EVANZ KENNELS.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 )i:1 Renewal Permit # I LI `' OLIO
j
Name: (nett t•ff V"\ uk- I Lit Kennel Name:
Mailing Address: bg A3. 3 6? Kennel Location: 6, S'5 3 ,41. ci " 0 c
City ht,(ThA , AZ ZIP 8-ST:53 County Supervisorial District
Home Phone: S?' 9 Kennel Phone: 6 — C c7,2 /
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. biAR 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. _16122_ I/VVe 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. At.. I/We certify that I/VVe have 1) ,Z dogs and that the kennel meets the definition in statute.
I/VVe certify that INVe have not been convicted of a violation of A.R.S. §§ 13-2910 (cruelty to animals)
or 1332910.01 (dog fighting), or any other state, county or municipal animal welfare law. (Violations of license
and 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
prie 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.
6. I /We certify that I/VVe are submitting a valid copy of the rabies vaccination certificate for each
dog with this application.

lAtile understand that a dog remaining within the kennel is not required to be licensed individually under
AS 1'1-1008. Ilwe 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. I/We 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. 410 I/VVe 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. fikt 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 cX, 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/We certify that the kennel permit is being used solely for the purpose of licensing my own multiple
comrton dogs in my household.
INVe certify that all of the information VWe have provided is true and accurate under penalty of law.
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: R13-168181 Receipt Date: 0812812013
Person ID: P0999788
Phone: 602 8430219
EVANZ KENNELS
16853 N 39TH DR 8/28/2013 5:14:57PM
PHOENIX, AZ 85053
Item: Animal ID: Reference No: Price: Each: Amount:
KEN PERMIT A7777777 K14-000040 $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
KJENSEN EBUSOFF

• 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
tiCtUf t-Ci—) rilcur i)tin uti) -Z-i3 16911
.. treat .., Cityry, . .-1 Stattiz i
Dr r
- 1 - N) 3elc'vi
Species: Sex: Age: Size: Predominant Breed: . Colors:
Dog lei Male t5i! 3 mo to 12 mo ($1 Under 20 lbs.A1
Cat 0 Female El 12 me or older 1:1 20 - 50 lbs. D IHTAVOCYC LIPYI if;1141. k
tiCil-t;--i-
Other: 0 Neutered El Actual AgetPlnY3 Over 50 lbs. 0
(SpecIfY) ActualA.P_Ibs / Ve: ,..e-Artc.5c RA-p
p , F._ Veterinarian's: # A ty? ci f1-2-
DATE VACCINATED: Pro ducer ........„),Lic se ,
1
---7 .avi 3 (First 3 letters)
'I . (Signature)
Month Day Year A 1 yr. Lic./Vacc.
Address:
I:13 yr. Lic./Vacc.
VACCINATION EXPIRED: Other
---7 32PI -_) .'7)61 571 , At 2F:772 I
ler opt,
Month Day Year Vacc. Serial (lot) no.
VETERINARIAN'S COP" RABIES VACCINATION CERTIFICATE
NASPHV Form #51 . [Rabies Tag Number
Owner's Name and Ad( print - use bell point pen or type'
PRINT - Last First M.I. I Telephone
No. Street City State Zip
Species: Sex: Age: Size: Predominant Breed: Colors:
Dog pl Male p_ 3 mo to 12 ma 0 ' Under 20 lbs. JAt_
Cat 0 Female 0 12 ma or older INL, 20 - 50 lbs. El
Other: 1:1 Neutered D Actual Age _ , Over 50 lbs, El
(Specify) ActuaLL. lbs Name:
j114;34 4
DATE VACCINATED: Producer: Veterinarian's: #
(license No.)
(Fast 3 letters)
Month Day Year 0 1 yr. LiciVacc. (Signature)
Address:
3 yr. LiciVacc.
VACCINATION EXPIRED: Other
Month Day Year Vacc. Serial (lot) no.

RABIES VACCINATION CERTIFICATE
Rabies Tag Number
NASPHV Form 5 I
Owner's Name & Add PRINT - use ballpoint pen or type
Last First r.... Telephone
No. Street City State Zip .
SPECIES: SEX: AGE: SIZE: PREDOMINANT BREED: COLORS:
Dog 0 Male 0 3 mo. - 12 mo. 0 Under 20 lbs. 0
Cat 0 Female 0 12 mo. or older0 20 - 50 lbs. 9 hi, . k f
Other 0 Neutered 0 Over 50 lbs. 0 NAME:
Please specify
. I
DATE VACCINATED: VETERINARIAN:
PRODUCER: .
• Veterinarian's #i
Month Day ' Year License No.
Firs 3 letters ,.
VACCINATION EXPIRES: I yr. Lic. /Vaccine 0 . .. ,
3 yr. Lic. /Vaccine $3 Veterinarian's Signature
7 /9 ALL/
Month Day Year Address:
Vaccine Serial (Lot) No.
RABIES VACCINATION CERTIFICATE
Rabies Tag Number
NASPHV Form 5?
Owner's Name & Adi PRINT. use ballpoint pen or type
Last First rd. Telephone
No. Street City State Zip
SPECIES: SEX: AGE: SIZE PREDOMINANT BREED: COLORS:
Dog O. Male 0 3 mo.- 12 mo. .0 Under 20 lbs. 0
Cat 0 Female 0 12 mo. or older 0 20 - 50 lbs. 0
Other 0 Neutered D Over 50 lbs. 0 NAME:
Please specify
DATE VACCINATED: VETERINARIAN:
PRODUCER:
Veterinarian's #:
Month Day Year License No.
(First 3 letters
VACCINATION EXPIRES: 1 yr. Uc. /Vaccine 0
3 yr. Uc. /Vaccine yi Veterinarian's Signature
Address:
Vaccine Serial (Lot) No.

