2019-06-11 McBreen, Joseph & Charlene-BaileyFARMERS
Farmers Smart Plan Home Declarations INSURANCE
PolicyNumber: 32965-39-06 Premiums
Effective: 6/1/202212:01 AM ... ....... ............. I ............... ..............
Expiration: 6/1/2023 12:01 AM Policy pren4urn $3„298,26
Named Insured(s): Charlene McBreen
Joseph McBreen Your policy premium includes aTotal Discount Savings of
1440 Fieldcrest Dr $2,510.35
Blair, NE 68008-3722 *also see Information on Additional Fees below
e-mail jmmcbre@gmail.com
Address(es):
Property Insured: 1440 Fieldcrest Dr
Blair, N E 68008-3722
Underwritten By: Farmers Insurance Exchange
6301 Owensmouth Ave.
Woodland Hills, CA 91367
ZZRUR• •= .
Year of Construction
Construction Type
Roof Type
Roof Surface Material Type
2011
Wood Siding Over Frame
Composition Shingles
Composition Shingles
This is not a bill.
Your bill with the amount due will be mailed separately.
Age of Roof 7
Occupancy Owner Occupied (Primary Res.)
Number of Units 1
Note: Roof Surface Material Type is a grouping of similar roof types for the purpose of claim settlement. Roof Surface Material Type will
be verified at the time of claim investigation and corresponds to the schedule outlined in the "Definitions” section of your policy.
Property Coverage
Coverage
Limit
Coverage
Limit
Coverage A - Dwelling
$372,000
Coverage C - Personal Property
$204,600
Extended Replacement Cost
10% ($37,200)
Contents Replacement Coverage
Covered
(In Addition to Coverage A Limit)
Coverage B - Separate Structures
$37,200
Coverage D - Loss of Use
$74,400
Additional Living Expense Term
12 Months
Liability Coverage
Coverage
Limit
Coverage
Limit
Coverage E- Personal Liability
$1,000,000
Coverage F- Medical Payments to Others
$1,000
farrners.com Policy No. 32965-39-06 Questions? Manage your account:
Call your agent Tony C Schmitz at (402) Go to www.farmers.com to access
895-3663 or email your account any time!
tschmitzl @tarmersagent.con?
56-6177 2nd Edition 10-17 3/24/2022 Page 1 of 3
CITY OF BLAIR - 2023 PET LICENSE APPLICATION I - 1)_- off
If you live in Blair City limits and own a clog(s) and/or cat(s), complete this form and return with check made payable to:
City f Blair @ 218 S 16th St o Blair,, NE 68008
You may legally own a combination of four (4) adult pets, but no more than three (3) adult dogs
or three (3) adult cats per residential or dwelling unit.
M• 1
Owner Address:
►�,�
city/state/zip:
`lairs N 68008 '(
Phone # "� U ct" �� � 1
LICENSE FEES: Dog or Cat: $16.00
Altered Do or Cat: $11 00
***PLEASE READ CAREFULLY***
YOU ARE REQUIRED BY LAW TO LICENSE YOUR PETS.
Failure to do so is a violation of City ordinances 6.103 and carries
a penalty of a fine up to $150.00 per pet.
PET LICENSES RENEWALS ARE DUE BY x/15/2023. The City shall
recognize a microchip Identification number as the license number. It
shall be unlawful for any dog or cat to wear any license or other city
Identification other than that Issued by the City of Blair for such dog or
cat. The City of Blair renuires proof of rabies vaccination to
be submitted with your license application.
