ARIZONA WORKING DOG KENNEL.PDF

Maricopa County
Animal Care And Control
2500 South 27th Avenue n.,96
Phoenix, AZ 85009
(602) 506-7387 Tele.
(602) 506-2739 Fax
KENNEL PERMIT APPLICATION
New )54, Renewal Permit #i tt" 0-1(:)
Name: Ca 5c_kci r-c,e Kennel Name:S(46 70 v10 i/uotr: ri 0 .
. , ,. ,
Mailing Address: q st-i 5- LO, 1)PI Yad Kennel Location: 9s-zy s-- u.).. 14e lo W--(- Rc#
oty<0 nes o Az ZIP C5'5- 33-3 County Supervisorial District 5--
Home Phone: ( e;d3 Kennel Phone b,D- 9-4
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 "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 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. LI _ I/VVe 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. c( I/We 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. f INVe certify that IANe have dogs and that the kennel meets the definition in statute.
4. C4 I/We 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. k-NC I/We 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
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.

7. _ cr I/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.
8. ( 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. .( 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.
Is this kennel permit being obtained for the purposes of operating a busin9ss including but not limited to
breeders, groomers or boarding establishments? (Please check one) 4.1 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 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.
1/11Ve certify that all of the information VWe have provided is true and accurate under penalty of law.
eiut
Applicant Signature tuts-aistiP Date: ()()-- 010 )
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

IVA d71, LLS1.-IFc. 14.-I %AUL Ly
Animal Care & Control
2500 South 27th Avenue
Phoenix, AZ 85009
Phone: (602) 506-7387
pets.maricopa.gov
KENNEL PERMIT PREMISE INSPECTION
APPLICANT i-sclla
STREET ADDRESS 9s-z-(s— /A). I4.e her
CITY, STATE, ZIP it)&
HOME PHONE q 36- 1 9 3,‘, BUSINESS PHONE 03 - -iqqf
COUNTY DISTRICT KENNEL LICENSE !Nil -014.1,, NUMBER OF DOGS
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
CORRECTIVE 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 Date 13

Maricopa County Animal Care and Control
2500 S. 27th Avenue
Phoenix, AZ 85009-6797
(602) 506-7387
http://pets.maricopa.dov
Receipt Number: R13-117738 Receipt Date: 06/10/2013
Person ID: P1949332
Phone: 623 9361436
AZ WORKING DOGS KENNELS
9545 W HEBER RD 6/10/2013 11:16:09AM
TOLLESON, AZ 85353
Item: Animal ID: Reference No: Price: Each: Amount:
KEN PERMIT A7777777 K14-000046 $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
REYNOLDS EBUSOFF

Kcvs\ek., c K
- L\ 6
VACCINATION RECORD
RABIES VACCINATION CERTIFICATE Tag fee $:
Name
ADAPTED NASPHV FORM 51 Tag #:
Cert. Serial #: E RABIES
Owner's Name & Address PRINT - use ball point pen or type
E LYME DISEASE
PRINT LAST FIRST MI TELEPHONE 62.—
E CANINE DISTEMPER
]<e,hi1e.../1 AP izakt d WoriZky DO!cf jç4#7— 2‘9./
E CANINE PARAINFLUENZA
NO. STREET CITY N'i STATE ZIP
1M hteibk- 1.3=1,Arce/e45-44.) ,414-zce-)ci E. CANINE ADENOVIRUS 2
W
SPECIES: SEX: AGE: SIZE: PREDOMINANT BREED: COLORS: E CANINE PARVOVIRUS
Dog eig- Male 0 3 Mo. to 12 Mo. 0 - Under 20 lbs. El D4efromobt E CANINE CORONAVIRUS
Cat El Female Ac. 12 Mo. or older [OC° 20 - 50 lbs 0 0 CANINE BORDETELLA
Other 0 Altered a 4iv, Over 50 lbs. X NAME: ..