Rabies Tag Number
NASPHV Form #51
Owner's Name and Address Print - use ball point pen or type
PRINT - Last First M.I. Telephone
i '1 1..h i CO- L6-1Y
r --aiA-k-f+-- City State Zip
No. treet
Species: Sex: Age: Size: Predominant Breed: Colors:
Dog 'A Male CI 3 mo to 12 mo CI Under 20 lbs. /14 Hzx 161 .4.__ __
Cat 0 Female IX 12 mo or older NI 20 - 50 lbs. CI Volnese
Other 0 Neutered 0 Actual Age Over 50 ,4s. CI WIAI•4e
(Specify) Actual_ t) lbs. Name:
a irei•-
f ...--, Veterinarian's: # t pi 1 L) 9.4 t E 4A'2_ P "—
DATE VACCINATED: Producer: F 1 (License No )
3 (First 3 letters)
(signature)
Month Day Year El 1 yr. Lic./Vacc.
Address:
rg 3 yr. Lic./Vacc.
VACCINATION EXPIRED: Other 3) .eLD E IL514- 5f-
--1-20,1,e, 0---cat2Z1
Cnt-iS7 I
Month Day Year 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
PCLL414 • MOZ Ar 1 1 t_ (-1 t pod.-1Cii21- wn
Itpt.53 net )r Ci State
Acril- . Pheril i X
Species: . Sex: Age: Size: Predominant Breed: Colors:
Dog Ogl Male 0 3 mo to 12 mo 0 Under 20 lbs. Dil LUill R
Cat E Female D9 12 mo or older A 20 - 50 lbs. 71 ‘__. 1-t DA.11C4YOCC
Other: 0 Neutered CI Actual Age Over 50 lbs. •
PPecIfY) Actual_a._ lbs Name' ,
DATE VACCINATED: Producer: p e Veterinarian's: # 1 I ' M Al-
(License No..)
---1 (XI 13 (First 3 letters) 0A an,, 7,, c.' .Arel/
Month Day Year (Signature)
CI 1 yr. Lic./Vacc.
18:1 3 yr. Lic./Vacc. Address:
VACCINATION EXPIRED: 3)4be ica“-.54--
Other
I
i e - fiript, P/2:35*1 I
Month Day Year Vacc. Serial (lot) no.

VETERINARIAN'S COPY RABIES VACCINATION CERTIFICATE
- NASPI41/ Form #51 Rabies Tag Number
Owner's Name and Addrer _ Print - use ball point pen or type .
PRINT - Last First M.I. Telephone
No. Street City State Zip
Species: Sex: Age: Size: Predominant Breed: Colors:
Dog cial Male X 3 mote 12 mo 0 Under 20 lbs. M p ctiWr
Cat 0 Female 0 12 moor older X 20 - 50 lbs. 0
Other: • Neutered 0 Actual Age _II 1/4- Over 50 lbs. •
(SPecr(Y) Actual_lbs. Name:
i Li 74.
DATE VACCINATED: Producer: Veterinarian's: #
(License No)
(First 3 letters)
Month Day Year 0 1 yr. LiciVacc. (signature)
Address:
X3 yr. Lic./Vacc.
VACCINATION EXPIRED: Other
Month Day Year Vacc. Serial (lot) no.
RABIES VACCINATION CERTIFICATE
NASPHV Form #51 Rabies Tag Number
Owner's Name ,-, Addref Print - use ball point pen or type
PRINT - Last First M.1. Telephone
No. Street City State Zip
Species: Sex: Age: Size: Predominant Breed: Colors:
Dog q Male RI 3 me to 12 mo II Under 20 Ibs. • p
Uilltl_e--
Cat 0 Female 0 12 mo or older NI 20 - 50 lbs. 0
Other: • Neutered 0 Actual Age I Vi -I/ Over 50 lbs. •
(Specify) i Actual _lbs. Name:
Alq
DATE VACCINATED: Producer Veterinarian's: # (License 140.)
i
(First 3 letters)
-Month Day Year 0 1 yr. tic./ Vacc. (signature)
Address:
03 yr. LicJVacc.
VACCINATION EXPIRED: Other
6
_a_ Clr)
Month Day Year Vacc. Serial (lot) no.

