KENNEL PERMIT RENEWAL FOR NANCY CHAPMAN DBA CHAPMAN KENNELS.PDF

Maricopa County Animal Care and Control

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

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

Receipt Number: R21-659364 Receipt Date: 10/19/2021
Person ID: P1246031
Phone: 623 9106579

CHAPMAN KENNELS Bo.
4201 W TIERRA BUENALN 10/19/2021 10:37:56Al

PHOENIX, AZ. 85053

Item: Animal ID: Reference No: Price: Each: Amount:
KEN PERMIT AT777777 K21-000024 $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? 5 Shange: $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: | AUN

A7777777 KENNEL PERM - BORN 9/14/1999, SPAYED, UNKNOWN/MIX, TRICOLOR DOG

License Information:
Tag Number: License Expires: Animal# Vacc Date: Vacc Expires:

Pet Licensed/Registered To: Chapman Kennels

Please retain this receipt with your pet's records

luffmanm WBUSOFF

Maricopa County

Animal Care & Control
2500 South 27" Avenue
Phoenix, AZ 85009
Phone: (602) 506-7387
pets.maricopa.gov

KENNEL PERMIT K22-000024

PREMISE INSPECTION

Number of Dogs:12

Name Nancy Chapman Kennel Name: Chapman Kennels P1246031

Mailing Address: 4201 W Tierra Buena Ln Kennel Address:4201 W Tierra Buena Ln
City: Phoenix State: AZ Zip:85053 City: Phoenix State:AZ Zip:85053
County Supervisorial District: 4

Phone: 623-910-6579 Kennel Phone: 623-910-6579

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 DAYS GIVEN
BEFORE REINSPECTION. (Note: There will be $49 re-inspect fee payable to the
Inspector by check upon each return visit.)

Deputy Enforcement Agent & Badge #: Lt. Chris Kunszt #3 Date: IP ~ /3- 2]

October 2015

Maricopa County

Animal Care and Control
2500 South 27th Avenue
Phoenix, AZ 85009
(602) 506-7387 Tele.

(602) 506-2739 Fax

KENNEL PERMIT
APPLICATION K22- COOO24

O New wf Renewal
Name: Wipes) CHa wy Kennel Name: (Ap 019) ALPWIELS
Mailing Address: 20) (0 Y/e204 LUEPP¢ Kennel Address: £20/ L). Viczen Lupus Lj
city: OO State: AZ Zip: JSO5 5 city: Aeuix_A2 zip: _F5053
County Supervisorial District: Wg .

Phone: 6 23-G)0-6I TP. Kennel Phone: 623- 9/0-65 77

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.” 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. i C ie 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. Vez We certify that I/We have Lk. dogs and that the kennel meets the definition in statute.

3. NE. \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).

4. 7) — Me 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. ail _| We certify that We are submitting a valid copy of the rabies vaccination certificate for each
dog with this application.

6.) 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 A.R.S. § 11-1008 except if the dog is only being transported to another kennel which has a permit issued
under this section.

7.7)(— Me 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. Nee 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..

9. ne _The 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.

Wh
Applicant Signature Vous. Aayotie— Date: Lol g / Lor)

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

OWNER'S COPY RABIES VACCINATION CERTIFICATE

#51 Rabies Tag Number
NASPHV Form
Owner's Name and Address Print - use we point pen or type a aan
rs a al.
PRINT - Lagt NG f92 o- Peg
Chapman, Mares 633-4)

Street

“y20) La Terre acre [LX Glendyle “Se de O53

Age: Size: Predominant Breed: Colors:
ge: :

2 Sex:
Speci Wala 7) ere | sees 0 K ie Clad Ble hens

Cat (1|Female [1] 12 mo or older 20 - 50 Ibs. x4
Other: (1 | Neutered C1 | Actual Aare Over 50 Ibs.

pecity) Actual_}2.Ibs. | Name: CG Se wan

Veterinarian’s: # Vi 1 2s) }; g
DATE VACCINATED: Producer: 2 0 a oy of
2.2) Do (First 3 letters) Lr: WA Ou
nature)
Month Day Year wo Lic./ Vace. ee 3 2 gE, fe f ¢: a

yr. Lic./Vace.
VACCINATION EXPIRED: “oth et y) Jeropre , A Qe FS. )
2.2). 3 | 372929 a
Month Day Year Vacc. Serial (lot) no.

