PERMIT APPLICATION FOR BROWN 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 )gf( Renewal Permit
Name: levaDo Kennel Name: ecr-A,or. n no
Mailing Address: ?C*) E_ \--101` Kennel Location: b 3 g LEE 1
City 5Ck AZ ZIP County Supervisorial District
Home Phone: Kennel Phone:
Please complete and sign this application and return it to the above address with payment in the amount of three
hundred twenty eight dollars ($328.00) within ten (10) days of receipt
Pursuant to Arizona statute and county ordinance, a person "operating a 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. I/We assume complete responsibility for the kennel at the premises for which I/we are making
app !cation 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
premises for which I/we are making application for a permit.
3. ' l/We certify that I/VVe have ' ,-)2,1 dogs and that the kennel meets the definition in statute.
4. 1 4 '( /1/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.)
/ .0,1(1)
I/VVe 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. 11-84 vi I /We certify that I/VVe are submitting a valid copy of the rabies vaccination certificate for each
dog with this application.

7. A II/We understand that a dog remaining within the kennel is not required to be licensed individually under
ARS 11-1008. 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. 1;',A' CV,L, 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. 14\ 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. J 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 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. iv) INVe 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/VVe have provided is true and accurate under penalty of law.
Applicant Signature Aa447( 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: R13-149189 Receipt Date: 07/27/2013
Person ID: P0907164
Phone: 480 6543722
BROWN KENNELS 7/27/2013 1:18:18PM
6328 E HALIFAX DR
MESA, AZ 85205
Item: Animal ID: Reference No: Price: Each: Amount:
KEN PERMIT A7777777 K14-000006 $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

OWNER'S COPY RABIES VACCINATION CERTIFICATE
NASPHV Form #51 Rabies Tag Number
Owner's Name and Address Print - use ball point pen or type
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OWNER'S COPY RABIES VACCINATION CERTIFICATE
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RABIES VACCINATION CERTIFICATE Tag fee $:
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Cat 0 Female Rr 12 mo. or older 0 20 - 50 lbs. 0
Other D Neutered 0 Over 50 lbs. 0 NAME:
Please specify
DATE VACCINATED: VETERINARIAN: -1 Op
1 F-7-
i PRODUCER: veterinariaws* I 8,
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n h Day ' ear Lcense o.
First 3 letters
VACCINATION EXPIRES: 1 yr. Lit./Vaccine ' ARA, Ari ...4. < A.2
3 yr. Lic. /Vaccine Veterinarian's Signature . .
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Vaccine Serial (Lot) o. -- e.,,c-,(- Re ?8

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RABIES VACCINATION CERTIFICATE
Rabies Tag Number
NASPHV Form 51
Owner's Name & Address PRINT - use ballpoint pen or type _
Last First (\Mi. Telephone
(3- 0 \1
No, Street City ,State Zip
e (5c. --L., asa.a.c
3 r)I? E A (Ilk Sk
SP CIES: SEX: AGE: SIZE: PREDOMINANT BREED:
Dog ?r Male 0 3 mo.- 12 mo. 0 Under 20 lbs. 17B M70.k-Ve\f1
Cat 0 Female jil 12 mo. or olderyl 20 - 50 lbs. 0 \f) \ h \4 \ACk
Other 0 Neutered 0 Over 50 lbs. 0 N M,
Please specify C atAex
DATE VACCINATED: VETERINARIAN:
3 PRODUCERi ‘V
Veterinarian's #:4-7-----:163
Month Day Year License No.
First 3letters
VACCINATION EXPIRE : 1 yr. Lic. /Vaccine 0 0,4' 4-.11/Cri ‘14".'ff
3 yr. Lic. /Vaccine IS Veterinariag Signatureg
\ \-/
C3. I (05 /3
M nth Day ' tear ?) (2) Address_._,, • •
Vaccine Serial (Lot) No. 0 e_ fiz- 48.3-R1
I e"
RABIES VACCINATION CERTIFICATE
Rabies Tag Number
NASPHV Form 51
Own 's Name & Address PRINT - use ballpoint pen or type
Last First M.1. Telephone
/a9/39X.
3 C c ...„.... C60
No Street Stan
c).0
SPECIES: SEX: AGE: SIZE: PREDOMINANT BREED: COLORS:
Dog Rt Male 0 3 mo.- 12 mo. 0 Under 20 lbs. cit ,h t 4-) ra tIO n
Cat 0 Female lEi" 12 mo. or older 0 20 - 50 lbs. 0 I 14 kOk.
Other 0 Neutered 0 Over 50 lbs. 0 N
Please specify '
DATE VACCINATED: VETE RI ARIAN:
3,
1 PRODUCER: -2— I 1
Veterinarian's #:
Mo th Day Year r License No.
First 3letters
a,,74y-p.,),,
VACCINATION EXPI E : 1 yr. Lic. /Vaccine 0
3 yr. Lic. /VaccineJO Veterinarian's Signature .......- 1 ....1.1.\ 31,
I
17
Month Day ' Year ,il‘ ID 9 A AddressH_.