Vt I EIRINARIAN'S COPY RABIES VACCINATION CERTIFICATE
NASPHV Form #51 Rabies Tag Number
Owner's Name and Adds Print - use ball point pen or type
PRINT - Last First M.I. Telephone
No. Street City State - Zip
Species: Sex: Age: Size: Predominant Breed: Colors:
Dog R Male 0 3 me to 12 mo 0 Under 20 lbs.A ?
Cat • Female I;ij. 12 mo or older 0 20 - 50 lbs. •
Other: • Neutered 0 Actual Age 3 / Over 50 lbs. 0 N
(Specify) i Actual___Ibs. Name: I
IA:GB.4AL-
DATE VACCINATED: Producer: Veterinarian's: *I
(License No.)
(First 3 letters)
Month Day Year • 1 yr. UciVacc. (Signature)
0 3 yr. Lic./Vacc. Address:
VACCINATION EXPIRED:
Other
Month Day Year Vacc. Serial (lot) no.
nu-N,FilAN S COPY RABIES VACCINATION CERTIFICATE
NASPHV Form #51 Rabies Tea Number
Owner's Name and Addri Print - use ball point pen or type
PRINT - Last First M.I. Telepho
No. Street City Stet Zip
Species: Sex: Age: Size: I Predominant Breed: Colors:
Dog 0 Male 0 3moto 12 mo0 Under 20 lbs.gi
Cat 0 Female 12 mo or older 0 20 - 60 lbs. 0
Other. 0 Neutered 0 Actual Age_ Over 50 lbs. 0
(*wily) Actual_ lbs.
DATE VACCINATED: Producer Veterinarian's: (ucerpN No)
Month Day Year 0 1 yr. Uc./Vacc. (Sigrelutei
Addross.
0 3 yr. UciVacc.
VACCINATION EXPIRED: Other
Month Day Year Vaoc. Serial (lot) no.

Number
Zip Colors: Number
Tag Zip Colors:
Rabies Telephone No.) Tag j.4
State (License Rabies Telephone No.)
M.I. Breed: r''' Cf # I State (License
I• M• Breed: #
CERTIFICATE Predominant Veterinarian's: U116=15;:f.e
type Name: (signetuiv) Address: CERVFICATE Predominant Veterinarian's: (Sienettne)
or type Name: Address:
#51 pen lbs.'R 0 0 lbs. or
Form point lbs. lbs. #51 pen fgl 0 0 _lbs.
First City 20 50 50 I Form point lbs. lbs. lbs.
VACCINATION NASF'HV bell Size; Under - Over Actual First City 20 50 50
use 20 letters) 3 Other no. VACCINATION NASPHV ball Size: Under - 20 Over Actual letters)
- 0 1 (First Lic./Vacc. Lic./Vacc. use 3 Other
Print mo older (lot) - 0 0 (First lic./Vacc. LiciVacc.
12 or Age 1 yr. yr. Serial Print rim older
RABIES to mo mo Actual Producer 1 0 V.1„3 12 or Age yr. 3y
Age: 3 12 Wm RABIES mote mo Actual Producer 01 0
0 0 I Age: 3 12
Addres
COP EXPIRED: Addre 0 04 0 EXPIRED:
and Street Female Neutered Year Yeif
ARLn'jS Sex: Male VACCINATED: and Street Female Neutered Year
Name Last Day Day Sex: Male VACCINATED:
'TFfllN - 0 0 VACCINATION Name Last 0 0 Day VACCINATION
Owner's PRINT No. Species: Dog Cat Other (SPediY) DATE Month Month - 7S1
Owner's PRINT Species: Dog Cat Other. DATE Month

VETEPINARAN'S COPY RABIES VACCINATION CERTIFICATE
,-- NASPHV Form #51 Rabies Tag Number
Owners Name and Addrei . Print - use ball point pen or type
PRINT - Last First M.1. Telephone
No. Street City State Zip
Species: Sex: Age: Size: Predominant Breed: Colors:
Dog (6 Male 0 3 mo to 12 mo 0 Under 20 lbs. 03, 42
Cat S Female pc 12 moor older 0 20 - 50 lbs. CI PAeli. k
'c'•
Other. 0 Neutered 0 Actual Age Over 50 lbs. El
(SPecifY) Actual_lbs Name:
i
DATE VACCINATED: Producer: Veterinarian's: # , .....VC1 CiZ
(..,......- No.) .
(Frs' 3 kittens)
Month Day Year Di yr. Lic./Vacc. ls+griature)
0 3 yr. LiciVacc. Address:
VACCINATION EXPIRED:
Other
3 1 ) i -> __SLIG--134 11
Month Day Year Vacc. Serial (lot) no.
RABIES VACCINATION CERTIFICATE
NASPHV Form #51 Rabies Tag Number
Owner's Name and Addret Print - use ball point pen or type ---
PRINT - Last First M I. Telephone
. Street City State Zip
..
Species: Sex: Age: Size: Predominant Breed: :
e
Dog iril Male 0 3 mo to 12 mo 0 Under 20 lbs. 553 1 111 Cr
Cat 0 Female 12) 12 moor older • 20 - 50 lbs. 0
Other: 0 Neutered 0 Actual Age- Over 50 lbs. 0
(Spear) Actual ____ lbs . Name:
illp •ftla
DATE VACCINATED: Producer: Veterinarian's: #
(License No
(Foist 3 letters)
Month Day -Year 0 1 yr. LiciVacc. Istnaluno)
• 3 yr. LiciVacc. Acidress:
VACCINATION EXPIRED: Other
,
Month Day Year Vacc. Serial (lot) no.