9
Replacement Fee for Lost Tag: $5.00
Included is a State Fee of $1.25 being colt to fund the Nebraska Dog & Cat Operator Inspection Program
PET 1 Dog ❑ Cat Spayed Ne to ed ��^ License Fee $ _
Pet Name Birthdate i'�ex 1 �t�
ColorBreed** $ **
Declared Dangerous or Potentially Dangerous Dog: ❑ Y
MICROCHIP #��5 '1(Ifi applicable) SUBTOTAL: $
RABIES VACCINATION DATE: Q(_ n (3 yr) (1 yr) City Tag
P1"#2 Dog ❑Cat ,Spay Ngt d License Fee$
Pet Na e Birthdate exColorBreed** **
Declared Dangerous orPotential) D er us Dog: '4t' LlN
MICROCHIP #qS5, S ® (If applicable) SUBT®TAL: $
RABIES VACCINATION DATE: (3 yr)_ (1 yr) City Tag*
PET #'3 , ❑ Dog ❑ Cat ❑ Spayed/Neutered License Fee $
Pet Name Birthdate Sex
Color Breed** Replacement$ **
Declared Dangerous or Potentially Dangerous Dog: ❑ Y ❑ N
MICROCHIP # (If applicable) SUBTOTAL: $
RABIES VACCINATION DATE: (3 yr) (1 yr) City Tag #
*PLEASE INCLUDE THE CITY TAG NUMBER 'IF THIS IS A RENEWAL
** (This fee is due along with License Fee if requesting at the time of license renewal.)
Do Not Send Cash by Mail TOTAL ENCLOSED ,�`C"
If you have questions, please contact Blair Police bepartment at (402) 426-4747
++++++++++++++++++++++++++++++++++++++++++++++++++++++++++¢+++++++++++++.....+
NEW PET/NEW RESIDENT LICENSING REQUIREMENTS (March 15/ate fee date notapplicable fornewpets/newresiden&)
Newly Acquired Pets: New Residents to Blair:
• Must be Iloensed within 10 days of ownership n Must register pets within 10 days of
• <OR> at 6 months of age if puppy/kitten residency.
to
00
(D
0
C--�)
C)
E
Ln
tq
0 70
C) 0
0
E
C)
C3
i
w
-z
CL U
Lq
C:
Z
cl)
c
(Ij >
01 0
N
fa
OL
U
0
Im
Q
ol
U
It
V)
C5
-i--
-Fu
-=
fv
cli
CL
C31 [9
m
U1-Fj
co :25
2:
0 .0
u
Gl
0
cl
41
>
C)
U :J- ct!
o
w
0
U 2.
'
o
r=
0 C)
Q
>
0
•
U
to
-
E
TL
E
di
-0
o
CL
• �i �
1
u.'-'
70
c
ao
of
CaE
8)
CO
x
ul
C.
--i
c
r: 0
CS
i 0
0
ei
CL
U ej
Et
0
W
n a
O
-0
cEat4tu
— v < CO
_0
. r_
0
m
M
CZ
(U
Fa
0
U-
0
Z
06
o
0
C,
Qj E E
:a P
CL —0
E
ro
a)
LL
0
0) ai
0)
Qt
Q1
rn
OL
0
(n
0
L 0
E
M
4n
0
:3
1:-
O
aj 0
> U
01 �o
> <
ai
>
vt
U
0
u
0
u
a
OJ
U)
C)
Q
C�
LL
!E
0 -0
tr�
, Li)
0
w
•E
v)
0
m
(At
C)
>
2
�
.2
a0
4A
0
0
0
E
E
o
U
U
C (o
CL r-
:3 .0
01
c u
co M
ra I
2 2! 0 E
QN u Q
00
0
a
c
co
E
(n
ChfV u CO
-0 @7
I
'o
w
al uj
of Lu
CL
C3 0 LZ Z .0
LZ z
o
u
01:
m
N -Z: a u
E
E 0 o
0
lk.
co
E oj
u)
Gi
oj >
o
u
m
Q1
L!�
zi
cx
M,
lu
V)
0 ,
,
LU
ai
E:--
01
a) _0
c
fl)
a)
4
(1) <
TM
12
L1 W Lb z
n
U
I Ix
Z -0
CL.
ull
U
u
w
C)
E
0
u E
U
E
C =,M
o
ip
tY
cu
C;
to
Ve
0 E65
N Ln
oj
cr
a
R
of
al
m
0-
C
I -W
c
u
0
Fli
00
(D
0
C--�)
C)
E
Ln
tq
41)
0
Un
N
i
-z
CL U
Z
cl)
c
fa
Q
ol
U
It
C5
-i--
-Fu
-=
fv
cli
C31 [9
m
U1-Fj
co :25
2:
Gl
0
cl
41
>
C)
U :J- ct!
o
w
0
U 2.
