Extracted text (via ocr_local)
15483 characters
Maricopa County
Animal Care and Control
2500 South 27th Avenue
Phoenix, AZ 85009
(602) 506-7387 Tele.
(602) 506-2739 Fax
KENNEL PERMIT
APPLICATION
Ol New WW Renewal K20 - OCGOC4
Name: 2, )-4 Lp O-<b pds LS Kennel Name: 2a 7 Jactthex Pescne
Mailing Address: SPAS 2 5 Joe Kennel Address: _§ VN 4 SK rfVT .
City: 720"s __ State: AZ Zip: SB 2.0 City: 124 AZ Zip: so
County Supervisorial District:
Phone: 2/ YOGS LF 2s Le? Kennel Phone: WO — rd Sa “STGS
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.” 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 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. Je 1 IWe 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, AzJwe certify that I/We have \ \ ___ dogs and that the kennel meets the definition in statute.
3s" 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 similar violations of any other state, county or municipal animal welfare law.
(Violations of license and leash laws DO NOT apply).
tS \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.
5. | We certify that [We are submitting a valid copy of the rabies vaccination certificate for each
dog with this application.
6A Awe 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 kenne! 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.
Wd Zz S We understand that a person who fails to obtain a kennel permit under A.R.S.§11-1009 is subject to a
pénalty of twenty-five dollars in addition to the annual fee.
7
evils \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..
=i
oS fSthe 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 Signature <2, a {2 L Ege Date 7/74 vite 6° BAO
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: R20-293993 Receipt Date: 09/09/2020
Person ID: P0858375
Phone: 480 9845960
E VALLEY RESCU KENNELS et
8125 E 5TH AVE 9/9/2020 11:45:24AM
MESA, AZ 85208
Item: Animal ID: Reference No: Price: Each: Amount:
KEN PERMIT A7777777 K20-000009 $350.00 1 $350.00
Total Fees Due: $350.00
Payments: Cash: $350.00
Check:
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 : i
; 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
ite Animal Care & Control
pe (4
“SR 2500 South 27" Avenue
ones Phoenix, AZ 85009
ote ipo Phone: (602) 506-7387
ae ES
pets.maricopa.gov
KENNEL PERMIT K20-000009
PREMISE INSPECTION
Number of Dogs: 11
Name: LINDA A. SHIVELY Kennel Name: EAST VALLEY RESCUE KENNELS
Mailing Address: 8125 E 5™4 AVENUE Kennel Address: SAME AS MAIL
City: MESA State: AZ Zip: 85208
County Supervisorial District: 2
Phone: 480-984-5960 Kennel Phone: 480-984-5960
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.
Property was inspected on September 9, 2020; there are 11 dogs on the property that are
properly vaccinated for rabies and contained to the property in controlled conditions.
Deputy Enforcement Agent & Badge #: Lt. Romero #4 Date: 9/9/20
October 2015
OWNER'’S COPY
Owner’s Name and Address
RABIES VACCINATION CERTIFICATE
NASPHV Form #57
Print - use ball point pen or type
Rabies Tag Number
PRINT - igi L; First Mul. Telephone
Shively DE | a Wor F9bo
ree! City . State Zi
Nae pees, Avex Mesa Nr» Fla ° ?
Species: || Sex: Age: Size: Predominant Breed: Colgys:
Dog Male 3 mo to 12 mo Under 20 ro If h Py,
Cat “C1] Female 12 mo or older AH 20 - 50 tbs. CJ Loy pose
lhe (| Neutered 1 Actual 57 Over 50 Ibs. [1] —
sail / Name
NO, | Actual Z Ibs. Se . :
Gnovyoa_|———
DATE VACCINATED: Prod | > Veterinarian’s: # a 2oDVMGG
roducer: 2 | Oo EE Teertse No)
lo iS _F (First 3 letters) Sn Femou Cbebiw bf
lonth Day Yea x 11 yr. Lie./Vace. (Signature)
Address: "
. 3 yr. Lic./Vacc. CH STs
VACCINATION EXPIRED: owner 325 FE. 1§ Hh
Das
2 | 3505734 Fouspe, Ar<P5H)
Month Day Year
Vacc. Serial (lot) no.
_
OWNER'S COPY
RABIES VACCINATION CERTIFICATE
NASPHV Form #517
Rabies Tag Number
fe rn aa
VACCINATION EXPIRED:
(11 yr. Lie./Vace.
yf 3 yr, Lic./Vace.