El LEPTOSPIROSIS
(Specify) es, eetu (tHeidir
if Ci FELINE LEUKEMIA VIRUS
DATE VACCINATED: PROD tir 1 .2 FELINE PANLEUKOPENIA
Veterinarian's # 1 32
License No. E FELINE RHINOTRACHEITIS
Month Day Year (First 3 Letters) E FELINE CALICI VIRUS
q if Veterinarian's eiC l , _..A ,_ .4.1.t7 P ieg L FELINE CHLAMYDIA
r. Lic. acc. 0 Signature
VACCINATION EXPIRES: rte . RAel/AC3 E FELINE IMMUNODEFICIENCY
- Address 2& i.% re i eAtev VIRUS
Month Day Year 4#12 (\sv 1S-8 t?r4 AleAhe/AP/Z ,
E40,oie Serial cW No. Boehringer
Ingelheim
VAC0410001
VACCINATION RECORD
RABIES VACCINATION CERTIFICATE Tag fee $:
Name
ADAPTED NASPHV FORM 51 Tag #:
Owner's Name & Address PRINT - use ball point pen or type Cert. Serial #: E RABIES
E LYME DISEASE
PRINT LAiST.(e4ma j FA IRs-r,fr.izemd Iscpiz_nv MI TELEPHONE
E CANINE DISTEMPER
54/7— 'NW
, yo....a5.3 E CANINE PARAINFLUENZA
NO. STREET CITY ItATE ZIP
C CANINE ADENOVIRUS 2
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SPECIES: SEX: AGE: SIZE: PREDOMINANT BREED: COLORS: C CANINE PARVOVIRUS
Dog Pi-- Male Cl 3 Mo. to 12 Mo. 0 Under 20 lbs. El noire/On dit ekk 1_ CANINE CORONAVIRUS
Cat El Female ig. 12 Mo. or older g 20 - 50 lbs 0 cd E CANINE BORDETELLA
Other 0 Altered 0 ,vre Over 50 lbs. NAME: 4 Rite
LEPTOSPIROSIS
(Specify) ( - . STItiefii QVC1 rhlt*).‘e' — 0 FELINE LEUKEMIA VIRUS
DATE VACCINATED: PROD CE7.4er / 32/ 0 FELINE PANLEUKOPENIA
Veterinarian's #
License No. 0 FELINE RHINOTRACHEITIS
1560140 .20/3 151° 5 If
Month Day Y (First 3 Letters) fur „,45 istrAiL.4, E FELINE CALICIVIRUS
Veterinarian's 9/
E FELINE CHLAMYDIA
. r. ic.Nacc. RY6 V rt— Signature ti/l0
VAyINATION .1201 EXP IRES. 3 . E FELINE IMMUNODEFICIENCY
...- yr. Lic.Nacc.g Address 2'1? •1::4 VA VIRUS
Month Day Year 4 t12.08.4A- Phoeo-)9 *02. EiraV
No. rfis Boehringer
Ingelheim
VAC0410001

MAR-20-2012 17:12 From: To:4008940579 Pa9e:3t10
Kebme*._ Peccs\\A- ot-k6
r•-•
A 19
RIVERSIDE PARK VETERINARY CLINIC
11 .1 E Park St
Grants Pass OR
(541) 479-8361
12/06/2012
Client : Renee Traylor
1630 VAlliams Hwy PMB089
Grants Pass, OR 97527
Phone : (707) 954-5871
0. 1tacIP Ac064?.: 31709.F
flre40:: bobaiinan PinScherl.
Sex :M : Black & Red
DOB 02121/2012
RABIES VACCINATION INFQRMATION
• 4
DE DUE: 12/05/203,-
DATE PERFORMED: 12/06/2012 '
BRAND: lmrab 1 IF
PRODUCER: Merial
TAG NUMBeR:
SERIAL NUMBER: 18175B 9/13
TYPE: Killed
MICROCHIP NUMBER:
•••
:7 • erd* Certify thatl have vaccinated this animal in act ordance With the company's •
recommendation for the: vaccine used on the above date.
Sign re of liceriSed veterinarian ejifrinistering vaccine.