'
o
r=
0 C)
Q
>
0
LO m
m J6q
to
TL
E
-0
o
CL
70
c
8)
CO
x
ul
C.
--i
it
>
0 0
i 0
0
ei
CL
U ej
Et
0
W
ro
O
-0
cEat4tu
— v < CO
_0
. r_
0
m
M
CZ
I > 0 Qj
0 0) cy)
Fa
U-
0
Z
06
o
V)
c
u
0
Fli
r0otkOX6
✓ I I � b
CITY OF BLAIR ® 44MV0
If you live in Blair City limits and own a dog(s) and/or cat(s), complete this form and return with check made payable o:
City of Blair e 218 S 16th St 9 Blair, NE 68008
You may legally own a combination of four (4) adult pets, but no more than three (3) adult dogs
or three (3) adult cats per residential or dwelling unit.
LICENSE RENEW VAS ARSE ®UE: March 15 2021
Owner Name:
Owner Address: 'e, C`
City/State/Zip: Blair, NE 668008 per(
Phone #
Drivers License # or Date of Birth I6
LICENSE FEES: Dog or Cat: $16.00
Altered Dog or Cat: $11.00
Replacement Fee for Lost Tag: $5.00
***PLEASE READ CAREFULLY***
YOU ARE REQUIRED BY LAW TO LICENSE YOUR PETS.
Failure to do so is a violation of City ordinances 6.103 and carries
a penalty of a fine up to $150.00 per pet.
PET LICENSES RENEWALS ARE DUE BY 3115/2021 The Cityshall
recognize a microchip Identification number as the license number. It
shall be unlawful for any dog or cat to wear any license or other city
Identification other than that issued by the City of Blair for such dog or
cat. The City of Blair requires proof of rabies vaccination.
Included is a State Fee of $1.25 being collected to fund the Nebraska Dog & Cat Operator Inspection P ra
PET #1 Dog ❑ Cat ' Spayed NeLd License Fee $
Pet Name Birt date ex
Color Breed** 1 ep/acement$ **
Declared Dangerous or otenti lly Dangerous Dog: ❑ Y f_ N
MICROCHIP # 5GC✓( plicabl SUBTOTAL: $
RABIES VACCINATION DATE: Ck(3 yr) (1 yr) City Tag #
TTa
PET # 'Dog ❑Cat pa / e License Fee $
Pet Na a Birthdate x _ .
Color Breed** c /acement$ **
Declared Dangerous,o otentially�D hgerous Dog: X Y ❑ N i ��
MICROCHIP (If applicable) SUBTOTAL: $ 1
RABIES VACCINATION DATE: (3 yr);4 (1 yr) City Tag #
PET #3 ❑ Dog ❑ Cat ❑ Spayed/Neutered License Fee $
Pet Name Birthdate Sex
Color Breed** Replacement $ **
Declared Dangerous or Potentially Dangerous Dog: ❑ Y ❑ N
MICROCHIP # (If applicable) SUBTOTAL: $
RABIES VACCINATION DATE: . (3 yr) (1 yr) Ci1Z' Tags
116
E
m
*PLEASE INCLUDE THE CITY TAG NUMBER IF THIS IS A RENEWAL
** (This fee is due along with License Fee if requesting at the time of license renewal.)
o
Do Not Send Cash -by Mall TOTAL ENCLOSE
VISA / MC # Expires: Security Code:
Signature
If you have questions, please contact City Hall at (402) 426-4191 or by Fax: (402) 426-4195
......++++++t++++.....a-++++.+++++....++++++........++¢+++.... •+++++.....++++++
NEW PET/NEW RESIDENT LICENSING REQUIREMENTS (March 151ate fee date notapplicable fornewpetalnewresidents)
Newly Acquired Pets: New Residents to Blair:
® Must be licensed within 10 days of ownership ® Must register pets within 10 days of
le <OR> at 6 months of age if puppy/kitten residency.
