2020.12.09 KENNEL PERMIT RENEWAL FOR ZDENEK BLABLA DBA APINE 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 K2I - GO0063%:

—=olon Qk BUBLA. of Renewal

O New
Name: A (pre Kenuele Kennel Name:
Mailing Address: 2 G6 VI b6(AV Kennel Address: y 94/6 VG (AV
Citys Cur prin State: Az zip: PS © / city: Serie Az zip: FS. “PX

County Supervisorial District:

PhoneLOC Ex4 404 Kennel Phone: COZ $8z. GGOK
6072 Sa? SOO oO

Please complete and sign this application and return it to the above address with payment in the amount of three
hundred fifty dollars ($350.00) within ten (10) days of receipt.

NOTE: Failure to renew the kennel permit by the expiration date of the previous year kennel permit will result in
penalty fees for each dog being assessed at $6 per month for unaltered dog and $3 per month for altered dog in
addition to the permit fee. It is suggested the renewal application be submitted 4 - 6 weeks in advance of the
expiration date to allow timely processing. :

Pursuant to Arizona statute and county ordinance, a person must obtain a kennel permit issued by the Board
of Supervisors if the person operates a kennel in which there are five or more dogs which are not individually
licensed. A.R.S. §11-1009(A). A kennel is defined as “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(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 at time of inspection. Failure of inspection may result in
denial of the kennel permit and require individual licensing of each dog under the provisions of A.R.S. §11-
1008.

PLEASE ANSWER THE FOLLOWING QUESTIONS AND INITIAL EACH RESPONSE

1. po We assume complete responsibility for the kennel at the premises for which IAve 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).

iP _ \We certify that I/We have _ 4 __ dogs and that the kennel meets the definition in statute.

ee AN 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 similar violations of any other state, county or municipal animal welfare law.
(Violations of license and leash laws DO NOT apply).

Sine certify that all dogs over the age of three (3) months that are kept, harbored or maintained on the
premtises-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.

5. MWe certify that We are submitting a valid copy of the rabies vaccination certificate for each
dog with this application.

: 8 Bee uriderstand that a dog remaining within the kennel is not required fo be licensed individually under .-
iS

AR. 11-1008. I/we also understand that a dog leaving the controlled kennel conditions shall be licensed
under A.R.S. § 11-1008 except if the dog is only being transported to another kennel which has a permit issued
under this section.

7 /We understand that a person who fails to obtain a kennel permit under A.R.S.§11-1009 is subject to a
penalty‘of twenty-five dollars in addition to the annual fee.

8. (We understand that a person who knowingly fails to obtain a kennel permit within thirty days after
written fetification from the county enforcement agent is guilty of a class 2 misdemeanor..

; he undersigned understand that that the kennel permit does not authorize the operation of any type
of business and is solely used for the purpose of licensing multiple dogs.

\We certify that all of the information I/We have provided is true and accurate under penalty of law.

Applicant Signat Date: gq. 1S: QORO

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.

October 2015

Maricopa County Animal Care and Control

2500 S. 27th Avenue
Phoenix, AZ 85009-6797

(602) 506-7387
http://pets.maricopa.gov

Receipt Number: R20-304658 Receipt Date: 09/22/2020
Person ID: P1890454

Phone: 602 3324404

ALPINE KENNELS ae.
29416 N 161ST AVE 9/22/2020 11:48:30AM

SURPRISE, AZ 85387

Item: Animal ID: Reference No: Price: Each: Amount:
KEN PERMIT A7777777 K21-000039 $350.00 1 $350.00
Total Fees Due: $350.00
Payments: Cash:
Check: $350.00
Credit Card:
Total Payments Received: ——- $350.00
Would you like to share your experience with our service to you? Thank You!
Please visit our website at http://pets.maricopa.gov and click on "I Change: $0.00
Want To and Contact MCACC" to email your comments for our oe ‘:
; Balance Due: $0.00
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

aguayot WBUSOFF

Maricopa County

FRICC Animal Care & Control
AY “Re 2500 South 27" Avenue

Phoenix, AZ 85009
Phone: (602) 506-7387
EES pets.maricopa.gov

KENNEL PERMIT K21-000039

PREMISE INSPECTION

Number of Dogs: 14

Name: ZDENEK BLABLA Kennel Name: ALPINE KENNELS
Mailing Address: 29416 N 16187 AVENUE Kennel Address: SAME AS MAIL
City: SURPRISE State: AZ Zip: 85387