Dr, Saran Adams 5833

ARIZONA WORKING DOG KENNEL PERMIT NO. K13-046
Date of Vaccination: 05-29-13 Certificate No. 0
Next Vaccination on: 05-29-14 Previous Vaccination:
VETERINARY CLINIC OWNER OF ANIMAL
Rasnic Animal Clinic James Lamb
PO Box 386 PO Box 114
1070 Industrial Park Rd
Duffield, VA 24244 Duffield, VA 24244
276-431-2360 (276) 708-6844
This is to certify...
THAT I HAVE VACCINATED THE ANIMAL DESCRIBED BELOW AGAINST RABIES.
Patient information...
PATIENT: Gretta TAG NO: 00623
SPECIES: Canine BREED: Doberman
SEX: Female AGE: 24 months
WEIGHT: 0.00 lbs COLOR: Black and Tan
MICROCHIP:
MFG BY: FD, SERIAL: 8171730,_ 5XPIRES: 01-09-14, ADMIN: SC
Signed:
TIM RAS D.V.M. License: 5579
Other Vaccinations...

ARIZONA WORKING DOG
KENNEL PERMIT NO. K13-046
CERTIFICATE OF VACCINATION
Date of Vaccination: 05-29-13
Next Vaccination on: 05-29-14 Certificate No. 0
Previous Vaccination:
VETERINARY CLINIC
Rasnic Animal Clinic OWNER OF ANIMAL
PO Box 386 James Lamb
1070 Industrial Park Rd PO Box 114
Duffield, VA 24244
276-431-2360 Duffield, VA 24244
(276) 708-6844
This is to certify...
THAT I HAVE VACCINATED THE ANIMAL
DESCRIBED BELOW AGAINST RABIES.
Patient information...
PATIENT: Raven
SPECIES: Canine TAG NO: 00622
SEX: Female BREED: Doberman
WEIGHT: 59.00 lbs AGE: 10 months
MICROCHIP: COLOR: Black and Tan
MFG BY: FD, SERIAL: 0 EXPIRES: 01-09-14,
ADMIN: SC
Signed:
TIM 1362fici IC, D.V.M. License: 5579
Other Vactinatiorig7.
(4>

ARIZONA WORKING DOG KENNEL PERMIT NO. K13-046
RABIES VACCINATION CERTIFICATE Tag fees: VACCINATION RECORD
ADAPTED NASPHV FORM 51 Tag #: Name
Owner's Name & Address PRINT- use ball point pen or type Cert. Serial #: 0 RABIES
PRINT LAST I FIRST MI TELEPHONE 4203— E LYME DISEASE
kehheli ArIzoNct WOPX1Pity DV (i'7- / E CANINE DISTEMPER
NO. STREET ST A ZIP Ss(363 0 CANINE PARAINFLUENZA
Si16-. W. HeheriC Tofie (Win) #0 4(.2' 0 CANINE ADENOVIRUS 2
SPECIES: SEX: AGE: SI : PREDOMINANT BREED: COLORS: 0 CANINE PARVOVIRUS
Dog I;it Male Ar. 3 Mo. to 12 Mo. Under 20 lbs. 0 1Dohemudh 8 kkk 4.,
Cat El Female 12 Mo. or older 42(. 20 - 50 lbs 0 0 CANINE CORONAVIRUS
Other 0 Altered / /1„....:2 Over 50 lbs. g : NAME: 1 eir ke it's* E CANINE BORDETELLA
(Specify) LI LEPTOSPIROSIS
'1 0 FELINE LEUKEMIA VIRUS
DATE VACCINATED: PRODUCER: 1 321 0 FELINE PANLEUKOPENIA
Veterinarian's # .i
s_27-2o13 8 0 License No, Li FELINE RHINOTRACHEITIS
Month Day Year (First 3 Letters) Li] FELINE CALICI VIRUS
Veterinarian s ":71717/1dir lr ."/ Mr ,
VACCINATION EXPIRES: 1 yr. Lic.Nacc. \I% R AV AC-3 Signature L FELINE CHLAMYDIA
5;27,20 iic 3 yr. Lic.Nacc. Clit W. E FELINE IMMUNODEFICIENCY
Address li 1/ 100:S) CSYCiteAle VIRUS
Month Day Year J215366,4
5.42,_ 143vppipiiiitti No.
