DESPERADO HOUNDS KENNEL.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
ID New -)i(Renewal Perrnit # ( - 01 3
Name: 3e((% IA. ! IC`e rice_ Kennel Name: 5S ee tadr) )40“ n d_S
Mailing Address: aril 0 Mei rose%, Kennel Location: iEE Metros e
City G- 1 bp rk- , AZ ZIP gsai County Supervisorial District a
Home Phone: 44 - 3-7 9- 0 9 q3 Kennel Phone: SAke
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
ape!, 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/VVe certify that the kennel has been approved by the local zoning authority (if applicable) at the
prei for which I/we are making application for a permit.
I/VVe certify that I/We have g¼ dogs and that the kennel meets the definition in statute.
4. 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. I/VVe certify that all dogs over the age of three (3) months that are kept, harbored or maintained on the
pree 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
doEiLi this application.

7. INVe understand that a dog remaining within the kennel is not required to be licensed individually under
AR 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.
8. V VVe understand that a person who fails to obtain a kennel permit under ARS 11-1009 is subject to a
pertit- 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
writtenj 'iotification from the county enforcement agent is guilty of a class 2 misdemeanor.
10. AL- Is this kennel permit being obtained for the purposes of operating a business including but not limited to
br ers, 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 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.
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 IlWe have provided is true and accurate under penalty of law.
Date: 9 25,..wL3
Applicant Signature
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.dov
Receipt Number: R13-149191 Receipt Date: 07/27/2013
Person ID: P0999267
Phone: 480 2790993
DESPARADO HOUND KENNELS
2070 E MELROSE ST 7/27/2013 1:20:08PM
GILBERT, AZ 85296
Item: Animal ID: Reference No: Price: Each: Amount:
KEN PERMIT A7777777 K14-000013 $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
NDA UGENT1 RABIES VACCINATION CERTIFICATE
230 NORCO DR.
NORCO, CA. 92860
Phn: 19511736-3633 )4 C.-6 1 d5&YE-- , .
\ eterinarian: Michael Butchko, ['VIVI
Animal Information 5498 Mission 11:rd. Rt.:tidy CA :A • AAA
Name: CASH Species: CAN Breed: BEAGLE Color: TRICOLOR Sex: M Age: 7Y8M
Vaccination Information
Vaccination Date Vaccinated: 09/17/12 Type Vaccination: RABIES BOOSTER GOOD 3 YR Next Vaccination: 0911 7/1 5
Producer/Lot/Serial number: MERIAL IMRAB3 RV12558
CUT- >
Owner <-CU
LINDA UGENTI RABIES VACCINATION CERTIFICATE
2310 NORCO DR.
NORCO, CA. 92860
Phn: 19511736-3633 1 /1/i1C-etz,e, d.a7;Zi
!Asp eteriparian: B.0 Michael Butchko, LA/M
Animal Information CA 92509 Phone .M115118-2,42
Name: D1VA Species: CAN Breed: BEAGLE Color: WHITE Sex: F Age: 10Y1M
Vaccination Information
Date Vaccinated: 09/17/12 Type Vaccination: RABIES BOOSTER GOOD 3 YR Next Vaccination: 09/17/15
Vaccination Producer/Lot/Serial number: MERIAL IMRAB3 RV12558

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CaringHeart VACCINATION CERTIFICATE
Official Proof of Vaccination
Veterinary Services LLC Keep this record in a sate place. Duplicate requests $10. Corporate Office Hours:
Mon - Fri 9:00 am - 5:00 pm
480-699-9950 P.O. Box 7479 • Mesa, AZ 85216
PET OWNER: Fill out sections #1-3 OFFICIAL RECORD - PLEASE PRINT CLEARLY ww,v.caringheartsvetservice.com
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Address: 11,11 1 , 1 L-1:11 1-1.1 Ii 1 1 1 1 1 1 1 1 1 11 _1
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Email: 1111111111111111 1 1 1 1 1 1 1 1 1 1
Home: Cell: ( Work: (
ccIliowledge having read and I understand the back of this document. Being aware
rsthise facts, I give my permission to CARING HEARTS VETERINARY SERVICES v
and/or the Doctor to treat and/or administer the vaccinations listed below. DATE
(HI IrHv Client I Existing Client Did you get a reminder card in the mail? El Yes J No There is a $1-$3 waste disposal fee per animal. Prescription ONLY fee $10.