(First 3 letters)
Lone Fem de 4
Owner's Name and Address Print - use ball point pen or type Y
PRINT/ Last First Ml. | Telephone
= F Ff ‘ =
Shively Lewd fo 7H) S560
Strebt Ma State Zip
Nore eh" Sih Je yd FF 20%
Species: Sex Age: a) Predominant Breed: Colors:
Dog a Male yf 3 mo to 12 mo (1 | Under 20 and Ip F eo
Cat Female [1] 12 mo or older 20-50lbs. C1 Goq™ ~
Other: (J | Neutered C1 | Actual Age — Over 50 Ibs. (J <j
{Spec} L Actual. Ibs. | Name:
Pay | Aowws lore |——___—
DATE VACCINATED: Producer: 2 ?) f Veterinarian’s: # rh ia
Monel]
{Slgnature)
Address:
Other
lo iS dx |_ 3609934
Month Day Year Vacc. Serial (lot) no.
2S Foo (Stk SF
Zonjee, A> *¥)
[ “OU (JO)) [EYES “99e/\ wea, Keq YiUoI
f DCEILIC OC Bor
(L059 1% LY“ Ye sun :C3uldxX3 NOLLWNIDOWA
AS PASS | JC e SSSI, ‘ooen or 3k 8
sooeas'ory JA LO) yee, Keg yuo!
Vii a ee op (sianel € 3413) ria ST Of
(
Pd
v
——farT=tp/ # 1S,UBLEULIO}O/\, [Foe | seonpold :GSIWNIDOVA Siva
i 5)
1
re]
i
LD
ef! th SI
No)
yA
Qe
Ane 59
(License
(Signature)
r
2
9
feo,
cw
Veterinarian’s: #
Joep
Address: 3 2b
Ibs Name:
. oO
Over 50 J
Actual
Producer: [2 QO
Other
(First 3 letters)
¥
3 yr. Lic./Vacc.
11 yr. Lic./Vaec.
F50§
Vacc. Serial (lot) no.
a4
Year
1S 19.
Month Day
0)
|
Other: (1 | Neutered C1 | Actual Age
(Specify)
VACCINATION EXPIRED:
Jo 1S _22-
DATE VACCINATED:
Month Day Year
—— AGO 3
lo suen ‘SO ae Cremoy be (yoeds) = = g
earns Co ‘sai 0g 4200 aby remov | J peeinen | 2] 98u10 3 “So \
. Oo ‘saios - 02 epic goowz. |] elewes reo 2 @ Ly o
fa WM YY Fvsal oz sopun | [J ow Z} oF OW _~ oe slen 5oq 8 2 MN
‘ 2 =
:S810]09 :peeig JUBUILOPeld :8ZIS :xeg | :seloeds 8 cs tS os
EQS
e4 ae) a) sf. Ss e Se -on| = |
a| hs wy Wa rau eFs a wi 22 as
0945 FaA- TA ope AOS E ENN. yl
auoydesL| ‘TIN qsilg 382] - LNIdd ro) oh ¢
\ edhy 40 ued uIOd jJeq asN - Wd ssalppy pue SweN S,eUMO x S| Z
seeuarig be sexoe L.g# WO AHISYN | = 2 tea
BZLVOIILYAO NOLLVNIOOVA salavd AdOO S.HENMO & 2 s Bk
o
OSs vias
2 Se
Os: | 8;
ELs. 2 32
gis g£ [S) so
Z2rse g 3c
NS “ou (Jo)) fees “OOe/\ seen Keg Uuol oes ese
f StBICT. | of AT OF 822
4 A
BIL tY WY, og —— zi cK
ee j :G3UldX NOLIWNIOOWA > = a) Fs
Le YAS/ FF STE see soenron sk ey 2 as| #2
Ganyeubis) vsoensront AE oF Kel =e = yy ~ os
i Clad), a 2S . og
whe ys bj (sional ¢ 18413) < 3i~< Bea
. ce 2 Woo
(on asuaor) a
7/*t # sueyeuvere\ | E} 0 rl ueonPole :CALWNIOOWA Slva $ 1 wo
Z ~ af z Fi
SF $ = =| RH oe
/oureN “sq| yenioy A (Aioadg) S s : S| x 2 E
“S| OG 48AD AAP by femjoy |] peeinen Oo 4eu0 z E a atu