frTh i Boehringer
VAC0410001 \II01 Ingelheim
VACCINATION RECORD
RABIES VACCINATION CERTIFICATE Tag fee $:
Name
ADAPTED NASPHV FORM 51 Tag #:
Owner's Name & Address PRINT - use ball point pen or type Cert. Serial It: O RABIES
piej Xr L LYME DISEASE
PRINTI?,ST MI TELEPHONE
I .eix izonct, Vayi6k9 414 9/?.- .94?, El CANINE DISTEMPER
1 E CANINE PARAINFLUENZA
NO. STREET 4.. CITY , NotTAT ZIP
Cir3s446- w. Hekek Hat s t)74(Viet*Wf2 17L 33a53 L CANINE ADENOVIRUS 2
SPECIES: SEX: AGE: SCE: PREDOMINANT BREED: OLORS: I. Li CANINE PARVOVIRUS
Dog Vt Male 4Nr 3 Mo. to 12 Mo. Under 20 lbs. 0 17,0900,14t ed s 0 CANINE CORONAVIRUS
Cat CI Female 12 Mo. or older X 20 - 50 lbs E 0 CANINE BORDETELLA
Other CI Altered , Over 50 lbs. '•-• NAME: „viot , niee
I.. . I. :,, l;'?; 46,11, .., Li LEPTOSPIROSIS
(Specify) .
0 FELINE LEUKEMIA VIRUS
DATE VACCINATED: PROD CER , Veterinarian's # ) 3,2/ 0 FELINE PAN LEUKOPENIA
0 -13 -.2443 • - ' ID License No. Li FELINE RHINOTRACHEITIS
Month Day Year (First 3 Letters) Ariarrif __, E FELINE CALICI VIRUS
Veterinarian's
y ic.Nacc. E C FELINE CHLAMYDIA
VACCINATION EXPIRE : Signature 0 FELINE IMMUNODEFICIENCY
3 yr. Lic.Nacclif Address c ,,,1, , • ii° 1/1 <St t'Zi:.• VIRUS
Month Day Year a eizra(A pkoelt,-4 ii,vir. (552:40
Epoo (iLjNo. Boehringer
Ingelheim
VAC0410001

ARIZONA WORKING DOG KENNEL PERMIT NO. K13-046
VACCINATION RECORD
RABIES VACCINATION CERTIFICATE Tag fee $: Name
ADAPTED NASPHV FORM 51 Tag #:
Owners Name & Address PRINT - use ball point pen or type Cert. Serial #: 0 RABIES
0 LYME DISEASE
PRINT T j FIRST ft_el TELEPHONE 62.2,7 0 CANINE DISTEMPER
Errivize i 1/10,-1461.j ii 3 LI 7— 7eivi
0 CANINE PARAINFLUENZA
NO STREET IcITY S E ZIP
95216-- w. p-ei:20fr. R.- 723//ert-tbt.) am 0 CANINE ADENOVIRUS 2
SPECIES: SEX: AGE: SIZE: PREDOMINANT BREED: COLORS: CANINE PARVOVIRUS
Dog X Male tkr 3 Mo. to 12 Mo. Under 20 lbs. 0 Vabelos VA4tet 13 icicle cerd 0 CANINE CORONAVIRUS
