KENNEL PERMIT FOR MARILYN PAULEY DBA EVANZ KENNELS (2022).PDF
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Maricopa County
Animal Care And Control
2500 South 27" Avenue
Phoenix, AZ 85009
(602) 506-7387 Tele.
(602) 506-2739 Fax
KENNEL PERMIT APPLICATION
CO New’ [ Renewal Permit #20000 %
Kennel Name: t NAWZ
Mailing Address: / lh 5 2 nl BY PR MZ Kennel Location:
oy Aeearseoge AZ ZIP_& B Q63 County Supervisorial District,
Home Phone: GOQ — BY 3-2 AIg Kennel Phone: 544m 4
Name:
Please complete and sign this application and return it to the above address with payment in the amount of three
hundred twenty eight dollars ($350.00) 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-
4009 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
I< 4 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-
4001).
2. WN 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._WS_ I/We certify that I/We have J4} dogs and that the kennel meets the definition in statute.
4. We 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. Me\MWe 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. | We certify that I/We are submitting a valid copy of the rabies vaccination certificate for each
dog with this application.
ee
i. 1) \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. tA \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. Hl AWe 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. UIs 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:
4. An Arizona driver license pues after 1996 or an Arizona non-operating identification
license.
A driver license issued by’a state that verifies lawful presence in the United States.
A birth certificate or delayed birth certificate issued in any state, territory or
possession of the United States.
A United State certificate of birth abroad.
A United States passport.
A foreign passport with a United States visa.
An i-94 form with a photograph. ;
A United States citizenship and immigration services employment authorization”
document or refugee travel document. /
9. A United States certificate of naturalization. <A
10. A United States certificate of citizenship.
11. A tribal certificate of Indian blood.
42. A tribal or bureau of Indian affairs affidavit of birth.
oN
ONDAR
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. __ We certify that the kennel permit is being used solely for the purpose of licensing my own multiple
companion dogs in my household.
\We certify that all of the information I/We have provided is true and accurate under penalty of law.
Applicant Signature / Lit 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.
2 of 2
Maricopa County Animal Care and Control
2500 S. 27th Avenue
Phoenix, AZ 85009-6797
(602) 506-7387
http://pets. maricopa.gov
PELE OD
Y,
pte (
Receipt Number: R22-809091 Receipt Date: 04/06/2022
Person ID: P0999788
Phone: 602 8430219
EVANZ KENNELS aw.
16853 N 39TH DR 41612022. 11:37:30AM
PHOENIX, AZ 85053
Item: Animal ID: Reference No: Price: Each: Amount:
KEN PERMIT AT777777 K22-000040 $350.00 1 $350.00
Total Fees Due: $350.00
Payments: Cash:
Check: $350.00
Credit Card:
Total Payments Received: $350.00
Thank You!
Would you like to share your experience with our service to you? Changs: $0.00
Please visit our website at http://pets.maricopa.gov and click on "I Balance’ Due: $0.00
Want To and Contact MCACC" to email your comments for our
review.
Animal Information: INU
A7777777 KENNEL PERM - BORN 2/4/2022, SPAYED, UNKNOWNIMIX, TRICOLOR DOG
License Information:
Tag Number: License Expires: Animal# Vacc Date: Vacc Expires:
Pet Licensed/Registered To: Evanz Kennels
Please retain this receipt with your pet's records
luffmanm WBUSOFF
Maricopa County
Animal Care & Control
2500 South 27"* Avenuc
Phoenix, AZ 85009
Phone: (602) 506-7387
pets.maricopa.gov
KENNEL PERMIT K22-000040
PREMISE INSPECTION
NUMBER OF DOGS: 24
Name: Marilyn Paulie Kennel Name: Evanz Kennels
Mailing Address: 16853 N 39" Dr Kennel Address: 16853 N 39" Dr
City: Phoenix State: Az Zip: 85053 City: Phoenix State: Az Zip: 85053
County Supervisorial District: 3
Phone: 602-843-0219 Kennel Phone: 602-843-0219
1. Are all dogs over the age of three months properly vaccinated for rabies and in possession ofa
valid rabies vaccination certificate? Yes
2. Isthe 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
NOTE: Copies of each rabies vaccination certificate must be attached to the Kennel Permit Premise
Inspection form.