OWNER'S COPY RABIES VACCINATION CERTIFICATE
NASPHV Form #51 Rabies Tag Number
Owner's Name and Address Print - use bell point pen or type
PRINT ../ .st 1111h \r‘ First IcV.I. Telephone
InCOWC\ — 1 NO-CC f\ ltg0 (0S'i 32,29
Noise)) 51seet C \__ Q\ ,N Ncoti sic City kfle
ine9:).. $u3S9.05
Species: Sex: Age: Size: Predominant Breed: Colors:
Dog 73 Male ft 3 mo to 12 mo • Under 20 lbs. 21 CY
Cat CI Female El 12 mo or olderg 20 - 50 lbs. El \\Nkk\v/A), eik VV1
Other: II Neutered X Actual Age_ Over 50 lbs. CI
(specify) Actual_lbs
DATE VACCINATED: Producer: Veterinarian's: I IL2--1-11-1--
(License No)
q aq (Firs t 3tters) le
5013
Month Day Year • 1 yr. Uc./Vacc. (Signature) 3.2s- E is-it/ 3-7 :
71 3 yr. Uc./Vacc. Mdress:
VACCINATION EXPIRED: Other 7,-,iez Az, h72,Fi
9 .,r) f)-DUO g.g 1A3- 90R
Month Day Year Vacc. Serial (lot) no.
OWNER'S COPY RABIES VACCINATION CERTIFICATE
NASPHV Form #51 Rabies Tag Number
Owner's Name and Address Print - use ball point pan or type
PRIN Last First M.I. Telephone
o 604 322
Notp, strt 0, A.N4 sk ty\ Cityezsa frtate
ftrA0
Species: Sex: Age: Size: Predominant Breed: Colors:
Dog 0 Male • 3 mo to 12 mo • Under 20 lbs. 0 e\i‘ A\vAry
Cat CI Female ri 12 mo or older E 20 - 50 lbs. •
Other: •I Neutered • Actual Age._ Over 50 lbs. CI tit) \'1*.k e-
PPectrY) Actual_lbs NamGc1/4,\A)\I
I A tilt
DATE VACCINATED: Producer: Veterinarian's: # • al
. No
/
r) If) _kk3 (First 3 letters) IL Mid* ti..—.. / 1,t-as.7.41/
Month Day Year • 1 yr. Lic./Vacc. (Sine ure
Address:
k3 yr. Lic./Vacc.
VACCINATION EXPIRED: Other Other
T1 '66 6 Wb ri o t
ifrr?ei
onth Day Year Vacc. Serial (lot) no.

OWNER'S COPY RABIES VACCINATION CERTIFICATE
NASPHV Form #51 Rabies Tag Number
Owner's Name and Address Print - use ball point pen or type mi. cianetn4
PWT - Last First 6
g\A0.roa -392a-
Ny03 ger 14 c,\ s_at sk.. yylcAa State
Ys-Aac
Ar.Z
Species: Sex: Age: Size: Predominant Breed: Colors:
Dog e Male 0 3 ma to 12 mo • Under 20 lbs.,fg
• CJIA/1„CilkkO. ig()J4 el-k*k'
Cat Cl Female $ 12 mo or older 20 - 50 lbs. 0
Other: • Neutered 0 Actual Age 50 lbs. 0 1-0 05 'HS i it
Amoy) Le yrs Actual_lbs. N
et;
CAil
DATE VACCINATED: VACCINATED: Producer: Veterinarian's: # AZ.11_0____.
(License No.)
a0 13 (First 3 letters) i Xll J.
M7 onth V Year ; 1 yr, LIc./Vacc. (Signature) ws--1::
Address: 3.25.Eir...74
Y.S# 3 yr. Lic./Vacc.
VACCINATION EXPIRED: Other
7,-.-„pc, A Id 1-Dri
s 2-s. Li srloyi
2I1) )411 IP
Month Day Year Vacc. Serial (lot) no.
OWNER'S COPY RABIES VACCINATION CERTIFICATE
NASPHV Form #51 Rabies Tag Number
Owner's Name and Address Print- use ball point pen or type Al. _4/....„, ,
PRIN.- Last First Telephone
D CO t/J n Nason yao b 57f/20
ttrA\S-04 s+ pricco, It), ell t9.005
Nb 3 g4tret
Species: / Sex: Age: Size: Predominant Breed: Colors:
Dog Ai Male 0 3 ma to 12 mo CI Under 20 lbs. Ch . ii ra tA) II 6r
Cat • Female 12 moor o ldecl e 20 - 50 lbs. MI ' lelojk.A
Other: 0 Neutered 0 Actual Age Over 50 lbs. 0 I (l) 14 -t'e
(Specify) Actual_lbs. Name:
r
DATE VACCINATED: Producer: V f Veterinarian's: # No.)
7 0_ W5 (FIn3t 3 letters) al i 70-h-eX
Month Day Year 0 1 yr. Lic./Vacc. (Signature) 3 1f E.-- /s--7/3 — t
3 yr. Lic./Vacc.
VACCINATION EXPIRED: PIRED: Other
1
Month Day Year Vacc. Serial (lot) no.