County Supervisorial District: 4

Phone: 602-332-4404 Kennel Phone: 602-388-5000

1. Are all dogs over the age of three months properly vaccinated for rabies and in
possession of a valid rabies vaccination certificate?
YES

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

NOTE: Copies of each rabies vaccination certificate must be attached to the Kennel Permit
Premise Inspection form.

CORRECTIVE ACTION NEEDED FOR COMPLIANCE AND N/A DAYS GIVEN
BEFORE REINSPECTION. (Note: There will be $49 re-inspect fee payable to the
Inspector by check upon each return visit.)

This is a RENEWAL application.
There are 14 dogs on the kennel premises; all dogs have current rabies vaccinations and all
are confined to the kennel property under controlled conditions.

Deputy Enforcement Agent & Badge #: Lt. Romero #4 Date: 9/18/2020

October 2015

Date of Rabies Vaccination: 01-07-18

OWNER OF ANIMAL
First Name: _Zdenek

Address: _29416N 161 Ave

Certificate No: 0

Last Name: _Blabla

City: Surprise State: AZ

Zip: _85387

County:

This is to certify...

THAT I HAVE VACCINATED THE ANIMAL DESCRIBED BELOW AGAINST THE

RABIES VIRUS.

Patient Information:

Patient: Zuma Sex: Female

Species: Canine Age: _7Y

Weight: 55.00 Color and Markings: Sable
Microchip:

Breed: Shepherd, German

Signed: VA iA nde

'"Kell/ Hehn, DVM License:

Vaccinations Performed:

Vxn Rabies Vaccination, 3 Year

Next Rabies Vaccination Due: 01-06-21

4188

Rabies Vaccination Information:
Manufacturer: BOE

Lot Expiration: _Feb.2019

Serial Number: —_4150440A

Administered: Sq

15411 N 31st St. Phoenix, AZ 85032. Phone (602) 971-9651

Date of Rabies Vaccination: 01-07-18 Certificate No: _0
OWNER OF ANIMAL

First Name: _Zdenek Last Name: _Blabla
Address: _29416N 161 Ave

City: Surprise State: AZ Zip: 85387
County:

This is to certify...

THAT I HAVE VACCINATED THE ANIMAL DESCRIBED BELOW AGAINST THE

RABIES VIRUS.

Patient Information:

Patient: Zigge

Sex: Female

Species: Canine Age: 4Y
Weight: 60.00

Microchip:

Breed: Shepherd, German

Color and Markings: Sable

Kelly Hehn, DVM License: 4188

Vaccinations Performed:

Vxn Rabies Vaccination, 3 Year

Next Rabies Vaccination Due: 01-06-21

Rabies Vaccination Information:

Manufacturer:

Lot Expiration:

BOE Serial Number:

Feb.2019 Administered:

4150440A

Sq

“at care and kine”

15411 N 31st St. Phoenix, AZ 85032. Phone (602) 971-9651

Date of Rabies Vaccination: 01-07-18 Certificate No: 0

OWNER OF ANIMAL

First Name: _Zdenek Last Name: _Blabla
Address: _ 29416 N 161 Ave

City: Surprise State: AZ Zip: _85387
County:

This is to certify...

THAT I HAVE VACCINATED THE ANIMAL DESCRIBED BELOW AGAINST THE
RABIES VIRUS.