to 00
�E (D00 T 'Qa0 to O
a)
N >
CL
U
69
A
(D S
CC)
0
0
x
C�
�,Z)
C�
0 0
CLG
C)
C)
W)
in
co
-2
6
0
ro
U)
.2
C 0
0
Z)
U 0
—u
:tl_
:5
N La
tz
L)
0
-0
CL
0
LL
Kt -0 —
co
LU
N =q
(U
ra <
!2
-i5
E
t)
oj
>
0
u
U
(n
�
• .-2 E
E
CL
611
R —(L)
0i —
= 6 Ln (V
0 -
Ile
0
P': 0
ul
- 0
d
L.
0
L)
E
:3
:3N
CL
W
0i
0
(v uE
N
M
4
LL
iE
iE
�
0 -0
,
Lo
m
Q cc
>
0
C:
c
L CL
0)
.0
''o
o
0,
o 0-
0
E
E
6i R
0
a
U
(s
19
0
ac
m
U
:3 -0
E
>
N 0
u
0)
<
ob
oj '(4
co
c C) Vt
T
(n
T u E
E
O
C) " 1 00 (7,
u
ch 10 @)
u 00
�o
C:
P E
w
0) ui q,
c
z ui
0)
-a
Ln a 0 lz z
LE z
o
CL
lz u
Cl)
w N CL
0
E 0
0
mq
IA,
F.
LLu
c
[3GJ
E
zE
UC)
c:
(�2
0
Z-0
A
(D S
CC)
0
0
x
C�
�,Z)
C�
0 0
CLG
C)
C)
W)
in
co
-2
6
0
ro
U)
.2
C 0
0
Z)
U 0
—u
:tl_
:5
N La
tz
E w
>0
0
U
CL
0
LL
Kt -0 —
co
LU
N =q
(U
ra <
!2
a)
>
8 (1)
t)
oj
>
0
u
U
(D
C)
CTI
LO
Oz
6
(L
E
0
m
16
A"I
l
> E
0
U
'a C)
z cu
cli
CU
U
-r- -LA 42
�2
O
a
Iz M
cl
E 0 00
0
C.)
4iZf 00
E
c
0
U
0)
0
x
U
2
0 0
CLG
QE
x
d Cl
-2
0 0)
Lo
.2
C 0
CITY OF BLAIR - 2020 PET LICENSE APPLICI
O
If you live in Blair City limits and own a dog(s) and/or cat(s), complete this form and return with check made payable to:
City of Blair • 218 S 16th St • Blair, NE 68008
You may legally own a combination of four (4) adult pets, but no more than three (3) adult dogs
or three (3) adult cats per residential or dwelling unit.
LICENSE RENEWALS ARE DUE: March 15, 2020
Owner Name: MCBREEN, JOSEPH M & CHARLEN
Owner Address: 1440 FIELDCREST DR
City/State/Zip: Blair, NE 68008
Phone # (402) 533-9063 r7
Drivers License # or Date of Birth (_
***PLEASE READ CAREFULLY***
YOU ARE REQUIRED BY LAW TO LICENSE YOUR PETS.
Failure to do so is a violation of City ordinances 6.103 and carries
a penalty of a fine up to $150.00 per pet.
PET LICENSES RENEWALS ARE DUE BY 3/15/2020. The City shall
recognize a microchip identification number as the license number. It
shall be unlawful for any dog or cat to wear any license or other city
identification other than that issued by the City of Blair for such dog or
cat. The City of Blair requires proof of rabies vaccination.