Number
Zip Colors: vr Zip Colors: bindC.
Tag
Si( Telephone
Telephone No.) Rabies No.)
State State (License
(License
M.I. Breed: M.I. Breed: #
#
CERTIFICATE Predominant Veterinarian's:
type Predominant Veterinarian's: (Signatuit) type Name: (Signature) Address:
Name: Address: or
or #51 pen ja 0 0
pen ga 0 0 lbs. Form lbs. lbs. lbs.
point lbs. lbs. lbs. point City 20 50 50
First City 20 50 50 ball First -
ball Size: Under - Over Actual VACCINATION NASPHV use Size: Under 20 Over letters) It
use 20 letters) - 3 Othe
- a y 3 (First LiciVacc. Lic./Vacc. Other no. Print ma Age-. (First Lic./Vacc. Uc./Vacc. (lot
Print rno older d (lot) older
12 Age yr. yr. Serial 12 to or yr. 1 yr. 3 Serial
to moor Producer 1 3 RABIES Age: mo mo Actual Producer: 0 0 Wm
Age: mo 12 Actual 0 0 Vacc. J 3 12
3 Ad 0 0
Addrei 0 ri and EXPIRED:
and Street Female Year EXPIRED: i5 Year Street Sex: Male Female Neutered ci ear
Sex: Male Neutered VACCINATED: Name Last . VACCINATED: av
Name Last Day Day - 0 0 Day VACCINATION
- Species: IN 0 0 VACCINATION Owner's PRINT Species: Cat Other: (SPecifY) DATE Month g Month
Owner's PRINT No. Dog Cat Other (SPecifY) Month Month No. Dog

VETERINARIAN'S COPY RABIES VACCINATION CERTIFICATE
NASPHV Form #51 Rabies Tag Number
Owner's Name and Addre Print - use ball point pen or type
PRINT - Last First Mi. Telephone
No. Street City State Zip _
Species: Sex: Age: Size: Predominant Breed: Colors:
Dog g, Male Or 3 mo to 12 mo • Under 20 lbs. liK1 p /1
Cat 0 Female • 12 moor older Jiff 20 - 50 lbs. III S vci"
Other: 0 Neutered 0 Actual Age 43 Over 50 lbs. •
(Specify) Actual_lbs. ' Name:
Caf)Ct Man
DATE VACCINATED: Producer: Veterinarian's: #
(License No.)
(Fest 3 letters) .
Month Day Year (Signalers)
0 1 yr. LiciVacc.
0 3 yr. Ijc./Vacc. Address:
VACCINATION EXPIRED: -
Other
,
-t-.,- -16--
1h ay Year Vacc. Serial (lot) no.
VETERINARIAN'S COPY RABIES VACCINATION CERTIFICATE
NASPHV Form #51 Rabies Tag Number
Owner's Name and Addn Print - use bail point pen or type
PRINT - Last First M.I. Telephone
No. Street City State Zip
Species: Sex: Age: Size: Predominant Breed: Colors:
Dog 0 Male El 3 mo to 12 mo Under 20 lbs. 0
Cat 0 Female 0 12 ma or older 0 20 - 50 lbs. 0
Other: 0 Neutered El Actual Age Over 50 lbs. 0
(sPecify) Actual lbs.
DATE VACCINATED: Producer: Veterinarian's: # _
Poems No.)
(First 3 left
Month Day Year 0 1 yr. Lic./Vacc. (Signature)
Address:
0 3 yr. Uc./Vacc.
VACCINATION EXPIRED: Other
Ti Vacc. Serial (lot) no.

VETERINARIAN'S COPY RABIES VACCINATION CERTIFICATE
NASPHV Form #51 Rabies Tag Number
Owner's Name and Adt'. Print - use ball point pen or type
PRINT - Last First M.I. Telephone
No. Street City State Zip
Species: Sex: Age: Size: Predominant Breed: Colors:
Dog tj& Male 0 3 mo to 12 mo 0 Under 20 lbs.9c
Cat 0 Female 12 ma or older 20 - 50 lbs. 0
Other: 0 Neutered 0 Actual Age Age 3y Over 50 lbs. 0 rk,
(sPecitY) Actual lbs Name:
DATE VACCINATED: Producer: Veterinarian's: # (License No.)
(First 3 fetters)
Month Day Year 0 1 yr. Lic./Vacc. (Signature)
3 yr. LiciVacc.
VACCINATION EXPIRED: Other
Moith Day Year Vete, Serial (lott no.
- ` 11AN S C°P \ RABIES VACCINATION CERTIFICATE
NASPHV Form #51 Rabies Tag Number
Owner's Name and Addre Print - use ball point pen or type
PRINT - Last First M.I. Telephone
NO. Street City State Zip
Species: Sex: Age: Size: Predominant Breed: Colors:
Dog Male RI 3 mo to 12 mo Under 20 lbs. (2I'
Cat 0 Female 12 mo or older 0 20 - 50 lbs. 0 $1 tver
Other: Neutered E Actual Age / Over 50 lbs. 0
(Specify)
Actual Name:
DATE VACCINATED: Producer: Veterinarian; #
(license No,)
(Ft 3 Ietters)
Month Day— Year (Signature)
0 1 yr. Lic./Vacc.
PA 3 yr. LiciVacc. Address:
VACCINATION EXPIRED:
Other
t3 p
Month Day ear Vacc. Serial (lot) no.