I How did you hear about this clinic? El Flyer from Store El Promotional Mailer 71 Newspaper 0 Referral El TV 0 Radio 0 Website 0 Drive By 0 Other
[3 Dog El Ferret El Male 1 Sp/Neu t CI Pregnant El Dog CI Ferret [3 Male El Spay/Neut El Pregnant
171 Cat 13 Other El Female Cl On Medication (:I Cat El Other El Female CI On Medication
Name: Age: El VVks Name: Age: 0 Wks
Breed: Mos Breed: El Mos
Colors: CI Yrs Colors: El Yrs
FOR OFFICE USE ONLY - PLgASE DO NOT WRITE BELOW TN S LINE
Rabies Type: KILLED VIRUS Mfg. L71 , PRICE NEXT BOOSTERS Rabies Type: KILLED VIRUS Mfg. i I PRICE NEXT BOOSTERS
Lot # ". ( i Tag # Pees notinclude 3.4 6 12 36 Lot # Tag # (Does not include, 34 6 12 36
Frnce 01 boasters 1 We Months Months • . ••• ....„,,...-.. price othO3sle110 Weeks Months 144ordhs Months
Rabies Date Vaccinated: ' I ! me Rabies Date Vaccinated: . / /
Rabies Vaccination Due: / / S Wij Rabies Vaccination Due: / • "
DA2PPv / DA2PPv+L / Corona $ DA2PPv / DA2PPv+L / Corona
Bordetella - Nasal / Injectable $ Bordetella - Nasal / Injectal e $
Lyme / Rattle Snake $ Lyme / Rattle Snake $
Dewonntnq (Protal 50 mq/m11 cc $ Dewormlnq (Protal 50 md/rni) cc $
Cat 4-in-1 (FVRCP) / Leukemia $ Cat 4-in-1 (FVRCP) I Leukemia
Heartworrn / 3DX / 4DX Test 0 Pos 0 Neg $ Heartworm / 3DX / 4DX Test 0 Po s CI Neg
FELV / FIVI Parvo I Giardia Test 0 Pos 0 Nag $ FELV / FIV / Parvo I Giardia Test 0 Pos11 Neg_
Rx Heartworm Mfg: 1 Rx Heartworm Mfg:
Pefs Weight: 0 0-25# 0 26-50# CI 51-100# $ Pefs Weight: 0 0-25# El 26-50# n 51-100 !S _.7!Ill
Flea /Tick Control: $ Flea / Tick Control: ! S
Micro Chip Mfg. Micro Chip Mfg.
Micro Chip # Micro Chip #
Other. $ Other $
Other: $ Other: $
Other: $ Qty: @ $ Other $ Qty: @ $
Other. $ Qty: Other. $ Qty: 0 $
Treatment Fee: $ Script Fee: $10 $ Treatment Fee: $ . Script Fee: $10 $
Exam Fee: $5,120 Health Certificate: $25 $ .- Exam Fee: $5 $20 Health Certificate: $25 $
. Waste Disposal Fee: "$1 "ii $2 $3 $ , Waste Disposal Fee: $1 $2 $3 $
HR: -_L n Resp: - , NEX'T BOOSTER DUE ON: ... 1 1 ,' ./. HR: Resp: NEXT BOOSTER DUE ON: [ III
i
Temp: . Weight 4 _ .... NOTES / DOSAGE Temp. Weight: NOTES / DOSAGE.
PHYSICAL EXAM: .V PHYSICAL EXAM:
Gen. App. ch dced Unable)C:21 Checked o Unable o to Check
,i) Gen. App.