LICENSE FEES: Dog or Cat: $16.00
Altered Dog or Cat: $11.00
Replacement Fee for Lost Tag: $5.00
Included is a State Fee of $1.25 being collected to fund the Nebraska Dog & Cat Operator Inspection Program
CURRENT PET INFORMATION:
Type: Dom Spayed/Neutered: True License Fee: $ ,
Pet Name: Bailey Birthdate: Sex: Male
Color: Blue Merle Markings: Breed: Australian Shepherd
Declared Dangerous or Potentially Dangerous Dog: Replacement: $ **
Microchip #: 985112005802293 SUBTOTAL: $ i
Rabies Vaccination Date: 3/18/2016 10:00:49 AM 3 Year/1 Year Vaccination: 3YR
City Tag #? 1872*
* PLEASE INCLUDE THE CITY TAG NUMBER IF THIS IS A RENEWAL
** THIS FEE IS DUE ALONG WITH LICENSE FEE IF REQUESTING AT THE TIME OF LICENSE RENEWAL
*** SEE BACK OF FOR FOR BREED SPECIFIC LICENSE REQUIREMENTS
VISA / MC #
Signature
Do Not Send Cash by Mail TOTAL ENCLOSED $ 1' ,
Expires: Security Code:
If you have questions, please contact City Hall at (402) 426-4191 or by Fax: (402) 426-4195
++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
NEW PET/ NEW RESIDENT LICENSING REQUIREMENTS (March 15 late fee date not applicable fornewpets/new residents)
Newly Acquired Pets: New Residents to Blair:
■ Must be licensed within 10 days of ownership ■ Must register pets within 10 days of
■ <OR> at 6 months of age if puppy/kitten residency.
FROM :BSAC r FAX N0. :402-533-2722 Feb. 27 2020 03:02PM P1
Client ID: 6045
Client Name: Charlene McBreen
Address: 1440 Fieldorest Drive
Blair, NE 68008
Phone: (402)633-9063
Tag Number:
5325
Lot Number:
13420
Imrab Rabies
Vaccine
Producer:
Merial
K / MLV / R:
Killed Virus
Blair Small Animal Clinic PC
David E. Johhson DVM
1734 Front Street
Blair, Nebraska, 68008
(402) 033-2722
Rabi6a Cartificato
Patient IQ:
7704
Patient Name:
Bailey
SpeGiw;:
Canine
Breed:
Australian Shepherd
Sex:
Neutered Male
Color:
Blue Merle
Markings:
Birthday:
1112212014
Weight:
58,00 pounds on 6/7/2019
Microchip ID:
985112005802293
Vaccination Date:
Expiration Date:
Staff Name: David E. Johnson DVM
License Number: 1893
61700`19
617/2022
City of Blair, 218 S. 16" St, Blair, NE 68008
rise ° (402) 426-4191 Fax (402) 426-4195
� Pomt
www.blairnebraska.ora
NOTICE
DANGEROUS DOG DECLARATION
NOTICE DATE: June 11, 2019
Effective date of Declaration: June 22, 2019
TO: Joseph and Charlene McBreen
1440 Fieldcrest Dr.
Blair, NE 68008
Pursuant to City of Blair Municipal Code 6-128 the following animal(s) has been declared a
Dangerous Dog:
Bailey — Australian Shepherd
This Declaration is based on the attached synopsis of facts.
Based on this Declaration, you are required to comply with the following sections of the City of
Blair Municipal Code and submit the following to City Staff:
1) Written proof from Veterinarian that your dog has been spayed, neutered and
implanted with a microchip, along with the identification number (within 30 days
from declaration).
2) Written proof of public liability insurance of not less than $100,000 (within 30 days
from declaration).
3) Written proof from the Nebraska Humane Society of your attendance and
completion of the required "Potentially Dangerous Dog" class (within 90 days from
declaration).
IMMEDIATELY: Sec -6-103 LICENSES. Any person who shall own, keep or harbor a dog or
cat over the age of 6 months within the City shall, within 10 days after acquisition of said dog or
cat, acquire a license for each such dog or cat annually by or before January 1 of each year. —
Bailey is currently licensed — Tag #1872.
IMMEDIATELY: Sec. 6-131 DANGEROUS AND POTENTIALLY DANGEROUS DOGS;
RESTRAINED. It shall be unlawful for any person owning, harboring, or having the care of a
dangerous or potentially dangerous dog to permit such dog to go beyond the property of such
person unless the dog is under the control of a person 19 years of age or older, restrained
securely by a harness and leash no longer than 6 feet, and properly muzzled to prevent the dog
from biting.