CORRECTIVE ACTION NEEDED FOR COMPLIANCE AND -_— DAYS GIVEN BEFORE REINSPECTION.
(Note: There will be a $49 re-inspect fee payable to the Inspector by check upon each return visit.)
Deputy Enforcement Agent & Badge #: Jason True #014
oz /— Y- 6 - ar
-w cre VINA IUIN CERIFICATE
Owner's Name & Address
NASPHV Form 51
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Rabies Tag Number
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First
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No.
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State 01
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og Male 3 mo.-,12mo. [| Under 20 bat
Cat Female 12. mo.or alee 5K | 20- 50 Ibs. 2 Io ey Pooch Ther
Other [] | Neutered [] Over 50 Ib: vr
Please specify 7 7 Nae 7 uA
2yr wb nvedbber
DATE VACCINATED: a VETERI lak
2 /- { 2 | PRODUCER: | + | J y/
“Monh Dar Day? Year o E| Veterinarian’s #: A i, v7 =
(First 3 letters) License No,
VACCINATION EXPIRES: Da Tr Text D
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| yr. Lic. /Vaecine
3 yr. Lic. / Vaccine
Veterinarian’s Signature
OWNER'S COPY RABIES VACGINATION CERTIFICATE —___
NASPHV Form #51 Rabies Tag Numbe
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Dog | Male 3 mo to 12 mo [| Under 20 al recy
Cat ~ (| Female , 42 mo or older [1 | 20 - 50 Ibs.
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DATE VACCINATED:
Month Day Year
Producer:
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Month Day ” Year Address: VACCINATION EXPIRED:
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Macc. Serial.(lot) no.
OWNER’S COPY
Owner’s Name and Address
RABIES VACCINATION CERTIFICATE
NASPHV Form #51
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Rabies Tag Number
WWINEN 9 LUFT
's Name and Address Print - use ball point pen
NADIES VAUVUINALIVIN VENLIFIVAIE
NASPHV Form #517
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<— owner's COPY" HADIES VAGUINATION GENT TOATE - TOWNER'S COPY RABIES VACCINATION CERTIFICATE
NASPHV Form #51
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Rabies Tag Number
Owner's Name and Address
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Month Day Year
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1 Day Year
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RABIES VACCINATION CERTIFICATE
Rabies Tag Number
RABIES VACCINATION CERTIFICATE aajectag Number
NASPHY Form 51
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DATE VACCINATED: VETERINARIAN: Me VETERINARIAN:
. : IDATE VACCINATED: .
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NASPHV Form #51 Rabies Tag Number NASPHV Form #51 Rabies Tag Numbe
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Month Day Year
Vacc. Serial (lot) no.
Year
vacc. Serial (ot) no.
OWNER’S COPY
RABIES VACCINATION CERTIFICATE
Rabies Tag Number
; NASPHV Form #57
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Actual Pad
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Actual
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Ibs.
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Name:
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ier’s Name and Address
NADIES VAUVINALIVIN VEN TITIVAIG
NASPHV Form #51
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Rabies Tag Number
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DATE VACCINATED:
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Month Day Year
| VACCINATION EXPIRED:
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Month Day Year
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th Day Year (Signature)
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| DATE VACCINATED:
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| Month Day Year
| | VACCINATION EXPIRED:
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Vacc. Serial (lot) no.
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Year
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PRODUCER:
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(First 3 letters)
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3 yr. Lic./ Vaccine PX
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‘Vaccine Serial (Lot) No.