RABIES VACCINATION CERTIFICATE Rabies Tag Number
NASPHV Form S I
Owner% Name & Ad PRINT - we ballpoint pen or type n
Fipst.
Stu Zip
7°6 1/1) •
SPECIES: or SEX: g. AGE: SIZE: 'PREDOMINANT pc...7y_d_ BREED: COLORS:
Dog Male 3 mo.- 12 mo. 0 Under 20 lbs. Dr. ,
Cat Female 12 mo. or older X 20 - SO lbs. 0
Other 0 Neutered Over SO lbs. 0 NAME:
Please spectiy
DATE VACCINATED: VETERINARIAN:
PRODUCER: 9
// Veterinarian's #
Month Day Year (First 3 letters) License
VACCINATION EXPIRES: I yr. Lic, /Vaccine 0
3 yr. Lit, /Vaccine Veterinarian's Signature
E
Month Day Year Adde 1‘::1,
tine Serial (Lot) No.
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
k filax, lido ikoa- 3- 011
PULA .
NI , ,,Streett\) City rv, I S ater,_ ,
-eh Dr 1-1 11(101 i )4. fl
kA2 Dt?..5
Species: Sex: Age: Size: Predominant Breed: Colors:
Dog lior Male Xl 3 mo to 12 mo 0 Under 20 lbs.g flA 1-,V_
Cat 0 Female 0 12 mo or oldi liti 20 - 50 lbs. 0 rCloct ik:
Other: 0 Neutered 0 Actual AgeEiy_ Over 50 lbs. 0
(Specify) Actual...lbs. Name:
p e Veterinarian's: # .1 1 7 61 IV
DATE VACCINATED: Producer , (License N 4 1 /.1
-1 3c-, 3 (First 3 letters)
Month Day Year 0 1 yr. LiciVacc. (Signature)
maims:
13 yr. Lic./Vacc.
VACCINATION EXPIRED: Other
-F.-v/11fX- 1-1-7---ZbA 1
Month Day Year Wm 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
it5 au! t219 /15 - 017
Stieek..,,..1_, City pix,c411 t . x, State Rz
Species: Sex: Age: Size: Predominant Breed: Colors:
Dog IR- Male g 3 mo to 12 mo l=1 Under 20 lbs. it Si 1 Vitr
Cat D Female 0 12 mo or older‘4 20 - 50 lbs. 0 PCMI e
Other: 0 Neutered 0 Actual Age 4 y Over 5or.bs. CI
(Specify) Actual "1 lbs. ...,.— Name:
rati On ,
DATE VACCINATED: Producer p T Veterinarian's: # _ I 1161 . ) rk2.-
(License N o
(First 3 letters) e2A., /6",,„, T L/WAJ'el. .„ ., .
Month Day Year 1=1 1 yr. Lic./Vacc. (S ture)
1Z 3 yr. Lic./Vacc. Address:
VACCINATION EXPIRED:
Other - ,..) • 041-1-311-
- --7 n ILD S3V--t7) )e,,ftiqz,lf-OZ t
Month Day Year Vacc. Serial (lot) no.
. . _.... .._ .
Owner's Name and Address Print - use ball point pen or type
PRINT - Last First ., M.I. Telephone
Pakitleti niwt hin sta ciptira ;. - LiipL.F., -(.912,
SZ zorts, Ldogerr rN , City n
I--) hne_rt I )c:
Species: Sex: Age: Size: Predominant Breed: • Colors:
Dog TX Male IX 3 mo to 12 mo • Under 20 lbs. X Si I \s-e,i,
Cat • Female 0 12 mo or older IX 20 - 50 lbs. CI Poodle
Other: 0 Neutered 0 Actual Age Over 50 lbs. 0 ,
(Specify) FActu. al ; _lbs. Name:
CO1.-r(C ime- ()&464
DATE VACCINATED: Veterinarian's: # t 1 71 1 1P112
Producer: (License o.) 4 ,ii
(First 3 letters) A, '76;1.7, 60-c,,k7
--- i7)1 —I3- (Signature)
Month Day Year 0 1 yr. LiciVacc.
#3 yr. Lic./Vacc. Address: •
VACCINATION EXPIRED: 346 E__ 1/1^-9--
Other ,
-1 1LP ),97,P.t5-1 I -Ter„f4 6-7_ 5,).g)
Month Day Year Vace: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
Pal,Ale ' int;Lr li IN 60.) -343-- 6L)/4
t City I\ State Z,... „..,..a,
2`roarr?..-
Species: Sex: Age: Size: Predominant Breed: Colors:
Dog li Male `51 3 mo to 12 mo ';:: Under 20 lbs. til , )1kcy•
Pcia4 k
Cat 0 Female CI 12 mo or older CI 20 - 50 lbs. 0
Other CI Neutered 0 Actual AgeiOnV6 Over 50 lbs. 0
(Specify) Actual Li lbs. Name:
riV i rat,' on
LI i 4-", A.--
DATE VACCINATED: Producer: r Veterinarian's: # Z L ,2
(Li nse No.)
1 XI, I 5 (First 3 letters) 16n,47.,
Month Day Year 1:4r. 1 y Lic./Vacc. (Signature)
Address:
0 3 yr. Lic./Vacc. E 1 ,--i-i--S-f
VACCINATION EXPIRED: Other 2 0 *
I Al_q_ ,9??--157 / Teivtpt A-7-7533r . I
Month Day Year 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
YZIU 1 litin 1.,,w-v -tei
11,c1/65 3 K are, lizv . OW City stem
nalA I Y;
Species: Sex: Age: Size: ‘ Predominant Breed: Colors:
Dog 1/t Male Ii2 3 mo to 12 mo 0 Under 20 lbs. Cii, Lo h) k
PboAle
Cat CI Female 0 12 mo or older IX) 20- 50 lbs. CI
Other: 0 Neutered CI Actual Age Over 50 lbs. 0
(SPeciffY) Actual 1 lbs Name:
kncei
( 7,
DATE VACCINATED: Producer: r e- r Veterinarian's: ,,..., # .......4License No.)z,i9 4
(First 3 letters) ,(2,1 , ''r 1,/,--'
Month Day Year 0 (Sig re)
1 yr. Lic./Vacc.
Address:
IX 3 yr. Lic./Vacc. 135
VACCINATION EXPIRED: Other
'-1 at iu? 6
Month Day Year Vacc. Serial (lot) no.