Patient Information:

Patient: Jet Sex: Male
Species: Canine Age: 9Y
Weight: 60.00 . Color and Markings: Sable
Microchip:
Breed: Shepherd, German _
Signed: Lille. VA
“—™ Kelh/Hehn, DVM License: 4188

Vaccinations Performed:

Vxn Rabies Vaccination, 3 Year

Next Rabies Vaccination Due: _01-06-21

Rabies Vaccination Information:
Manufacturer: BOE Serial Number: _4150440A
Lot Expiration: _Feb.2019 Administered: Sq

care and ki

15411 N 31st St. Phoenix, AZ 85032. Phone (602) 971-9651

Date of Rabies Vaccination: 01-07-18 Certificate No: _0
OWNER OF ANIMAL

First Name: _Zdenek Last Name: _Blabla
Address: 29416 N 161 Ave

City: _Surprise State: AZ Zip: _85387
County:

This is to certify...

THAT I HAVE VACCINATED THE ANIMAL DESCRIBED BELOW AGAINST THE
RABIES VIRUS.

Patient Information:

Patient: Awesome Sex: _Male
Species: Canine Age: 13M
Weight: 55.90 Color and Markings: _Black
Microchip:
Breed: Shepherd, German
Signed: Lyf, L, Hp. inl Vr
Kelly Hehn, DVM License: 4188

Vaccinations Performed:

Vxn Rabies Vaccination, 3 Year

Next Rabies Vaccination Due: 01-06-21

4

Rabies Vaccination Information: : ;
Manufacturer: BOE Serial Number: _4150440A

Lot Expiration: Feb.2019 “Administered: Sq

“at care and kine"

15411 N 31st St. Phoenix, AZ 85032. Phone (602) 971-9651

Certificate of Rabies Vaccination

Date of Rabies Vaccination: 01-07-18 Certificate No: _0
OWNER OF ANIMAL

First Name: _Zdenek Last Name: _Blabla
Address: _29416N 161 Ave

City: _Surprise State: AZ Zip: _85387
County:

This is to certify...

THAT I HAVE VACCINATED THE ANIMAL DESCRIBED BELOW AGAINST THE
RABIES VIRUS.

Patient Information:

Patient: Borg Sex: Male
Species: Canine Age: 8Y
Weight: 60.00 Color and Markings: Sable
Microchip:
Breed: Shepherd, German
Signed: SL VE DAWA
“” Kelly/Héhn, DVM License: 4188

Vaccinations Performed:

Vxn Rabies Vaccination, 3 Year

Next Rabies Vaccination Due: 01-06-21

Rabies Vaccination Information:
Manufacturer: BOE Serial Number: _4150440A

Lot Expiration: _Feb.2019 Administered: Sq

Steqe an
Care and kin

15411 N 31st St. Phoenix, AZ 85032. Phone (602) 971-9651

Date of Rabies Vaccination: 01-07-18 Certificate No: _0
OWNER OF ANIMAL

First Name: _Zdenek Last Name: _Blabla
Address: _29416N 161 Ave

City: _ Surprise State: AZ Zip: 85387
County:

This is to certify...

THAT I HAVE VACCINATED THE ANIMAL DESCRIBED BELOW AGAINST THE
RABIES VIRUS.

Patient Information:
Patient: Boxa Sex: Female
Species: Canine Age: 7Y
Weight: 55.00 Color and Markings: Sable
Microchip:
Breed: Shepherd, German
Signed: LUE, ae,
Kelly Hehn, DVM License: 4188

Vaccinations Performed:

Vxn Rabies Vaccination, 3 Year

Next Rabies Vaccination Due: _01-06-21

Rabies Vaccination Information:
Manufacturer: BOE Serial Number: _4150440A

Lot Expiration: _Feb.2019 Administered: Sq

15411 N 31st St. Phoenix, AZ 85032. Phone (602) 971-9651

Date of Rabies Vaccination: 01-07-18 Certificate No: 0

OWNER OF ANIMAL
First Name: _Zdenek Last Name: _Blabla

Address: _29416N 161 Ave

City: Surprise State: AZ Zip: _85387

County:

This is to certify...