Skin 0 (i) E a) -ci Skin 0 CI
Eyes CI Tu 7703 (i) Eyes 0 0
Ears El 0 o Ears 0 0
Mouth 0 Mouth 0 0
HEALTH WITHIN NORMAL LIKTS 0 Z ‘-' HEALTH WITHIN NORMAL LIMITS
Ves t No C] Yes C] No El
Veterinarian' Location: Tech. Init: Fee: $
State Lic # Date: Pd $ Bal $ Cash p CC 0 CVC Cashier Init: TOTAL:
White: CARING HEARTS VETERINARY SERVICES LLC Yellow: CLIENT / COUNTY

CaringHeart VACCINATION CERTIFICATE
0255?
Official Proof of Vaccination
Veterinary Services tic Keep this record in a safe place. Duplicate requests $10. Corporate Office Hours:
Mon - Fri 9:00 am - 5:00 pm
480-699-9950 P.O. Box 7479 • Mesa, AZ 85216
PET OWNER: Fill oui seCtions #/1 -3 OFFICIAL RECORD - PLEASE PRINT CLEARLY wvvvv.aisringheartsvetservice.com
Last Name: First Name: 1A.1.1,11-11:_l I II I I I 1 II lil t
14_7171 (I !GI VII 61 rts-I61 I 1 I I 1 I I III
I 1 I I State: Zip: -F7 17
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11-1111.. L Cell: ( 9 ) 1.:04/ - Work: (
cici«toLlIdge having read and I understand the back of this document. Being aware
to,thirrff Is, I give my permission to CARING HEARTS VETERINARY SERVICES A ‘il
rrii:Hor the Doctor to treat and/or administer the vaccinations listed below. DATE .5
nt 0 Existing Client Did you get a reminder card in the mail? ri Yes 0 No There is a $1-$3 waste disposal fee per animal. Prescription ONLY fee $10.
I How did you hear about this clinic? ['flyer from Store o Promotional Mailer o Newspaper ID Referral o TV 13 Radio 13 Website 13 Dive By CI Other
-p Dog Ferret 171 Male D'Spay/Neut 1:3 Pregnant Dog CI Ferret 0 Male 0 Spay/Neut 0 Pregnant
Cat 10 Other 13 Female On Medication 0 Cat in Other (3 Female (3 On Medication •
Name: Age: Cl Wks Name: Age: El Wks
Breed: ciL tf. Mos Breed: CI Mos
0 Yrs Colors: a Yrs
FOR OFFICE USE ONLY - PLEASE DO NOT RITE BELOW THIS LINE'
Rabies Type: KILLED VIRUS Mfg. 1 ,- .; PRICE NEXT BOOSTERS Rabies Type: KILLED VIRUS Mfg. I j PRICE NEXT BOOSTERS
Lot # Tag # • (1:10es Dot include 3-4 6 12 35 Lot # Tag # (Does not include 3.4 6 12
Price of boostem) Wee 1 Months Months Months °L.n.npno,...1 Pow of boceIers.) Weeks Months Months Months,
Rabies Date Vaccinated: / ' 1 I I e '. —I Rabies Date Vaccinated: / / '
Rabies Vaccination Due: / $ /7) , Rabies Vaccination Due: $
DA2PPv / DA2PPv+L / Corona $ DA2PPv / DA2PPv+L / Cofopa • $
Bordetella - Nasal / Injectable $ Bordetella - Nasal / Injectable' ,
Lyme / Rattle Snake $ Lyme / Rattle Snake
Deworming (Protal 50 mg/m1) cc $ Deworming (Protal 50 mg/ml) $
Cat 4-in-1 (FVRCP) / Leukemia $ Cat 4-in-1 (FVRCP) / Leukemia $
Heartworrn / 3DX / 4DX Test 17 Pos CI Neg $ Heartworm / 3DX / 4DX Test 0 Pos 0 Neg $
FELV I FIV/ Parvo I Giardia Test 0 Pos El Neg $ FELV I FIV I Parvo I Giardia Test f7 Pos CIXeg $
Rx Heartworm Mfg: Rx Heartworm Mfg:
Pets Weight: 0 0-25# 0 26-50# n 51-100# $ Pet's Weight: 0 0-25# 0 26-5G# 0 51 00# $
Rea / Tick Control: $ Rea / Tick Control: $ •