19 ,7 /4
Number til) 119 1
Colors: el Number 3-- lock Colors: 1
Tag uo.9-a13-te z„ 5) _ lb-*‘+ Tag (./Oh , 2:-)q
Rabies Telephone n-Z No 6,...art Telephone LCO)Ii/ b ) o
Stat cn nse Rabies (Is, az-
(Lic E Statriz • 1 License
M.I. Breed: (Ni,ch # _..., -70-71'j: M.I. Breed: i # ,
t
CERTIFICATE ProAje_ ?5 ctinft-if .17..cfr-pt-
type 6 1 Predominant FlenCi Veterinarian's: air,.r CERTIFICATE Predominant e: Veterinarian's: re)
14 Name: (Signature) Address: type Address:
or , netn or Na( (sign.
#51 pen 1 yj 0 0 lbs #51 pen jg] Cl 113
Form point Mcur r), r lbs. lbs. lbs. Form MCAYI p lbs. lbs
City 20 t17 point lbs. lbs.
VACCINATION ball First 50 50 First City 20 50 50
NASPHV use Size: Under - 20 Over Actual letters) VACCINATION NASPHV ball Size: Under - Over Actual 4.
use 20 letters) I
- 0 Di vi 3 (First Lic./Vacc. Lic./Vacc. Other no. - 0 j/4 r 3 Other no.
Print mo older 14 0 (tot) Print mo (First Lic./Vacc. Lic./Vacc. (lot)
Dr 12 or Age yr. yr. 6errat 12 older Age_4_ yr. yr. `E.)41-tc:-.51 Serial
RABIES to mo Producer: 1 0 3 0:1 RABIES 3(3 to or 1 3
.6c14., Age: mo 3 12 Actual VaCC. Age: mo mo Actual Producer: A 0 Vacc.
1-e(1 / 3 12
Address Igl 0 0 Address Ir-1 ) ril 0 CI
and r, 1.itti,t st,x)., Female Neutered Year EXPIRED: Ack raw- and _Street VOM Neutered if3 ear EXPIRED: )4 Year
Sex: Male VACCINATED: I rN Sex: Male Female
Name Last X CI 0 yl Day •,?- =ray. Name Last — ilitiC,>'t VACCINATED: l'- Day Day
• - Nrtas VACCINATION - A CI 0 VACCINATION :9.,
Owner's PRINT Species: Dog Cat Other: (sPecI61 DATE 7 Month -7 squi.tur. Owner's PRINT I Species: Cat Other. (Specify) DATE 1— Month Month
No. Dog 1

-oDri k I
Number Zit5&;5 Colors: _CIL --1— 35-47 641
61(de._ tAi/v) G.
Tag uod-?-43 •.• Colors: 'Z_- e,--A-
Rabies Telephone 11-4.. _...14_r_l_ o.), r-511\ riZ., oa.,
State icense IG1116/..ov• Telephone 16/1—
M.I. )e. Breed: # .,..1(L E I Stateprz t (Licenslo.)
F
pazi ekv—i-- .ao)S rcrr M.I. Breed: #
CERTIFICATE >. Predominant P Veterinarian's: ure) ix • .3D6 T-Q-nVe_
type kill Name: (Sign Address: n ,4 Po(fi Veterinarian's: /az-
#51 or I Pi-Noty-ci IN; 0 0 type Predominant (Signature) Address:
Form pen ma,- tbs. lbs. #51 or Ph6-(3\-1
point City 20 lbs. 50 Actual_lbs pen art lbs.141 0 0
VACCINATION NASPHV ball First Size: Under 50 - Over letters) 71 Form point 20 lbs. lbs. Actuali.S_Ibs
-use 20 3 Other no. ball Fi 50 - 50
0 (First Lic./Vacc. Lic./Vacc. (lot) NASPHV use Size: Under 20 Over letters)
Print mo olderX S"):3,--If') - NC F 3 Lic./Vacc. Lic./Vacc. Other no.
..7t_t_c__ 12 or Age yr. yr. 3 Serial Print mo P (First (lot)
RABIES to mo mo Actual Producer: X--1 0 Vacc. 12 older Age yr. yr. Serial
.. Age: 3 12 to moor 1 3
Address i)ht,tle.ti X 0 CI Age: mo 12 Actual Producer 0 Vacc.
reek, EXPIRED: 3
• and Female Neutered Year Year Address tLti 0 0
Sex: Male VACCINATED: Y- j Etee EXPIRED:
Name Last X 0 0 Day n Day and Sex: Male Female Neutered G Year ,:?4)41(2 Year
- VACCINATION VACCINATED:
Owner's PRINT Species: Dog Cat Other: (SPecifY) DATE Month -7 Month Name Last - icte42,b 121 0 0 dc't Day :3CINATION Day
ier's NT 3 ler. city) rE 1 nth ,ntti

