $5 LATE FEE APPUES AFTER MARCH 31ST . RABIES VACCINATION CERTIFICATE YAVAPAI COUNTY ANIMAL CONTROL PHONE 7714260 RABIES NO. SES.EAST GURLEY 9 PRESCOTT, AZ COLOR - AGE SIZE SEX lt*G'S NAME 137 4/6 PleMer d8/k .)-te) r- )(3y /27 19) ,No. /a/5- LICENSE FEE PENALTY TOTAL HOME PHONE c6? 78 () OWNER WORK PHONE 3/4 471 LA, _ ./C1(;/ PHYSICAL ADDRESS MAILING ADDRESS ,sk),d//)( /9 DATE OF QC-I3 LATE OF VACCINATION UCENSE 'VET HINWITAL $5 LATE FEE APPLIES AFTER MARCH 31ST Desert Hills Animal Clinic www.dhanimalclinic.com 1039 E. Carefree Hwy Ste. A Phoenix, AZ 85085 (623) 581-1558 Rabies Certificate Patient ID: 6725 Id Client ID: 773 Patient Name : (Diamond Client Name: Lue Jeane Brooks Species: Canine <>1 Address: • 36614 N 23rd St Breed: Spaniel, Welsh Springer Sex: Female Desert Hills, AZ 85086 Color: Black White Phone: (480)488-1780 Markings: Birthday: 07/19/2002 Weight: 31.40 pounds on 612/2012 Tag Number 2836 Vaccination Date. 6/2/2012 Lot Number: 12557 Expiration Date: 61212015 Inventory Rabies Vaccine Producer: Merial K MLV / IR: Killed Virus Staff Name: Bryan L. Neidigh, DVM fea-AVARA. 8, ei\ License Number 3932 Desert Hills Animal Clinic www.dhanimalclinic.com 1039 E. Carefree Hwy Ste, A Phoenix, AZ 85085 (623) 581-1558 Rabies Certificate Client ID: 773 Patient ID: 8061_ Client Name: Lue Jeane Brooks Patient Name:IPearl/ Address: 36614 N 23rd St Species: Canine Breed: Spaniel, English Springer Desert Hills, AZ 85086 Sex: Female Color: Black White Phone: (480)488-1780 Markings: Birthday: 07/19/2002 Weight: 33.40 pounds on 61212012 *.) Tag Number: 2837 Vaccination Date: 5/2/2012 Lot Number: 12557 Expiration Date: 6/2/2015 Inventory Rabies Vaccine Producer: Merial K / MLV / R: Killed Virus 8,54.)tif\ Staff Name: Bryan L. Neidigh, DVM License Number: 3932 • Desert Hills Animal Clinic www.dhanimalclinic.com 1039 E. Carefree Hwy Ste. A Phoenix, AZ 85085 (623) 581-1558 Rabies Certificate Client ID: 773 Patient ID: .0_21913 Patient Nam+JUbileg -40 Client Name: Lue Jeane Brooks Address: 36614 N 23rd St Species: carol* Breed: Spaniel, English Springer Desert Hills, AZ 85086 Sex: Spayed Female Color: Black White Phone: (480)488-1780 Markings: Birthday: 03/05/2010 Weight: 35.20 pounds on 6/19/2012 Tag Number: 5047 Vaccination Date: 6/4/2011 Lot Number 12552 Expiration Date: 6/4/2014 MERIAL Producer: Merial K / MLV / R: Killed Virus Staff Name: Cornerstone License Number: 9/11/2013 Phoenix, AZ 85085 (623) 581-1558 Rabies Certificate Client ID: 773 Patient ID: 1156 Clierrt Name: Lue Jeane Brooks Patient Name: Ransom Address: 36614 N 23rd St Species: Canine Breed: Spaniel, English Springer Desert Hills, AZ 85086 Sex: Neutered Male Color: Black Tri Phone: (480)488-1780 Markings: Birthday: 03/28/2001 Weight: Tag Number 5049 Lot Number. 12552 Vaccination Date: 6/4/2011 MERIAL Expiration Date: 6/412014 Producer 'Menai K / MLV / R: Killed Virus Staff Name: Cornerstone License Number.