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2020-10-30 Powers, KendraP" [I'leVT E F)", I I'll, I'll U, I r-, R, M 01 R� T (L; r", (Gf, L E' 1,41'D [III, P D" 11 T 110 H bi L f N, T F 1", E, ' 1 0 POWERS, BENJAMIN T & KENDRA J orIt a ee SA ASI ANK NA 81 6014552r: :10 9X 2 860 I NC% C 29602-2060 11(i)V I - Irk 01 ARTY, Lit1fi! IT Coverage Limit of Liability A Dwelling $ 194,100 Other Structures $ 19,410 B Personal Property $ 145,575 C Loss of Use $ 58,230 Arson Reward $1,000 Credit Card, Bank Fund Transfer Card, Forgery, And Counterfeit Money $1,000 Debris Removal Additional 5% available/$1,000 tree.debris Fire Department Service Charge $500 per occurrence Fuel Oil Release $10,000 Locks and Remote Devices $1,000 Trees, Shrubs, and Landscaping 5% of Coverage A amount/$750 per item (, u ER'A( 22, ARUI UR IT9 Coverage Limit of Li Abi I ity L Personal Liability (Each Occurrence) $ 500,000 Damage to the Property of Others $ .1,000 M Medical Payments to Others (Each Person) $ 5,000 41 F LK, T [i 0 Ni Inflation Coverage Index: 340,3 D E D f("_11, -1, [1 El, L E_ 11� Section I Deductible Deductible Amount All Losses 1/2% (MIN) $ 1,000 L0 S',[ [;\ fl[' LE ("JIVI 10 H Al Replacement Cost -Similar. Construction 131 Limited Replacement Cost - Coverage B HO.2000 Page 2 of 4 Ad . uIlt Day Care Liability (for those providing adult daycare in their home) Energy Efficiency Upgrade (for replacing damaged heating unit, air conditioning unit, or water heater with equipment that is more energy efficient) Home Rental (for those who rent out their home for more than 30 nights yearly) Home Systems Protection (for covering the breakdown of permanently installed equipment) Service Line (for the cost of repairing damaged underground utility lines) Increased Personal Property (for higher limits above the standard policy limit, which is a percentage of your Coverage A -Dwelling amount) This notice contains only a general description of the coverages and is not a contract. All coverages are subject to the provisions in the policy Itself. Should you have a need for any of these coverages or higher limits, contact your State Farm Agent to discuss details, cost and eligibility. IMPORTANT INFORMATION ABOUT DAMAGE CAUSED BY FLOODING This policy does not cover damage to your property caused by flooding. You may be eligible for such coverage through the National Flood Insurance Program ("NFIP"), if you live in a participating community. For more information, contact your State Farm®agent or visit floodsmart.gov. Holstein Vet Clinic 718 South 19th Street Blair, NE 68008 402-426-7387 Printed: 04-24-23 at 1:47p CLIENT INFORMATION Name Kendra Powers (7083) Address 854 N 16th Street Male, Neutered Blair, NE 68008 Phone 402 426-4805 Cell 402-427-3214 PATIENT INFORMATION Name Helmut 03-17-24 Sex Male, Neutered Vanguard@ B ORAL { Bordetella Birthday 01-11-18 Codes ID 985141002844514 03-18-23 Color White/Gray 03-18-23 Reminded (none) Reminders for: Helmut 03-17-24 VETSCAN@ Flex4 Heartworm Test 03-17-24 Vanguard@ Rabies 1 {1 YEAR} 03-17-24 Vanguard@ B ORAL { Bordetella 03-17-24 Vanguard@ DAPP/1-4 {Distemper+L Spouse Ben Species Canine Breed Pit Bull Age 5y Rabies 23169 Weight 77.20 lbs Codes Last done 03-18-23 03-18-23 03-18-23 03-18-23 Patient Chart 718 South 19th Street Blair, NE 68008 402-426-7387 Printed: 04-24-23 at 1:47p CLIENT INFORMATION Name Kendra Powers (7083) Address 854 N 16th Street Blair, NE 68008 Phone 402 426-4805 Cell 402-427-3214 PATIENT INFORMATION Name Sex Pumpkin Female, Spayed 03-20-24 Birthday 08-12-11 Vanguard® Rabies 3 {3 YEAR} ID 52,10 lbs Codes Color Red and White Reminded (none) Reminders for: Pumpkin 03-20-24 VETSCANO Flex4 Heartworm Test 03-20-24 Vanguard® DAPP/1-4 {Distemper+L 03-04-24 Vanguard® Rabies 3 {3 YEAR} p� ;M Patient Chart Spouse Ben Species Canine Breed Basset Hound Age 11y Rabies 18961 Weight 52,10 lbs Codes Last done 03-21-23 03-21-23 03-05-21 State Farm Fire and Casualty Company A Stock Company nth Home Offices in Bloomington, Illinois PO Box 853907 Richardson, TX 75085-3907 aTi H-06-03D1-FB2D F H W 3200 POWERS, BENJAMIN T & KENDRA J 854 N 16TH ST BLAIR NE 68008-1221 Pc�ueY n�uMa>=� 27-GC-Fi875-0 HOMEOWNERS AVAILABLE COVERAGE NOTICE SEE RENEWAL DECLARATIONS IT IS IMPORTANT THAT YOU OCCASIONALLY REVIEW THE COVERAGES AND LIMITS IN YOUR HOMEOWNERS POLICY TO BE CERTAIN YOUR NEEDS ARE BEING MET. THE