Micro Chip Mfg. $ Micro Chip Mfg. $
Micro Chip # Micro Chip #
Other $ Other $
Other: $ Other $
Other $ Qty. @ $ Other $ Qty: @ $
Other: $ Qty: 0 $ Other: $ Qty'
Treatment Fee: $ Script Fee: $10 $ Treatment Fee: $ Script Fee: $10 $
Exam Fee: $5 $20 Health Certificate: $25 $ , 1 Exam Fee: $5 $20 Health Certificate: $25 $
Waste Disposal Fee: $1 $2 $3 $ Waste Disposal Fee: $1 $2 $3 $
HR: --". Resp: NEXT BOOSTER DUE ON: 1 / i . ...., HR: Resp: NE XT BOOSTER DUE ON: i
Temp: if,11` .`"i. Weight: . 7••• r.-P.4, NOTES /DOSAGE Temp: Weight NOTES /DOSAGE
PHYSICAL EXAM: PHYSICAL EXAM:
Oed p Unable El to CAeck ,_ -- Checked Unable to Check
Gen. App. Z 0 Gem APP. 0 0
Skin 0 0 Skin El 171
Eyes 0 0 3") c 3 --1 A 4-1 tCnA r' Eyes Ears 0 0
Ears 0 0 = , 0._ ,,, trj Cl C
Mouth ID cz. if lg ?_ `.' 7- Mouth Mou [3 Ei
HEALTH WITHIN q VORMAL LIMITS 0 ' 7) HEALTH WITHIN NORMAL LIMITS
Yes Er -. No in . Yes 7I No CI
Veterinarian: Location: Tech. Init: Fee: $
State Lie # Date: Pd $ Bal $ Cash (3 CC CVC Cashier Int • TOTAL: $
White: CARING HEARTS VETERINARY SERVICES LLC Yeilosw: CLIENT! COUNTY

CaringHeart VACCINATION CERTIFICATE
Official Proof of Vaccination
Veterinary Services ux Keep this record in a safe place. Duplicate requests $10. Corporate Office Hours:
Mon - Fri 9:00 am - 5:00 pm
480-699-9950 P.O. Box 7479 Mesa, AZ 85216
PET OWNER: Fill out sections #1-3 OFFICIAL RECORD - PLEASE PRINT CLEARLY www.caringheartsvetservice.com
Last Name: LED First Name:
Address: 11111[1 1 II d Lkl<1-1 1- 11111[1 11 1111 MI111111111
)yI ITh- l-Lkir1 -71111M1111111111111111111M 1 I II II state:11a Zip: ,114]1=r
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I
Cell: ( . Work: (
•.1kuricvviiihill]e having read and I understand the back of this document. Being aware
.1Lss I give my permission to CARING HEARTS VETERINARY SERVICES x
.11 AH11E:the Doctor to treat andfor administer the vaccinations listed below. DATE
it o Existing Client Did you get a reminder card in the mail? El Yes No There is a $1 -$3 waste disposal fee per animal. Prescription ONLY fee $10.
How did you hear about this clinic? El Flyer from Store IJ Promotional Mailer I] Newspaper J Referral J TV IJ Radio EJ Website 0 Diive By O Other
=EN
0 Dog 0 Ferret (71 Male aSpay/Neut 0 Pregnant RI Dog 0 Ferret .0 Male R-SpayiNeut (3 Pregnant
11 Cat 0 Other [3 Female [3 On Medication p Cat [3 Other .0 Female O On Medication
Name: . [3 Wks IIIIrr•II Age: 0 Wks
Breed: El mos 117-eedl., r-5tt '". ':- I 4..-7.. 1-..f El Mos
Colors: El Yrs CC(0)i-r ,--z.-----f- I 0. yrs
FOR OFFICE USE ONLY -PLEASE DO NOT WRITE BELOW THIS LINE
Rabies Type: KILLED VIRUS Mfg. All -a PRICE NEXT BOOSTERS Rabies Type: KILLED VIRUS Mfg. , j PRICE NEXT BOOSTERS
Lot ft - Tag # (Does not include 34 6 12 36 LOt # ', ( - Ci ( . ! - :, Tag # 42,srirc;,,,,Ms Mice (Does of not booSter4 include Waelm 34 Moths 612 Months .. ..