Cat 0 Female 0 12 Mo. or older ;X 20 - 50 lbs 0 0 CANINE BORDETELLA'
Other 0 Altered 0 )1 .,-, 8.1- Over 50 lbs. K NAME. 741 LEPTOSPIROSIS
re/ 2-1***oft 4.A et-er `‘ E do
(Specify) PP14 FELINE LEUKEMIA VIRUS
-40:W
DATE VACCINATED: PRODUCERr Veterinarians # i 3-( FELINE PANLEUKOPENIA
.2.42-20-0 5M9 License No. 0 FELINE RHINOTRACHEITIS
Month Day Year 4 0 FELINE CALICIVIRUS
,419p (First 3 Letters) Veterinarian's „
E FELINE CHLAMYDIA
1 yr. Lic.Nacc. Signature
VACCINATION EXPII4S. FELINE IMMUNODEFICIENCY
_ 3 yr. Lic.Nacc. Y--. Address CZ. c-gf OS W CSt VIRUS
Month Da y Var 2$0.8YG. •
4,ril Vacc. Serial (Lot) No. (7-.111 Boehringer
D0t13 .----P64 411/ Ingelheim
VAC0410001
RABIES VACCINATION CERTIFICATE Tag fee $: VACCINATION RECORD
ADAPTED NASPHV FORM 51 Tag #: Name
Owner's Name & Address PRINT - use ball point pen or type Cert. Serial • 0 RABIES
PRINT LAST FieST
Ke-h nel ) . MI PHONE 6g,3— LYME DISEASE
NO. w. A1^1Z0Pla WO k , 6-407— 0 CANINE DISTEMPER
7& W. /..le b el, pei rry., r . eseSTAT Z P 0 CANINE PARAINFLUENZA
SPECIES: SEX: AGE: a C CANINE ADENO VIRUS 2
Dog Xr Male 0 3 Mo. to 12 oil SIZE: P ' 'DOMINANT BREED: COLORS: 0 CANINE PARVOVIRUS
- t - 20 lbs.
Cat 0 Female ,7‹,_12 Mo. or . 4. • 20 - 50 lb F eH)11:4/ A316 d< 4 G CANINE CORONAVIRUS
Other 0 Altered ' p ,..7: , Ove c I s. :' E:r..40,td Rua* C CANINE BORDETELLA
(Specify) /
aPALAV gla4 Ahy LEPTOSPIROSIS
DATE VACCINATED: DUCER: 0 FELINE LEUKEMIA VIRUS
Jai , /-h... Veterinarian's # 1 3 2 / FELINE PANLEUKOPENIA
e k 8! 0 a License No.
Month Day Yea ,.... / FELINE RHINOTRACHEITIS
(First 3 Letters) 4 Veterinarians E FELINE CALICI VIRUS
VACCINATION EXPIRES: . Liclyacc. 21R 0 A 13 VAC- 3 Signature • /el& .'' 1ZEjr ,.. LT FELINE CHLAMYDIA
3 yr. Lic.Nacc: / 10- I .4 IN! i i.".%. 4" _Jr1 14 C
Address 44 — • : a ti• ._ a FELINE IMMUNODEFICIENCY
Month Day Year #1 2 163664 iP _All .' VIRUS
er al Lot) No. oeitbe, Apiz.. as-ay
dap.