Veterinarian’s #:
NA. V Rabies Tag Number NASPHV Form 51
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Le DATE VACCINATED: VETERINARIAN:
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OWNER’S COPY
Owner's Name and Address
RABIES VACCINATION CERTIFICATE
NASPHV Form #57
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Rabies Tag Number
PRINT First M.|. | Telephone
Lau abe, imbeyy fol PR-O2) 7
Streét, Ci . Zi
" UEL EL 3924 Dr Soepxe bia ESORS |"
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DATE VACCINATED:
3 Jy 22
Vionth Day Year
YACCINATION EXPIRED:
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Producer:
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(First 3 letters)
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Pitt yr. Lic./Vace.
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Month Day Year
Vacc. Serial (lot)no.
Veterinarian’s: #
(Signature)
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OWNER’S COPY
Owner's Name and Address
RABIES VACCINATION CERTIFICATE
NASPHV Form #51
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Rabies Tag Number
OWNER’S COPY
er’s Name and Address
NASPHV Form #51
Print - use ball point pen or type
KABIES VACCINATION CERTIFICATE
Rabies Tag Number
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c (| Neutered 1 | Actual rede Over 50 Ibs. 1) ,
Actual bs. ame, Le
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E VACCINATED: Producer: yAl } ca Veterinarian’s: # Teach
, Vv 2 (First 3 letters) LD. ae Wiel
th Day Year o1 (Signature)
yr. Lic./Vaec.
JA sy Lio Vacc. a a2 Fy IS TEST.
‘CINATION EXPIRED: Other % A Fx
» Jy 2E COPIES OPA r
ith. Day Year Vacc. Serial (lot) no.
OWNER'S COPY
ws Name and Address
RABIES VACCINATION CERTIFICATE
NASPHV Form #57
Print - use ball point pen or type
Rabies Tag Numbe
T- Last
Lesley, Marr hp
PRINT
Vin Caulers
First
Mavliy
M.l. | Telephone
Lady; 0277
First
Telephone
“FR- O2)/
“bod
west “7 2 3922 Or
7 ren, Ax fr |
Predominant Breed: Colors:
is pewbhe_\—asorre
a; Z > la JA
“324
Month Day Year
VACCINATION EXPIRED: oe “ er
3 dy ah SY2235
(First 3 letters)
1 yr. Lie/Vace.
Month Day Year
Vacc. Serial (lot) no.
(Signatite)
Address: IDS
City V4) State -
ha Lb. ee wa ae 7h A i) r L. Op 0K, OTP» ok (a 4 ies: Sex: Age: Size:
toes , . "| Male 1] 8 moto 12 mo D1 | Under 20 tos.
Species: | Sex: alee Size: Predominant Breed: Colors: 1 ia
Dog A Male 1] Smoto 12 mo (1 | Under 20 bs A ‘ bron .o Female 71 | 12 mo or olger J21 aes =
Cat “C1 | Female a 12 mo or older 71] 20-50 Ibs. O ; | Neutered fetal aeecble- bial pee
Other: [| Neutered C1 | Actual ae Over 50 Ibs. C1 . ' bbe 5
pect Sy | actual. Fes. WET y/ |
(LV, IvacoINaTED: | producer: 4 |s
DATE VACCINATED: Producer| A 6 le Veterinarian’s: # add t Qy QL aa
[a thorB le i Day oa
NATION EXPIRED: O
01 yr. Lie/Vaee.
Zs yr, Lic./Vace. .
SABE
Ls
B25
Vacc. Serial (lot)
no.
Veterinarian’s: # _ 42</7F5
‘ff
eer
Address: "ag Ee ISIS
OWNER'S COPY
RABIES VACCINATION CERTIFICATE
RABIES VACCINATION CERTIFICATE
(| Neutered C1 | Actual
NASPHV Form #51 Rabies Tag Number IER'S COPY
- Owner's Name and Address Print - use ball point pen or type NASPHV Form #57. Ee
PRINT - First Teleph - il point pen or type ;
Las Ley, Nar Ln j forty re 399 dame and Address Print - use ball point pen th a Sica 3 ;
pha 310k De een, HE O53 | aby Marsbyye Pan A ae a
Species: Sex: Age: Size: Predominant Breed: Colors: g 2 y vA Zz Sh: “Oni. A ek = De c@) colors:
Dog Male 3 mo to 12 mo [| Under 20 ins Gr. : a Sex: Age: Size: © Predominant : Breed: .