THAT I HAVE VACCINATED THE ANIMAL DESCRIBED BELOW AGAINST THE
RABIES VIRUS.

Patient Information:

Patient: Chubra Sex: Female
Species: Canine Age: 12M
Weight: 55.00 Color and Markings: Black and Tan
Microchip:
Breed: Shepherd, German
Signed: V7 a LAN
" Kelly"Hehn, DVM License: 4188

Vaccinations Performed:

Vxn Rabies Vaccination, 3 Year

Next Rabies Vaccination Due: 01-06-21

Rabies Vaccination Information:
Manufacturer: BOE Serial Number: _4150440A

Lot Expiration: Feb.2019 Administered: Sq

15411 N 31st St. Phoenix, AZ 85032. Phone (602) 971-9651

Date of Rabies Vaccination: 01-07-18 Certificate No: _0

OWNER OF ANIMAL
First Name: _Zdenek Last Name: _Blabla

Address: _ 29416 N 161 Ave
City: Surprise State: AZ Zip: 85387
County:

This is to certify...

THAT I HAVE VACCINATED THE ANIMAL DESCRIBED BELOW AGAINST THE
RABIES VIRUS.

Patient Information:

Patient: Chula Sex: Female
Species: Canine Age: _6Y
Weight: 55.00 Color and Markings: Sable
Microchip:
Breed: Shepherd, German.
Signed: Lh th LV~-
"Kelly Hehn, DVM License: 4188

Vaccinations Performed:

Vxn Rabies Vaccination, 3 Year

Next Rabies Vaccination Due: _01-06-21

Rabies Vaccination Information:
Manufacturer: BOE Serial Number: _4150440A

Lot Expiration: _Feb.2019 Administered: Sq

15411 N 31st St. Phoenix, AZ 85032. Phone (602) 971-9651

- Certificate of Rabies Vaccinati n : :

Date of Rabies Vaccination: 01-07-18 Certificate No: _0
OWNER OF ANIMAL

First Name: _Zdenek Last Name: _Blabla
Address: _29416N 161 Ave

City: _ Surprise State: AZ Zip: _85387
County:

This is to certify...

THAT I HAVE VACCINATED THE ANIMAL DESCRIBED BELOW AGAINST THE
RABIES VIRUS.

Patient Information:

Patient: Fury Sex: Female
Species: Canine Age: 3Y
Weight: 60.00 Color and Markings: Sable
Microchip:
Breed: Shepherd, German
Signed: Lise. pr
"Kelly Hehn, DVM License: 4188

Vaccinations Performed:

Vxn Rabies Vaccination, 3 Year

Next Rabies Vaccination Due: 01-06-21

Rabies Vaccination Information:
Manufacturer: BOE Serial Number: _4150440A

Lot Expiration: _Feb.2019 Administered: Sq

Date of Rabies Vaccination: 01-07-18

OWNER OF ANIMAL
First Name: _Zdenek

Address: 29416N 161 Ave

Certificate No: _0

Last Name: _Blabla

City: _ Surprise State: _AZ

Zip: 85387

County:

This is to certify...

THAT I HAVE VACCINATED THE ANIMAL DESCRIBED BELOW AGAINST THE

RABIES VIRUS.

Patient Information:

Patient: LuvLuv Sex: Female

Species: Canine Age: 3Y

Weight: 60.00 Color and Markings: _Sable
Microchip:

Breed: Shepherd, German

Signed: kh Sb. wal

\Kelly Hehn, DVM. License:

Vaccinations Performed:

Vxn Rabies Vaccination, 3 Year

Next Rabies Vaccination Due: 01-06-21

4188

Rabies Vaccination Information:
Manufacturer: BOE

é

Serial Number: _4150440A

Lot Expiration: _Feb.2019

Administered: Sq

15411 N 31st St. Phoenix, AZ 85032. Phone (602) 971-9651

Date of Rabies Vaccination: 01-07-18 Certificate No: _0
OWNER OF ANIMAL

First Name: _Zdenek Last Name: Blabla
Address: _ 29416 'N 161 Ave

City: Surprise State: AZ Zip: _85387
County:

This is to certify...