“a EW} 5 “Sqi OS - 02 apjo io ow ZL | efewes wo = < ae Q Mo
Vid af 4A Gisa oz 4epun ow zpopowe | ale 60d S 3 5 g
jojo a ipeaig queuwopeld :8ZIS by 1x8 ” sgaloadS é Fy s 2 3 &
(oxe iA TL (eClsF F
ah Sts! Este) 4 eet Sth “oN
OPEL SLL SOT 7pongs
auoudejet | “TW ySulg 27 - LNIYd
edfy 10 ued ulod jeg esn - Wid Ssalppy PUe SWEN SJ8UMO
. Jequunn bel seiqey Lg# U0 AHISYN
FLVOIILYAO NOLLVNIOOVA SAIdVa AdOO SEBNMO
COWNER’S COPY
Owner’s Name and Address
RABIES VACCINATION CERTIFICATE
NASPHV Form #57
Print - use ball point pen or type
Rabies Tag Number
PRINT ee hive i 13. ben
First
Telephone
‘MOTIF - SHO
Py ora A
ial
AdOO SAWANMO
SLVOISILYSD NOLLVNIOOVA Salavel
= Ss iw] B
ss 8 Fs §] FlSe| 5 BE
gO: g SI? © 38 Bay | 3/8
gs & sh § om! & ky els
Sey 2 8 Q O EA] 2
< re) <4 Oo als
Zz zZ Zpzoly l= 73
eo2n7e « |®
Sho UI a 3 25382)" |p
0)
fee ia) pe me
g 2 2
m ™ z
= Cao fe lg
s z BeoERk. 8
ce} fe} ote
8 wo 2 23°
= 29or X
gies 8 zee >
at Ee oo
aN iss aN 23 2
Sy of2 7 eS 5 =
gy $35 G 40 al
. @oao 12) c=
“ e FPORCD oS
3 Q3g°28N 2H
why 58482 2/3 2
Ss gg
ngee ~ 2g
= a 25
“oo He
> Bw ~
Eg SS | F z g
a 3 g aN 2
a € 5s Ce fo} kod
WE'D | “ SER :
N S F IA Sg SS
pS ass = U
*
\ IN 95 ~—DE
. | g
FA a
AS até _3|_ha Fy
bp £ Lis ion
PUSS ie
5 SS eel
wy S ¢ Bac, =
~ aq oa é =
/ i a = 3
& rae o
(ay g
Ne SEE. BA Ave
Species; | Sex: Age: Size: , | Predominant Breed: Colors;
Dog i Male (| 3 mo to 12 mo C]| Under 20 Ibs. IE ped
Ps
Cat Female ‘Z1| 12 mo or older f.| 20 - 50 Ibs. One Ee
Other: [| Neutered 1 | Actual roel Over 50 Ibs. eee
(Specify) Actual) 2. Ibs Name: if 3S >
7a AD r.
¥ AG VANES
DATE VACCINATED:
dae
Month Day Year
VACCINATION EXPIRED:
12 42 2)
Producer:
Bs yr. Lic./Vacc.
Cc
Zlol£
(First 3 letters)
0 1 yr. Lic./Vace.
Other
29312
Month Day Year
Vacc. Serial (lot) no.
2 /FG
Veterinarian’s: #
(License No)
ef
(Signature)
Address: 325 E. iS ASR
Jerpe, A2 G55)
~s
>
| OWNER'S COPY
Owner’s Name and Address
RABIES VACCINATION CERTIFICATE
NASPHV Form #57
Print - use ball point pen or type
Rabies Tag Number
PRINT iy ‘ ely b sjodle.
First
Ml. Telephone
YFo-NFY—-S 760
Ave.
oY Mesa Ax 2205
Zip
uv
No. ple C
Species: | Sex:
Dog Zi Male A
cat O|Female O
Other: (1 | Neutered 1)
(Specify)
Age:
3 mo to 12 mo
12 mo or older
Actual roc dye
Size:
20-50 lbs. O
Over 50 Ibs. C1
Actual G _Ibs.
Under 20 Ibs.
Predominant Breed:
Laocfle
Name: / > —
WwW
dau
DATE VACCINATED:
/0 J¥% /7
Month Day Year
VACCINATION EXPIRED:
Producer:
2\0\E
(First 3 letters)
1 yr. Lic./Vace.
% yr. Lic./Vace.
Other
27) Fo-~C
Month Day Year
Vacc. Serial (lot) no.