11Arnn I Ann, f(.";; Boehringer
4I IV Ingelheim

ARIZONA WORKING DOG KENNEL PERMIT NO. K13-046
VACCINATION RECORD
RABIES VACCINATION CERTIFICATE Tag fee $:
Name
ADAPTED NASPHV FORM 51 Tag #:
Owner's Name & Address PRINT - use ball point pen or type Cert. Serial #: RABIES
0 LYME DISEASE
PRINT LioiSAT FIP;pT I TELEPHONE
Kennel, Arizond Woksi<ikt o o S211 '7 — '79'97 0 CANINE DISTEMPER
NO. STREET 1 CITY V STAT ZIP g,6353 L CANINE PARAINFLUENZA
Ai
qs-iis W. Heber- Rd. Tai/eon) rig. - CANINE ADENOVIRUS 2
SPECIES: SEX: AGE: SI E: PREDOMINANT BREED: COLORS: L CANINE PARVOVIRUS
Dog isc Male K.... 3 Mo. to 12 Mo. Lil Under 20 lbs. El Dohey,),,,,* Bicki( ct, Cl CANINE CORONAVIRUS
Cat 0 Female 0 12 Mo. or older K 20 - 50 lbs Ell E CANINE BORDETELLA
Other 0 Altered 0 it., 441//jsalit. Over 50 lbs. 0 W4146714 ktutfr
LEPTOSPIROSIS
(Specify) 4, e647(5612r4f if 131,64g-
irlu' LI FELINE LEUKEMIA VIRUS
DATE VACCINATED: PRODUCER: \ I ellit egket) J.& "1- Veterinarian's # / 32 / I_1 FELINE PANLEUKOPENIA
BO E License No. L FELINE RHINOTRACHEITIS
Month Day Year (First t 3 Letters) if t E FELINE CALICIVIRUS
? Veterina rian's
1 r. Li c.Nacc. 0 WSVAef Ii FELINE CHLAMYDIA
VACCINATION 6-s-_. EXPIRES: 016 Signature di i / C FELINE IMMUNODEFICIENCY
3 yr. Lic.NaccX4t ...t . Address / 0 oe w. S1-4,44, VIRUS
Month Day Year 1:41(.5a6644 Elleglakki_,APLX_r_35AV
..... xp .=. iggio, No.
Boehringer
VAC0410001 ri...."... \IOW Ingelheim
RABIES VACCINATION CERTIFICATE Tag fee $: VACCINATION RECORD
ADAPTED NASPHV FORM 51 Tag #: Name
Owner's Name & Address PRINT - use ball porn pen or type Cert. Serial #: LI RABIES
PRINAST i FIRST MI 0 LYME DISEASE
'd) . Cci-i yin. TELEPHONE 5fli- 0 CANINE DISTEMPER
NO. STREET 3-4(f7 -
civis-hts5.- C.I.U._ „ ASTATE ZIP 9 _ 0 CANINE PARAINFLUENZA
vv, Heeet. ,W9 1 otiarcrhi /q-fr,i-zofrui
SPECIES: 6-333 D CANINE ADENOVIRUS 2
SEX: AGE: SIZE: PREDpEANT BREED: COLORS: O CANINE PARVOVIRUS
Dog tir-- Male kr 3 Mo. to 12 Mo. El Under 20 lbs. El 17 de'
Cat 0 Female 0 12 Mo or older e a< 20 - 50 lbs o 12 AkircAlg* Sid4e CD CANINE CORONAVIRUS
Other 0 Altered 0 ›.- 4 yin., Over 50 lbs. X NAME: El CANINE BORDETELLA
(Specify) Kinoil kit cr-i- E LEPTOSPIROSIS
DATE VACCINATED: 0 FELINE LEUKEMIA VIRUS
PRODUCER
# / 3/ CI FELINE PANLEUKOPENIA
,(1.(1-1- 11D 1 License No. 0 FELINE RHINOTRACHEITIS
Month Day Year
rd (F•rst 3 Letters) Veterinarian's / r7 7 7 • 0 FELINE CALICIVIRUS
V 1 yr. LiN c.acc.1 A 0 ' 1/ i. or p 0 FELINE CHLAMYDIA
VACCINATION EXPIRES: Signature .