OWNER'S COPY RABIES VACCINATION CERTIFICATE
NASPHV Form #51 Rabies Tag Number
Owner's Name and Address Print - use ball point pen or type
PRINT st First 0 M.I. Telephonec
C OW\
No(nag teeti+ c, C ity Se
SO-.. §25A05
Species: Sex: Age: Size: Predominant Breed: Colors:
Dog ill Male )ZI 3 mo to 12 mo CI Under 20 lbs.25 cirl 1‘.A.0\,1 kk ot IA)
kilio 0
Cat 0 Female E 12 mo or older CI 20 - 50 lbs. 17
Other: 0 Neutered CI Actual Age___IL Over 50 lbs. C] Fa L,ki 4t7t5
(Specify) Actual lbs Nar .locy
r 14TZ
DATE VACCINATED: Producer: 10 Veterinarian 's: #
( cense No.)
(First 3 letters) a ‘4./.....e,
Month Day Year Ill 1 yr. Lic./Vacc. (Signature) 3..2.s- E--, ,s-t/
Address: s7.-:
)293 yr. Lic./Vacc.
VACCINATION EXPIRED:
Other .7:7242) A 21 or"-S4)
9 K d.o I b 3 -dAT5- 0
9 ft-
Month Day Year Vacc. Serial (lot) no.
OWNER'S COPY RABIES VACCINATION CERTIFICATE
NASPHV Form #51 Rabies Tag Number
Owner's Name and Address Print - use ball point pen or type
.1. trfn,z6...„/-39),,1
PiT - Last First
E. \....\aso 5\
No. .12,-6e-Aeet ,miti„so,.. it)..t..e ai
Species: Sex: Age: Size: Predominant Breed: Colors:
Dog cei Male CI 3 mo to 12 mo 0 Under 20 lbs. r1 r\ faN,1 nizt-tIke
Cat 0 Female 0 12 mo or older CI 20 - 50 lbs. El
Other: El Neutered • Actual Age Over 50 lbs. CI
(Specify) Actual lbs. Name:c to,
ir \\ /)-- l/IY\_5\1
DATE VACCINATED: Producer: ? V all Veterinarian 's: # Ill • •
. :: No.)
(First 3 letters) • c)'?. ' /
q —C I \/ AMIL.
Month Day Year CI 1 yr. Lic./Vacc. (Signature) E-* is-ti
3 yr. Lic./Vacc. Address: 3 41)._s-
VACCINATION EXPIRED:
her
q A e)-0 \rQ '---(r 5c)
Month Day Year Vacc. Serial (lot) no.

OWNER'S COPY RABIES VACCINATION CERTIFICATE
NASPHV Form #51 Rabies Tag Number
Owner's Name and Address Print - use ball point pen or type
PRAT - Last First M.I. Telephone
brOtiM $i-2 a - c c i? /y VS4 5-_Y 3222-
N.623 g #reet ---- , - ntate
Q //AOC/. /9i3*-C4' W:g.,205-
Species: Sex: Age: Size: Predominant Breed: Colors:
Dog Ii:f Male • 3 mo to 12 mo 0 Under 20 lbs. Z ii L 1,
r6tivq9'
Cat 0 Female /El 12 moor older 0 20 - 50 lbs. 0 Lf I. " 114 L4 4-
Other: 0 Neutered CI Actual Age Over 50 lbs. • ‘,Jhl ie/
(Specify)
Actual lbs V
1 s rri(ne
r r
DATE VACCINATED: Producer Veterinarian's: # 4.2/1481_____
(License NO
7 _171013 (First 3 letters)
fl / Z^(7:i
Month Day Year 0 1 yr. Lic./Vacc. (Signature)
Address: 3.2S E.., 5i sr
0 3 yr. Lic./Vacc. /
VACCINATION EXPIRED: Other
7 9,7 oia ig- ,s-9o/9
Month Day Year Vacc. Serial (lot) no.
OWNER'S COPY RABIES VACCINATION CERTIFICATE
NASPHV Form #51 Rabies Tag Number
Owner's Name and Address Print - use ball point pen or type
PRAT - Last First MI. . Telephone
Y30‘5-02-7-3-
Nro 9 0,3,..Strpt 0.c,\ .1 fo sA.. State
iffigq V*3-O:5----
Species: Sex: Age: Size: Predominant Breed: Colors:
Dog ii Male 0 3 mo to 12 mo 0 Under 20 lbs.
Cat 1:11 Female Z 12 mo or older 0 20 - 50 lbs. 0 1 IA IA.11_ 0 I irckfilt
Other: CI Neutered 0 Actual Age _i__ Over 50 lbs. 0
(Specify)
Actual lbs L aTe s \
DATE VACCINATED: Producer: * EU Veterinarian's: # 1---
(License No.)
(First 3 letters) 04.
Month ay Year 4 1 yr. Lic./Vacc. (Signatures 3 )_5- E. i 5- ti
Address: St
O leryr. Lic./Vacc.
VACCINATION EXPIRED:
Other
77--vp, A "2-.
9 a() 901 b delP95-170A '11:?)
Month Day Year Vacc. Serial (lot) no.