• RABIES VACCINATION CERTIFICATE
NASPHV Form #5/ Rabies Tag Number
Owner's Name and Address Print - use ball point pen or type
PRINT - Last n First .. M.I. Telephone
t-t it . ri !..43--a13- c5t46
Street kAtivl \c. Stath,.z t e,..
iri-4 1) .7ft-11- Or'
Species: Sex: Age: Size: Predominant Breed: . . Colors:
Dog g Male 0 3 mo to 12 mo 0 Under 20 lbs. f;ii Si i QC-V.
Cat 0 Female X 12 mo or older pii 20 - 50 lbs. 0 PC:CA it
Other: 0 Neutered 0 Actual Age Over 50 lbs. 0
(Specify) Actual --7 lbs. Name:
D ivck
DATE VACCINATED: P roducer:, Veterinarian's: # u) 1,q , A2 -
P F i•T ,
(FIrst 3 letters) i2"1-, - , -t (e;a4r4a/
Month Day Year 0 1 yr. LIc./Vacc. (Si6ature)
Address:
X3 yr. Lic./Vacc. •
VACCINATION EXPIRED: Other ',)6 E
6-1-.2,539 l
-7 Rp 16.-7 1 --refi'vp.e-
Month Day Year 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 r•\ First , Ml. Telephone
IbLil i'eL.I inCLY I 1(.4 n (4) •V+3 - CO-19
NI. .p _ c, __Street City phoo\ Stem
t, 5 k ) 1‘144- Or I I X
Species: Sex: Age: Size: Predominant Breed: Colors:
Dog A Male 0 3 mo to 12 mo 0 Under 20 lbs.% Loh i k
PcyA, te
Cat 0 Female * 12 mo or older NI 20 - 50 lbs. 0
Other: 0 Neutered • Actual Agei* Over 50 lbs. 0
(Specify) Actual 1 lbs Nme:
(7.3por&nthLite.--
p r Veterinarian's: # 1 i 4(i 1 --7
DATE VACCINATED: Producer: T OJcense
-7 a-ti 13 (Fire 3 letters)
Month Day Year '44 1 yr. Lic./Vacc. (Signature)
Address:
. 3 yr. Lic./Vacc. .3 F- I ,e54'N- Si-
VACCINATION EXPIRED: Other
1 ') e, 1 1-1 ) -601
Month Day Day Year Vacc. Serial (lot) no.