RABIES VACCINATION CERTIFICATE [ Rabies Tes Nome
NASPHY Form 51 abies Tag Number

Owner’s Name & Address PRINT - use ballpoint Pen or type

Last

First a

SPECIES:

Dog 3mo.-12mo. 1]
Cat O | Female oO 12 mo. or older 4
Other (] | Neutered []
Please specify

Under 20 Ibs. [J
20 - 50 Ibs.
Over 50 Ibs.

PRODUCER: ble

(First 3 letters)

DATE VACCINATED:

_F_j}0 2)

Month Day Year

VETERINARIAN:

Veterinarian’s #:

License No.

< Andi Libap ptt
Veterinarian’s Signature gL Ex /SH ‘ye

sims Fane, Ase)

oe

VACCINATION EXPIRES: Tyr Lic./Vaccine []

y 3yn Le. Maccin Ph
wae 20, 2Y Y2P36F

Vaccine Serial (Lot) No.

owner's cory ~~ RABIES VACCINATION CERTIFICATE

NASPHV Form #51 Rabies Tag Number
Owner's Name and Address Print - use ball point pen or type

PRINT - La:

Chapmaa) Mine First £2344 awe

NOD 0) WA hevrahucns Ln Glendale Ar. “52 $

Species:, | Sex: Age: Size: Sh fey, ant Breed: Colors:

Dog Male A 3 mo to 12 mo C1] | Under 20 vant Shvh F2y 3 ina iro mctle

Cat 1| Female 42 mo or older 24 20 - 50 Ibs.
Other: (| Neutered C1 | Actual Age. Over 50 Ibs. O
t yr

(Specify) Actual fares. Name: Cook) >

DATE VACCINATED: naranteny OL? DIG
: Producer: 7 4) £ Veterinarian’s: # Woy
x 2 YR) First 3 letters) Le rx. iz Cth)

Month Day Year (14 yr. Lic/Vace (sigrature) 7

VACCINATION EXPIRED: how Uae, “en 3 aS vi 15: th 57.
2 2) 23 | 3929294) Sompe, M2 F5 9)

Month Day Year Vacc. Serial (lot) no.

R'S COPY RABIES VACCINATION CERTIFICATE

NASPHV Form #51 Rabies Tag Number
Owner’s Name and Address Print - use ball point pen or type

PRINT - First MLL. ver.

Llegorese, Mansy bart} 7b 40)F

No. Street

mo) Ww Tierr® Buena La Lhenry, Mie ISES3

Species: , | Sex: Age: Size: Predominant Breéd: Colors:

?
Dog Male q sneer iano Under 20 bl yar tha eles C Gre. /

Cat [| Female 12 mo or older 20 - 50 Ibs.

Other: [| Neutered (1 | Actual Age Gaye Over 50 Ibs. hy a
Speci Actual_}J Ibs. Name: ’
ISAK

DATE VACCINATED:

Producer: 2 O £ Veterinarian’s: # reson
/ 0; (First 3 letters) 4) A» >

Month Day Yea (Signature)

O11 yr. Uic:/Vacc. Address: 3 Dd £ EF. / StA a

Dis yr. Lic./Vacc.

VACCINATION EXPIRED: Other A re
—~ oe, ANF SIF].
) jo a2 |__ 293/06 Pope, M28 596)

Month Day Year Vacc. Serial (lot) no.

OWWNER'S COPY

Owner’s Name and Address

RABIES VACCINATION

NASPHV Form #51
Print - use ball point pen or type

CERTIFICATE

Rabies Tag Number

PANT Per NMapey First

om By A O99

No. by do Wa

Herre. Bux EY

Species: ,| Sex:
Dog ba Male
Cat Female

(Specify)

3 mo to 12 mo Under 20 Ib:

7
Age: ‘Size: ; Predominant Breed:
S a

re
ie alee
TE AG Co Gv | dobenhev
12 mo or older 20-50lbs.
Other: 11 | Neutered C1 | Actual Age. Over 50 Ibs. C1
Actual_} ) Ibs.

Name: La r hye

DATE VACCINATED:

_d 2) 20

Month Day Year

2223

Producer: Z| O E

(First 3 letters)

l yr. Lic./Vacc.
yr. Lic./ Vacc.