Cat [| Female A 12 mo or older" 20-50 lbs. O | Male 3 mo to 12 mo Under 20 noel ics ie fle
| Other: [| Neutered 1 | Actual Aeedop Over 50 Ibs. 1 . 4 Female 4A 42 mo or old 20 - 50 Ibs.
| ‘Speen Actual “Ibs. was » || Neutered [1 | Actual Age Over 50 ibs. C1 pe thew
| v ool. ow he ———— Actual_§_tbs. | Nae L
DATE VACCINATED: . Veterinarian’s: # af, ? i 7. 5 B J
Bredlicet| 2. ote (License No.) CCINATED: . Weenierere ES :
5 2 Pad ee First 3 letters) dds y Zo x AZ Ir 2 Producer: 210 > LE Z C
° ay ear 11 yr. Lic./Vacc. iui AN Q 1: Sorts .
f ‘Sianature)
VACCINATION EXPIRED: 28 yt Lied ace. “es a Ey oh 5K Year C1) yr. Lic./Vacc. naires: 32S 25 £ AS ae 5 A
, — Other 2 as S-yt Lic/ Vabb. A
32Y 16 £2)35 Pfc \AEIE) | movcoren| FO one fof 258, }
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Month Day Year Vacc. Serial (lot) no. IS a3 Py Sc OS F3 A
‘Day Year _ | Vace. Serial (lot) no.
TIFICATE
omerscor” RABIES VACCINATION CERTIFICATE —__ “msoor RABIES TAGGWATION GER Rabies Tag Number
NASPHV Form #51 abies, lag. Number,
Owner’s Name and Address _ Print - use ball point pen or type ‘Name and Address __ Print - use ball port pen or type vr Ta os ,
PRINT - La; First Mi. | Telephone ok = 7
. fa.ul 6 Ma rsbpl of Jot x-07) 7 Dg Min Lip. ON Yoepyi 7b eB 3 |”
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LCEES Ae. DTK bre [oensy A £2. Sy Fea pA 8 Ar Predotfinant Breed: Colors:
Species: | Sex: Age: _| Size: Predominant Breed: Colors: t y| Sex: a _4prieot
Dog (| Male 3 mo to 12 mo C1 | Under 20 ibs J ile j j 4 Mae O Ps mo 0 to 12 molP ur 20 2 ey pode .
Cat . C1 | Female a 12 mo or older, ZT 20-50 Ibs.” (| Female 42 mo or ee 0} 20 dite. Gagare ke
ee lame,
Other: C1} Neutered 1
(Specify)
Actual Aged ine
Over 50 Ibs.
ne me
o
Name:
Eouw thous.
Over 5'
Actual Lh ps.
Dy reo TH
| A4r220f:
DATE VACCINATED:
_3 2y 2
Month Day Year
VACCINATION EXPIRED:
3 7 285
Producer:
D4 yr. Lie./Vacc.
8 yr, Lic./Vacc.
Alo te
(First 3 letters)
Other
SY2)3E
Month Day Year
Vacc. Serial (lot) no.
Veterinarian's: # 0 ARL/EF_
(License No.)
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(Signature)
Address: 32S fe )5 7 WK SP
Parpe, A2b52F)
Veterinarian’s: # ance To}
!ACCINATED: Producer: [alole|
(First 3 letters) 7
(Gignature)
Day Year 1 yr. Lic./Vace. piiiese: js = 4 STs
NATION EXPIRED: O8 yee he a vy F525)
_ $4235
Vacc. Serial (lot) no.