• 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
Lei r)1C1 Li i'l C4Q-7:43-00Ncl
City r) , State
15504,75
Species: Sex: Age: Size: Predominant Breed: Colors:
Dog g Male fil 3 ma to 12 mo D Under 20 lbs. VC
Cat CI Female .)3 12 moor older N1 20 - 50 lbs. El POOA (f Wilt. 1-c,
Other: D Neutered 0 Actual Age_t_y_ Over 50 lbs. 0
(SPecity)
Actual.aLlbs Name: .
D71111.--i r(Vj I _Mk./
DATE VACCINATED: Producer . 70 F__ T Veterinarian's: # I irl 0-7.
(License ,.../,, o.)
—I _Z1 13 (First 3 letters) a,t,--i:;_f07_,6x.‹,.04/
Month Day Year (signature)
X 1 yr. LiciVacc.
ID 3 yr. Lic./Vacc. Address:
VACCINATION EXPIRED: 2,t5. a le.›tf--s-f-
Other
11,:n1-1 -7 I 1701-Ife-1417-
Month Day Year 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 paLA 101 First M.I. Telephone
ry-Actxt tooalL1 - 6).11
City 10 ,w State riz I 9;.(: 75
N1v(1-3streK)
3etk4- c`c
Species: Sex: Age: Size: Predominant Breed: Colors: Colors:
Dog Male El 3 ma to 12 mo El Under 20 lbs. kr
Cat El Female 12 mo or older g 20 - 50 lbs. ID
Other: 0 Neutered El Actual Age Over 50,Ds.
(Spec Name:
Actual "D lbs
DATE VACCINATED: Producer: F- Veterinarian's: # (ucen'ts, :rt AZ
f ;
(First 3 letters) CA Z-157-C.,1),Aj
Month Day Year (Signature)
E1 yr. Lic./Vacc.
3 yr. UcJVacc. Address:
VACCINATION EXPIRED:
Other
GD<73t-t61 _JT pe en - 5,-9e 1
Month Day Year 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
P)<AX ! ) 4 ir)
reet City iihc-)-eri r, Sta .z._ • _•,2>
1 (x) t--) 'Yi-4-4-- Or- 1)4
Species: Sex: Age: Size: Predominant p2 Breed: le Colors:
Dog >1 Male 0 3 mo to 12 ma 0 Under 20 lbs. tgi 1)444-e
Cat 0 Female IX1 12 mo or older [V 20- 50 lbs. 0
Other: El Neutered CI Actual Age 14 y Over 50 lbs. 0
(sPectry) Actual —7 lbs • Name: c
Li
DATE VACCINATED: Producer: p ,.. 3— Veterinarian's: # (License o
(First 3 letters) "rt- • Cen T. 01-Arli
Month Day Year GI 1 yr. Lic./Vacc. (Signature)
Address:
X- 3 yr. Lic./Vacc.
VACCINATION EXPIRED: Other a?-5
1.0 t-ri)71 --r—:„„pc,-?1
Month Day Year Vacc. Serial (lot) no.
RABIES VACCINATION CERTCRCATE Rabies Tag Number
NASPHV Form #51
Owner's Name and Address Print - use ball point pen or type Telephone
Firs)_ . I , M.I. oil
PRINT - Last i iii n tstw --2(4,3-
Vat A (GI r, 1,—, 0,L.0., cv / I Stal,442 ,....,10
Nq. 4treet 1 )C,
162-i.5-0,- Size: Predominant Breed: ., Colors:
Species: Sex: 0 Age: 3 ma to 12 mo El Under 20 lbs.X1 l_i_VIt it
Dog A Male A 12 mo or ot er 20 - 50 lbs. 0 • i)(t-tle
Cat 0 Female • Over 50 lbs. (at
Other: 0 Neutered Actual Age Na A3c174.
(Spay) Actual LP lbs
ki-
Veterinarian's: #
DATE VACCINATED: Producer. F r
I3 (First 3 letters) td(/1/1L '
(Signature)
Month Day Year 0 1 yr. Lic./Vacc. Address: ' •
x 3 yr. LiciVacc. 3?5, r
VACCINATION EXPIRED: Other
c 9 _ a — 7 I
7 ?-1 )Lo ..,) CS
Month Day Year 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 . i Mi. Telephone
Ck ti -i° 4 CAr a i Lir 620 -143 -Oil
-,) treet ir 15... Stiv tr:44c:z
itY Phu-•eki x.
Species: Sex: Age: Size: , Predominant Breed: Colors:
Dog .g1 Male 0 3 mo to 12 mo CI Under 20 lbs.g 1 I ())11,1.4-e
Cat 0 Female 154 12 mo or older xi 20 - 50 lbs. 0 POCA 1 t.
Other: 0 Neutered 0 Actual Age Over 50 lbs. 0 I (.01 —t- '
(SPefY) ci Actual I 42 lbs. Name:
efriAIM
DATE VACCINATED: Producer: f) I i_ Veterinarian's: # P('-"Z.
ems
1 41 177 (First 3 letters)
Month Day Year 0 1 yr. Lic./Vacc. (Signature)
Address:
"Q 3 yr. Lic./Vacc. . '
VACCINATION EXPIRED:
Other
i_e_pnix- IT-a:081
Month Day Year Vacc. Serial (lot) no.
RABIES VACCINATION CERTIFICATE
NASPHV Form #51 Rables Tag Number
Owner's Name and Address Print - use ball point pen or type
PRINT - Last First . M.1. Telephone
U.rt kt.d MO-VI 1 C\ (S001-14;-- CO-ICA
No Street City Stat
e
Species: Sex: Age: Size: Predominant Breed: /.. , Colors: ,
Dog pii( Male 0 3 mo to 12 mo 0 Under 20 lbs.A VC/
t, )1
Cat CI Female X 12 mo or olderX 20 - 50 lbs. 0 PC)Od le
Other 0 Neutered 0 Actual AgeL Over 50 lbs. 0 61aCV-
(sPectfY) Actualle_lbs Name:
ni f ocit,i
DATE VACCINATED: Producer Veterinarian's: # cir ? 'er-Z"
-1-' (Li e o
ilk I ; First 3 letters) .4 -. c, d-a-6,re,
Month Day Year • 1 yr. Lic./Vacc. (S ature)
Address:
18) 3 yr. Lic./Vacc.
VACCINATION EXPIRED: Other E
-1 a' '). It p ,13V-ri,71i —repettx. F9-- ain i
Month Day Year 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 r. First Mi. Telephone
14iLA IC t-- riVit,(1 1 i 4 . il)-41LE —baKi
loi.p,zrp,Streett w_ Stath_2.
Or cit
Species: . Sex: Age: Size: Predominant Breed: Colors:
Dog $ Male 0 3 mo to 12 mo D Under 20 lbs.1531 ,
Cat 0 Female g 12 mo or older gi 20 - 60 lbs. El Pocc1.[( bike
Other: 0 Neutered 0 Actual Age 4y Over 50 lbs. El
(Specify) Actual -7 lbs. Namefr, .
WA I
DATE VACCINATED: Producer: p Veterinarian's: #
F T .cense o.)
,
1 491. 13 (First 3 letters)
/r/174
Month Day Year El 1 yr. Lic./Vacc. (Signature)
Address:
3 yr. Lic./Vacc.
VACCINATION EXPIRED: E
Other
lasy_ 3f3701
i n )Lp f:5-11?--46.11
.-r-fli
Month Day Year Vacc. Serial (lot) no.
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
1101,1 le-L1 rTh.i ' I li (10 UN--643- caiel
No reet City VIN,›Cin i--% .i C SlatVIZ- if',,CO2
1 co?': K) 22N41-ti- Dr
Species: Sex: Age: Size: Predominant Breed: Colors:
Dog leb Male f=1 3 mo to 12 mo 00 Under 20 lbs. Ji0 pom le 6->rct):; n
Cat 0 Female 71 . 12 mo or older 0 20- 50 lbs. IN
Other: II Neutered ED Actual Agelklit3 Over 50 lbs. IIII
(specify Actual kj lbs Name:
C.4 ivYArrunTwiesi
I etf :7
DATE VACCINATED: Producer 9 F. 1 Veterinarian's: # 'cense ) 1/?1 No.) , (11.—
1 -Xt. 15 (First 3 letters)
Month Day Year g 1 yr. Lic/Vacc. (Signature)
Address:
0 3 yr. LiciVacc.
VACCINATION EXPIRED: Other
-1 3-1 14 62)att--6-7 1 .17€A-rl ‘ -e Fil— ?:›9.1)
Month Day Year Vacc. Serial (lot) no.