Rabies Date Vaccinated: - I w...k.P.,-..d.1.., I ' 4 Foss of 1:00sterL) Weeks Moths &tints Months Rabies Date Vaccinated: I /
Rabies Vaccination Due: / $ 15. —.1 1 Rabies Vaccination Due - // _ $
DA2PPy / DA2PPv+L / Corona $ DA2PPv / DA2PPv+1/ Corona $
Bordetella - Nasal / Injectable Bordetella Nasal / Injectable $
Lyme / Rattle Snake $ L me I Rattle Snake $
Deworminq (Protal 50 mg/ml) cc $ Deworminu (Protal 50 mg/m1) cc $ ,
Cat 4-in-1 (FVRCP) / Leukemia $ Cat 4-in-1 (FVRCP) / Leukemia $
Heartworm / 3DX I 4DX Test 0 Pos 0 Neg $ Heartworm / 3DX 4DX Test 0 Pos 0 Neg $
FELV / FIV I Parvo I Giardia Test 0 Pos 0 Nen $ FELV FIV Parvo Giardia Test 0 Pos CI N $
Rx Heartwonn Mfg: Rx Heartworm Mfg:
Pet's Weight: 0 0-25# 0 26-50# 0 51-100# $ _, Pets Weight: 0 0-25# 0 26-50# O 51-100# $ .. ..
Flea / Tick Control: $ 1 Flea /Tick Control $
Micro Chip Mfg. $ Micro Chip Mfg. $
Micro Chip # Micro Chip #
Other: $ Other $
Other. $ Other $
Other $ Qty: @ $ Other: $ Qty: @ $
Other: $ Qty: 0 $ , Other: $ Qtr. 9 $
Treatment Fee: $ Script Fee: $10 $ Treatment Fee: $ Script Fee: $10 $
Exam Fee: $5420 Health Certificate: $25 $ , 24Exam Fee: $5 120 Health Certificate: $25 $ r-k I. ..)
Waste Disposal Fee: $ 1 , $2 $3 $ , Waste Disposal Fee: $1'N $2 $3 $
. ,
HR: ' \ — • Resp: .--i. ., i. 1 • k -) NEXT BOOSTER DUE OR '-". I i I .,,, • (,- HR. ' irfA./) Resp: i--L"--) NEXT BOOSTER DUE ON . C I , I - /,---
Temp; rivl - Li Weight. 4 --it -T. NOTES / DOSAGE Temp: f - ,...... '.;"\ . 1 " M/eight.c. 1./ . .--,:.. n NOTES / DOSAGE
PHYSICAL EXAM: IA-. , PHYSICAL EXAM:
Clieded ' _ '. , Chocked Unable to Check
Gen. App. CI u"a bb6 chld , -,. Gen. App. 0 El
Skin 0 0 Skin El El
Eyes ID 0 i -`,;:c.?":.‘..; > Eyes 0 0
Ears 0 0 o Z (-.) Ears El El
Mouth 0 0 -n 13 X _.4 M 8 (-)-‹ 0_ a Mou Mouth 0 0
HEALTH WITHIN NORMAL LIMITS 2 8 A _ II (:) -4' al, En HEALTH WITHIN NORMAL LIMITS
Yes El No n 0- tr (IT- St a 7-1 Lt_ Q. —. c', -t. Yes 13 No 0
Veterinarian - Location:_ )3 Tech. Mit: Fee: $
State Lic # Date: Pd $ Bal $ - Cash o CC D eve Cashier hit: ) TOTAL: $
White: CARING HEARTS VETERINARY SERVICES LLC Yellow CLIENT / COUNTY