THAT I HAVE VACCINATED THE ANIMAL DESCRIBED BELOW AGAINST THE
RABIES VIRUS.

Patient Information:

Patient: Tank Sex: Male

Species: Canine Age: TY

Weight: 65.00 Color and Markings: Sable
Microchip:

Breed: Shepherd, German

Signed: Lh fl Jy

Kelly Hehn, DVM License: 4188

Vaccinations Performed:

Vxn Rabies Vaccination, 3 Year

Next Rabies Vaccination Due: _01-06-21

Rabies Vaccination Information:
Manufacturer: BOE Serial Number: —_4150440A
Lot Expiration: Feb.2019 Administered: Sq.

Date of Rabies Vaccination: 01-07-18 Certificate No: _0

OWNER OF ANIMAL

First Name: _Zdenek Last Name: _Blabla
Address: _29416'N 161 Ave

City: Surprise State: AZ Zip: _85387
County:

This is to certify...

THAT I HAVE VACCINATED THE ANIMAL DESCRIBED BELOW AGAINST THE
RABIES VIRUS.

Patient Information:
Patient: Sarko Sex: _Male
Species: Canine Age: 12M
Weight: 60.00 Color and Markings: Sable
Microchip:
Breed: Shepherd, German
Signed: VE, A bbof, Wu
7 "Kelly Hehn, DVM * License: 4188

Vaccinations Performed:

Vxn Rabies Vaccination, 3 Year

Next Rabies Vaccination Due: _01-06-21

Rabies Vaccination Information: ‘ ‘
Manufacturer: BOE Serial Number: _4150440A

Lot Expiration: _Feb.2019 Administered: Sq

Date of Rabies Vaccination: 01-07-18 Certificate No: 0

OWNER OF ANIMAL :

First Name: _Zdenek Last Name: _Blabla
Address: _29416 N 161 Ave

City: _ Surprise State: AZ Zip: 85387
County:

This is to certify...

THAT I HAVE VACCINATED THE ANIMAL DESCRIBED BELOW AGAINST THE
RABIES VIRUS.

Patient Information:
Patient: Gus Sex: Male
Species: Canine Age: 12M
Weight: 65.00 Color and Markings: _Sable
Microchip:
Breed: Shepherd, German
Signed: LW 1M, LAN
Kelly flehn, DVM License: 4188

Vaccinations Performed:

Vxn Rabies Vaccination, 3 Year

Next Rabies Vaccination Due: _01-06-21

Rabies Vaccination Information:
Manufacturer: BOE Serial Number: _4150440A

Lot Expiration: _Feb.2019 Administered: Sq

15411 N 31st St. Phoenix, AZ 85032. Phone (602) 971-9651

ertificate of Rabies Vaccination

Date of Rabies Vaccination: 01-07-18 Certificate No: 0

OWNER OF ANIMAL -

First Name: _Zdenek Last Name: _Blabla
Address: _29416 N 161 Ave

City: Surprise State: AZ Zip: _85387
County:

This is to certify...

THAT I HAVE VACCINATED THE ANIMAL DESCRIBED BELOW AGAINST THE
RABIES VIRUS.

Patient Information:

Patient: Haka Sex: Female
Species: Canine Age: 12M
Weight: 60.00 Color and Markings: Sable
Microchip:
Breed: Shepherd, German
Signed: Ly IA Ln
Kelly Hehn, DVM License: 4188

Vaccinations Performed:

Vxn Rabies Vaccination, 3 Year

Next Rabies Vaccination Due: 01-06-21

Rabies Vaccination Information:
Manufacturer: BOE Serial Number: _4150440A
Lot Expiration: Feb.2019 Administered: Sq