Veterinarian’s: # Ale /I57 _
Segoe Eis Ave
Tenpils A2d- F525)
st
» wepss ds
Ct ¢ :ssouppy
{gumeuBis)
PFW LE VU
“OU (JO)) [BLAS ‘D0e/
wee, Aeq UUOW
yink ta
Jeu10
‘oe /Orq JA og
rooea rd WA L
(sien6] € 3S413)
3/0 1S
ctl Tl
*3uldX4 NOLLWNIDOWA
wea, Aeq yuo
Ri ti
Sg ee Se) # (S,UBLBULEIE\, aeonpodd ‘CELVNIOOVA S1vd
EXC
veurey | “SUA eNIOW (Gyo0dg)
SS ano 1 ‘sai og 1809 Hheby remoy | 1] paeinen |] euI0
—speoer CL ‘salos-oz|Piepiou ow zi) erewey] 0
FA qi sa 0Z 4epun | [J ow ZL oF ow a sew 6oq
2S10]0D 1peeig JUeUIWOpald 2921S 36 xeS ‘sejoeds
fi 4 ii i
ames BST £5 é
diz Lote “2 7 DYE a i 743 | peas 3 ‘ON
576 § ~hdb-a APART APONTTS
euoudsieL | ‘TW Sil f © 861 - LNId
ff
dequinn Sel seiqey
ed/q 10 ued julod |Jeq esn - JU
LG# WWOF AHdSVN
SLVOISILYAD NOILVNIOOVA Salava
SSe/pply PUB SLUBN S,JeEUME
AdOO S.uSNMO
le
“OU (JO)) Jeag ‘90e/,
wea, Keq yuo
TCE ST
Pe t/7 Ch2
— Poa
prot
oO
oO
“sl 0S 4800
“sq| 09 - 0%
peisai oz sepun
Sa fg JOO :G3uIdX4 NOLLWNIOOVA
e We e/"° wok — sooej /Or7 JA om
ai * (eunyeubig) vooea ror 4k FO wea, eq uo
PRE Caen Grr"
+ :
Sik sat # ‘S,UBLEULIEIe\ S| O [TS |xeonpoua :GALWVNIOOWA Alva
TO
ra say
d owen | “SA Jen (Auloads)
AApz bv jemoy
BvePI0 JO OW ZL
[J ow Z, o} ow ¢
:eBy
peveinen | J seul
Pe ayewe4 Oo
ven 5oq
ixeg | :saloeds
2021S
RABIES VACCINATION CERTIFICATE
OWNER'S COPY
NASPHV Form #51
Print - use ball point pen or type
Owner’s Name and Address
IN °
2 eit © yy 1
8 EWS Als x
2 jessy Age NS SA
be een PROS
} S 2 <
ag | XB Ge OS
aN ola sl=eVWGu
AVE re me = . ch
=| 2 |e a
SE o £ NIE x \
uyo Zz > @z
og Pie
Sa
to)
2 &
. - £240
a N lo)
i 5B
222 8. e
NEo sts g
HIRO 2 gg x
Om Sle 888 as
2 SS5AE
o5 zess Se
—s. Alf ss me
c 3
Sd S23 = ae |=
SS oO & RS Os
ay "og 8 Laer 4/2
Sr} 6 2 & S 3 ow 3
VXI SE a 3 2 8
“Ys or oa gs
RH my <Un a
Laas ie) wu
“SIs 4 © © A vy. Fw
\igi 3s ir a & =
viStl. o ES w—jg x Als
“JR 15 85 3 & = of =
- =~! Oo ®
SPO a wy Zz 2 4 Zz
a Qo = S Als
1 4x00 g a & “A
Ee 0 8 = $ Z
Zz ws 5s Ws 6
=F lo j8 ex se pe Ae 8 Az
ia fe} oa08 a <x fe} ™~“I|o
a |2 |onoa0 08 a s ¢ $
1S10]0D, 1peesg JUBUILUOPeald
diz Ler 4 tH SAU KIO “y/ 45 a abedeh 4 “ON
DIS-hB5-ME oP] ATOLIC
euoydeyaL. TI ySdlg 27 - LNIdd
Jequuiny Se, seiqey
ad} 40 ued ulod |jeq esn - JULid
LG# WU04 AHASVN
ALVOlsILYAD NOILVNIOOVA Salgva
sseippy PUB SLUEN SJeUMO,
AdOO S.HANMO