VACCINATION EXPIRED: Other

3729294

Month Day Year

Vacc. Serial (lot) no.

votes 22 ET
Veterinarian’s: we, , we

(Sidftatire) ”

aos: 325 i: wan

OWNER'S COPY

RABIES VACCINATION CERTIFICATE

Owner's Name and Address

NASPHV Form #51

Print - use ball point ben or type

Rabies Tag Number

PRINT - Last
apenas,

First
NG, Sa

Ml. [Telephone

b2~F 4 0/F

Street

* Y2lo Z Me Jerre Buena Lo

Species:
Dog Ala iia
Cat O]|Female 0

Other: [| Neutered O
(Specify)

Age: Size:
3 mo to 12 mo O | Under 20 Ibs-4

Mews 9° 459% Over 50 Ibs. 1
actual JY. bs,

12 mo oF oldey 20-50ibs. ide Che ley G Bite fedits

4 j , Stat ps5 |
de Dy
Predominant Breed Colors: a

Name:

Sonpey

DATE VACCINATED:
1G
Month Day Year

VACCINATION EXPIRED:

_)

Month Day Year

Producer:

(First 3 letters)

011 yr. Lic./Vacc.
yt. Lic./Vacc,
Other

LF3/I

Vacc. Serial (lot) no.

6) £| Veterinarian’s: # Ee)

Lge LanJs el!

ties 328 rr, ISS

Forfa, Mac F S25]

Owner’s Name & Address

RABIES VACCINATION CERTIFICATE
NASPHY Form 51
PRINT - use ballpoint pen or type

Rabies Tag Number

First ML. | Telephone

~ Chopmers Nine 643-0574

Street

* Yo) LW Terud, Briengho, Phy Ak FL0S3

SPECIES: SEX:
Dog Male
Cat 1 | Female

AGE: SIZE: PREDOMINANTBREED: COLORS:

Over 50 Ibs. Fi NAME:

Please specify

es
THYr 170 Os 2.

3 mo.- 12 mo. Under 20 Ib:
Gp Bnet. | Unies scat jus Lo Cab Led

Other [] | Neutered]

DATE VACCINATED:

G 30 2)
Month Day Year (First 3 letters) ZZ Zak Dott L/
VACCINATION EXPIRES: | yr.tic. Vaccine O Ap Soe

G ,
oe. oo DD F. 3 6 gy Address:

VETERINARIAN:

PRODUCER:|7 | ole Ae LIE4

Veterinarian’s #:

3 yr. Lic. /Vaccin

Veterinarian’ Signature 3 25 be / ST; rf SK

Vaccine Serial (Lot) No.

Pps AFF |

Owner's Name & Address

RABIES VACCINATION CERTIFICATE
NASPHY Form 51
PRINT - use ballpoint pen or type

Rabies Tag Number

Last First ML. | Telephone
” Che mar / pues 613-9 0-65 7F

treet

* Yo) plo

"Terre cee Za “T-< (O82

SPECIES: , | SEX:

Dog ‘4 Male

O, | 3mo.- 12 mo. Under 20 Ib:
Cat (| Female ef Tana or tert 20 - 50 Ibs. ‘a Shh Tous Gee

Other [| Neutered] Over 50 Ibs. NAME: Cc]

“| AGE: SIZE: pneenle BREED: [COLORS:

Please specify

Fwy lo 7 1k bad

DATE VACCINATED:

730

Month Day” Year

736

Month Day” Year

VACCINATION EXPIRES:

VETERINARIAN:
PRODUCER: &
40 ig Veterinarian’s #: A 2 VE Lo

(First 3 letters) aA A. W/
| yr. Lic. /Vaccine I z Bak bbb alas
3 yn Lic. Nocce Veterinarian’s Signature PAS E - ik ia

Vaccine Serial (Lot) No.

BBG lm ope hoF OE)

Owner's Name & Address

RABIES VACCINATION CERTIFICATE
NASPHV Form 51
PRINT - use ballpoint pen or type

Rabies Tag Number

First M.._| Telephone

/

Last
Chapmnirs Nape b2-J|-F) 0-65 99 a

No. 7 Street J

yao) (is [err fauenn px fx, fs

Foy

SPECIES: , | SEX: AGE: SIZE: PREDOMINANT BREED: — | COLORS:
Dog 4 Male 3mo.-12mo. [1] | Under 20 Ibs. _ AY Pe
Cat Female 12 mo.or older{Z | 20 - 50 tbs. OD Lh ,
Other 1] | Neutered 1] 4 Over 50 Ibs. NAME: , 7 ae
Please specify >~ bb

yr Dy L; LO. CR

DATE VACCINATED:

we oo AE

Month Day Year
VACCINATION EXPIRES:

ea

Month Day Year

VETERINARIAN:

FRODUCER: Z Oe Veterinarian’s #: Az LF4 la

License No.