Joseph and Charlene McBreen
June 11, 2019
Page 2
IMMEDL4TELY: Sec. 6-136 DANGEROUS DOGS; CONFINED. No person owning,
harboring, or having the care of a dangerous dog shall permit such dog to go unconfined while
unattended on the premises of such person. A dangerous dog shall be securely confined, in a
humane manner, indoors or in a securely enclosed and locked pen or structure suitably designed
to prevent the entry of young children and to prevent the dog from escaping. The pen or
structure, if allowed by zoning regulations, shall have secure sides and a secure top. If the pen or
structure has no bottom secured to the sides, the sides shall be embedded into the ground no less
than one foot or have a concrete pad with sides secured to the concrete pad. The pen or structure
shall also protect the dog from the elements. The owner of a dangerous dog shall post a City
approved warning sign on the property where the dog is kept so that the sign is clearly visible at
all times and inform the public that a dangerous dog is on the property.
WITHIN (30) DAYS: Sec. 6-129 DANGEROUS AND POTENTIALLY DANGEROUS
DOGS; SPAYING OR NEUTERING; MICROCHIP IDENTIFICATION AND LICENSE
REQUIRED. Any dog declared dangerous or potentially dangerous shall be spayed or neutered,
implanted with microchip identification by a licensed veterinarian at the owner's expense and
written proof of spaying or neutering and the microchip identification number being
provided to the City within 30 days after such declaration is entered.
WITHIN (30) DAYS. Sec. 6-132 DANGEROUS AND POTENTIALLY DANGEROUS
DOGS; PROOF OF INSURANCE. The owner of any dog declared dangerous or potentially
dangerous shall be required to present written proof of public liability insurance of not less
than $100,000.00 to the City within 30 days after such declaration. Such insurance shall be
required to remain in effect as long as such dog is declared dangerous or potentially dangerous
and shall be verified annually at the time of licensing.
WITHIN (90) DAYS: Sec. 6-130 DANGEROUS AND POTENTIALLY DANGEROUS
DOGS; CLASSES REQUIRED. The owner of any dog declared dangerous or potentially
dangerous shall be required to attend, at the owner's expense, a responsible pet ownership class
approved by the City within 90 days after such declaration is entered. (Please contact the Dawn
Thrapp, Nebraska Humane Society (402) 444-7800 Ext 220 for information on the "Potentially
Dangerous Dog" classes you are required to attend. These classes are only offered every other
month and attendance at two (2) classes is required for successful completion. Do not delay in
registering to meet your (90) day requirement. Also, you will need to request a verification letter
from the Humane Society as proof of successful completion.)
NOTE: A copy of the verification letter must be provided to the City.
You have a right to appeal this declaration and revocation decision to the City Council
Police Committee. An appeal of this declaration must be made within ten (10) days of the date
of mailing or date of personal service of this notice and must be made in writing to the City of
Blair, along with payment of the appeal fee of two hundred dollars ($200.00), payable to the
City of Blair. A hearing will be held by the City Council Police Committee within ten (10) days
of the date of filing your written appeal, at which time you will have an opportunity to appear
Joseph and Charlene McBreen
June 11, 2019
Page 3
and offer evidence to dispute the declaration. A final determination to affirm or deny the
declaration will be issued within ten (10) days of the hearing by the City Council Police
Committee.
The written appeal and the appeal fee should be sent or delivered to the following address: City
of Blair, 218 S. 16th Street, Blair, NE 68008, and clearly marked as "Notice to Appeal" at the
top of the document. Failure to provide sufficient data regarding what matter is being appealed,
or failure to pay the appeal fee will be considered a waiver of appeal.
Non-compliance of any of the above ordinances will result in the owner being declared a
Reckless Owner by the City of Blair, pursuant to Chapter 6, Section 6-138 of the Blair City
Code; and will result in the revocation of all pet licenses associated with this animal(s) and
you will be required to surrender the animal(s) to any City Law Enforcement Officer or
Animal Control Officer within (24) hours. An appeal of such declaration can be heard by
the City Council Police Committee. The filing fee for such appeal is $200.00.