61"./462-alMS-- 3 yr. Lic.Nacc.X Address i' • ti W. <Slate- Ave, LI FELINE IMMUNODEFICIENCY
Month Day Year 0#1711?3ta VIRUS
2... .Acl4niliott V No. PhOeftd-Z7 4107i %ZiVf
Boehringer
VAC0410001 ,.... 111W Ingelheim

ARIZONA WORKING DOG KENNEL PERMIT NO. K13-046
RABIES VACCINATION CERTIFICATE Tag fee $: VACCINATION RECORD
Name
ADAPTED NASPHV FORM 51 Tag #:
Owner's Name & Address PRINT - use ball point pen or type Cert. Serial #: Li RABIES
PRINT LAST FIRST 17 MIO,ai TELEPHONE Li LYME DISEASE
kekine,6 Aelzond WOrki 6-417— El CANINE DISTEMPER
NO. STREET Tta C, CANINE PARAINFLUENZA
Ci5iii S. W. Heber Rc1 2 72gYllen cnsi Ais7zornci ZIP 85,36-3 Li CANINE ADENOVIRUS 2
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SPECIES: SEX: AGE: I SIZE: PREDOMINANT BREED: COLORS: G CANINE PARVOVIRUS
Dog P‹ Male EZ 3 Mo. to 12 Mo. 0 Under 20 lbs. 0 Db),erklidk 8 idzi( & CI CANINE CORONAVIRUS
Cat 0 Female 12 Mo. or older 20 - 50 lbs t__, ,--,
Other 0 Altered / 46241, Over 50 lbs. NAM pim--)-- E CANINE BORDETELLA
e.-bstsit , C! LEPTOSPIROSIS
(Specify)
E FELINE LEUKEMIA VIRUS
DATE VACCINATED: PRODUCER: Veterinarian's it / 3 2 C FELINE PANLEUKOPENIA
-is-- 0/ aril' 8 0 License No. C, FELINE RHINOTRACHEITIS
Month Day Year Tv ",;1\ft, (First 3 Letters) D FELINE CALICI VIRUS
lk AY/ • Veterinarian's
Lic.Nacc. Li voITA/ Li FELINE CHLAMYDIA
VACCINATION EXPIRES: Signature
3 yr. Lic.NaccX E FELINE IMMUNODEFICIENCY
-/I5i--.Z) Address I 1° VIRUS
Month Day Year 41216866A R2496412kM—Mk/
E)997... Viedigot) No.
Boehringer
VAC0410001 Ingelheim
VACCINATION RECORD
RABIES VACCINATION CERTIFICATE Tag fee $: Name
ADAPTED NASPHV FORM 51 Tag it: E RABIES
Owner's Name & Address PRINT - use ball point pen or type Cert. Serial #:
Li LYME DISEASE
PRINT IST ,, FIRST MI TELEPHONE 6 24 3 -- D CANINE DISTEMPER
i<eAlhqi )0.7d, 7... Wo-kAt9 P. :_,- 31/ '7 - f-NW
. 0 CANINE PARAINFLUENZA
NO. ,STREET. _i #06e,fr, jea C____ ITY ATE ZIP
cik13.- - lilt i j Da e-tro-A0 izaget 8(5-353 0 CANINE ADENOVIRUS 2
SPECIES: SEX: AGE: SIZE: PRED9INAVIAREED: COLORS: 0 CANINE PARVOVIRUS
Dog tg- Male II 3 Mo. to 12 Mo. Li Under 20 lbs. e413 V3 . fropy- _____51__ Afit9z44;404 D CANINE CORONAVIRUS
Cat 0 Female A I 12 Mo. or older X- 20 - 50 lbs 0 CANINE BORDETELLA
Other 0 Altered E .Z L‘--ky';;t., Over 50 lbs. ig NAME: C AXE"' 111/ DI blaoclkt LEPTOSPIROSIS
?a- 81,Loge-r- —
(Specify) 4 Kii-yr4" clotfr 0 FELINE LEUKEMIA VIRUS
0 FELINE PANLEUKOPENIA
DATE VACCINATED: PRODUCER: z Veterinarian's # 1 R /
2 - / 3 -apis ' 4 P FT License No. 0 FELINE RHINOTRACHEITIS
Li FELINE CALICIVIRUS
Month Day Year First 3 Letters) ) Veterinarian s
,tp, '71-1 El FELINE CHLAMYDIA
VACCINATION EXPIR S: yr. Lic.Nacc. Signatures / 1.2412ti E FELINE IMMUNODEFICIENCY
3 yr. Lic.Naccg Address 4 124 • 1.14 (C-- taJe4/4te VIRUS
.2 -13 -20g2 It 3 aff01 9'7G.
Month Day Year 8,,e3aeriSLot) P46 et, f IX2 11;-"?.. 85.0r/
Eior: No. Boehrmger
ilMi Ingelheim
VAC0410001