Dy» Loo Filoby,
Veterinarian’s Signature Bed ix Vis7A iy ih
yapaey _|rme — Zoofre, (pole

Vaccine Serial (Lot) No.

(First 3 letters)

lyr. Lic. /Vaccine []
3 yr. Lic. /Vaccine

RABIES VACCINATION CERTIFICATE

-_ Lhep Inge Naney

Rabies Tag Number
NASPHV Form 51
Owner's Name & Address _PRINT - use ballpoint pen or type
First Telephone

633

~1)085.79

No. Street City ye Staty + | Zip.
F.0] vs is Terre. Bueps Let Bor 7D, Fpsy

SPECIES: | SEX: AGE: SIZE: .; PREDOMINANT BREED: _ | COLORS:

D Male [1] | 3 mo.- 12mo. Under 20 Ibs on : CMY,

cat Female 12 mo.or rel 20-501bs. O fe Siney Lola,

Other [1] | Neutered] ie syy_[ Over 50 bs] |NAME:

Ptease speci i Th ib Ah of a

DATE VACCINATED:
o 2

Month Day Year

Month Day Year

VACCINATION EXPIRES:

7 3° oY

VETERINARIAN:

Veterinarian’s #: A 2e Z, ZZ & 7

PRODUCER: VA re) te

License No.

De Rend Mt

(First 3 letters)

L yr. Lic./Vaccine 1]

3 yr Lic. /Vaccine

YIF36F

Vaccine Serial (Lot) No.

Veterinarian’s Signature aad EL SIAS 7s

Address:

RABIES VACCINATION CERTIFICATE

_— Lapras, Napisy

NASPHV Form 51 Rabies Tag Number
Owner’s Name & Address PRINT - use ballpoint pen or type .
Last First MI. | Telephone

623-9 0-6 579

Breet

edo} Wo fi ICYYE Bstgen Lae

Pht. |FSOS3

SPECIES:

SEX: AGE: SIZE: ma BREED: |COLORS: _
Dog So. Male 3 mo.- 12 mo. Under 20 Ibs- - Yr
Cat ‘C1 | Female d 12 mo.or se 20 - 50 Ibs. By / oie Eon C a vu U
Other] | Neutered 7] pL | over 50 tbs. C) [Names
Please specify FRR

? / ch ? iedgel

DATE VACCINATED:

730. 2/

Month Day Day Year

VACCINATION EXPIRES:

|G 70°

Month Day Day

* Year

VETERINARIAN:

Al a2 f2F5

License No.

4: oni Leb,
Veterinarian’s we

PRODUCER:|77_ oO £

(First 3 letters)

Veterinarian's #:

lyr. Lic. /Vaecine []

3 yr.Lic. Vaccine

Ish s7-

Address: Fe rf
Vaccine Serial (Lot) No.

1o-f52-F)

RABIES VACCINATION CERTIFICATE

NASPHV Form 51 Rabies Tag Number
Owner’s Name & Address PRINT - use ballpoint pen or type
Last | 2 First ML. | Telephone

. ai *

pyri A apex 623 “YY )0-BS 79

Street City yp. 4), Zip
oe) bh Tierra Buca br fh Xe, £8O53
SPECIES: , | SEX: AGE: SIZE: Anon tiee BREED: —|CoLons:
Dog ‘4 Male 3 mo.- 12 mor Under 20 veh a e
cat ‘O| Female 12 mo.or older] | 20 - 50 Ibs. Lore Le Lav), 4
Other [) | Neutered a _| Over 50 Ibs. NAME: ”
Please specify ad sacs L Ny "4 £
Hl phy.

DATE 0).

Month pA Year

VACCINATION EXPIRES:

O ds.

,
Year

Month

PRODUCER: 7 0 IC

VETERINARIAN:

Veterinarian’s #: A Zo /, Z, ia

License wy

Veterinarian’ Signature ‘ps Le Lael

ko |i vane, Mor SDF)

Vaccine Serial (Lot) No.

(First 3 letters)

1 yrsLic. Vaccine Pf

3 yr.Lic./Vaccine []