Enclosed is a copy of Section 6-101 through 6-139 of the City of Blair Municipal Code. The
procedure for determination of Dangerous Dog may be found in Section 6-135. The procedure
for determination of a Reckless Owner may be found in Section 6-138.
PHIL GREEN, ASSISTANT CITY ADMINISTRATOR
CITY OF BLAIR, NEBRASKA
CITY OF BLAIR - 2021 PET LICENSE APPLICATION
If you live in Blair City limits and own a dog(s) and/or cat(s), complete this form and return with check made payable to:
City of Blair 9 218 S 16th St * Blair, NE 68008
or three (3) adult cats per residential or dwelling unit
You may legally own a combination of four (4) adult pets, but no more than three (3) adult d6gs'—
A, ,AA
LICENSE RENEWALS ARE DUE: March 15,2021
Owner Name: -x C-A
Owner Address- gr-t,�" c, - A
city/state/zip: Blair, NE 68008
Phone #
PET LICENSES RENEWALS ARE DUE BY 312512021 The City shall
recognize a microchip identification number as the license number. It
shall be unlawful for any dog or cat to wear any license or other city
identification other than that issued by the City of Blair for such dog or
cat sx_;_ of —W.—
LICENSE FEES: Dog or Cat: $16.00
Altered Dog or Cat: $11.00
Replacement Fee for Lost Tag:
Included is a Sbft Fee of $1.25 being collected to fund the Nebraska Dog & Cat Operator Inspection
PET #1 1 q` i
Dog 0 Cat --,�WSpayed/Neutered License Fee$
Pet Name 1, i Birthdate '2" Sex r<
Color 'ELL, i- A 'k�T, Breed** a Y�,,,,, %n, S- r!N Replacement $_
Declared Dangerous or Potentially Dangerous Dog: Ll Y �0
MICROCHIP #q' J (If appli e) SUBTOTAL: $
7 7
RABIES VACCINATION DATE: 124".", (3 yr)yr) _ City Tag #L,, —
PET #Z,- ]ja�Dog L1 Cat �Ul<Spaye lNeutered License Fee $
t
Birthda e I i h I e Pet Name Y.DcA-�, L , -, P Sex
Color it t5�44LLReplacernent$_
Declared Dangerous or Potentially Dangerous Dog- -1 N
Z9 ' ,,(If applicable) SUBTOTAL:$ MICROCHIP 0 ` S 9 (5
RABIES VACCINATION DATE: (3 yr) (1 yr) City Tag
11 VET #3 LJ Dog L1 Cat L1 Spayed/Neutered License Fee $
Pet Name Birthdate Sex
Color Breed** Replacement $
Declared Dangerous or Potentially Dangerous Dog: Ll Y 0 N
MICROCHIP # (If applicable) SUBTOTAL: $
RABIES VACCINATION DATE:
*PLEASE INCLUDE THE CITY TAGAUMBER IF THIS IS A RENEWAL
(This fee is due along with License Fee if requesting at the rime of license renewal.)
Do Not. Sencl Cash by MaH TOTAL ENCLOSED $
g. . .. ..... ... . ..
A
If you have questio' s, please dobtact Blair Police Department at (402) 426-4747
..............................................................................
NEW PET/NEW RESIDENT LICENSING REQUIREMENTS (Mard� 151ate fee date not ap#kable fbrrxwpets1newre9ds7tF)
Ngmft &Muired Pets- New Residents to Blair-
• Must be kaised vvWn 10 days of mnasKp E Must register pets vothin 10 days of
• <OR> at 6 months of age Jf puppyftm residency.
77%u
iow"N ,
FARMERS
Farmers Smart Plan H=4`'Dedarations iNS"MANICP
f,
Blair., NE EB0,:)a`--722
till
6301 0,,Em=
Description of property
Year q,
ge ="j P 6
Tya-_ .;dn,, 0— F.,M'
c�-1rP" ed I r m,_, R�
Property Coverage
LibbRity Coverage
L-
2,�Lts— W-17 3/25/2021 Faqel (tf3
Declarations tcea)
Additional Coverage Options