FOLLOWING INFORMATION WILL ASSIST YOU IN THE REVIEW PROCESS. THE COVERAGE LIMITS FOR COVERAGE A -DWELLING, COVERAGE B -PERSONAL PROPERTY, COVERAGE L - PERSONAL LIABILITY, AND COVERAGE M -MEDICAL PAYMENTS TO OTHERS ARE LISTED ON THE ACCOMPANYING RENEWAL DECLARATIONS. PLEASE REVIEW THESE LIMITS TO DETERMINE IF THEY ARE ADEQUATE IN THE EVENT OF A LOSS. THE FOLLOWING IS A PARTIAL LIST OF THE OPTIONAL COVERAGES YOU HAVE NOT ADDED TO YOUR POLICY. THEY MAY BE AVAILABLE TO YOU FOR AN ADDITIONAL PREMIUM. Back -Up of Sewer or Drain (for damage caused bywater from outside the plumbing system which backs up through sewers or drains► Business Property (for higher limits) Business Pursuits Liability (for teachers, school administrators, sales persons, and clerical employees) Child Care Liability (for those providing child care in their home) Earthquake (for damage to buildings and personal property caused by an earthquake) Firearms (for broadened coverage and higher limits) Cyber Event, Identity Restoration, and Fraud Loss Incidental Business Liability (for those with an incidental office, studio, or school in the home) Jewelry and Furs (for broadened coverage and higher limits) Loss Assessment (for neighborhoods with Homeowners Associations) Nurses' Professional Liability (for those in the nursing profession) Personal Injury (for your liability to others caused by certain acts of libel, slander, invasion of privacy, or false arrest► Silverware/Goldware (for broadened coverage and higher limits) **Continued on Reverse Side** Agent KYLE ISKE Prepared ocroszoz� Telephone (402) 572-1118 Adult Day Care Liability (for those providing adult day care in their home) Energy Efficiency Upgrade (for replacing damaged heating unit, air conditioning unit, or water heater with equipment that is more energy efficient) Home Rental (for those who rent out their home for more than 30 nights yearly) Home Systems Protection (for covering the breakdown of permanently installed equipment) Service Line (for the cost of repairing damaged underground utility lines) Increased Personal Property (for higher limits above the standard policy limit, which is a percentage of your Coverage A -Dwelling amount► This notice contains only a general description of the coverages and is not a contract. All coverages are subject to M the provisions in the policy itself. Should you have a need for any of these coverages or higher limits, contact your State m Farm Agent to discuss details, cost and eligibility. IMPORTANT INFORMATION ABOUT DAMAGE CAUSED BY FLOODING This policy does not cover damage to your property caused by flooding. You may be eligible for such coverage through the National Flood Insurance Program ("NFIP"), if you live in a participating community. For more information, contact your State Farm®agent or visit floodsmart.gov. State Farm Fire and Casualty Company A Stock Company nth Home Offices in Bloomington, Illinois PO Box 853907 Richardson, TX 75085-3907 H-06-03D1-FB2D F H W 3200 POWERS, BENJAMIN T & KENDRA J 854 N 16TH ST BLAIR NE 68008-1221 Ilh��lu�rm�*urm�*ur � Il��lllli Location of Residence Premises 854 N 16TH ST BLAIR NE 68008-1221 Construction: Frame Year Built: 1950 4g�llur�m�n " RENEWAL DECLARATIONS AMOUNT DUE: None IIP���vucmmeucmt liis ml�aie IIL�v "IIfD If:11f:°. If�AIIIC:6 If:1Y IIDIf�"IIfCACIf:°.If:°. Policy Number: 27-CC-6875-0 Policy Period: 12 Months Effective Dates: DEC 10 2021 to DEC 10 2022 The policy period begins and ends at 12:01 am standard time atthe residence premises. Your State Farm Agent KYLE ISKE 15236 W MAPLE RD OMAHA NE 68116-5183 Phone: (402) 572-1118 Roof Material: Composition Shingle Roof Installation Year: 1986 Automatic Renewal If the POLICY PERIOD is shown as 12 MONTHS, this policy will be renewed automatically subject to the premiums, rules, and forms in effect for each succeeding policy period. If this policy is terminated, we will give you and the Mortgagee/Lien- holderwritten notice in compliance with the policy provisions or as required bylaw. IIII'�lflltlItlRlI��IV'�II�II'�lfll Iqq Please help us update the data used to determine your premium. Contact your agent with the year each of your home's utilities (heating/cooling, plumbing, or electrical) and roof were last updated. If�lf�lf:°.III IILUII Annual Premium $1,723.00 Credit 1,472.00 Vour premium has already been adjusted by the following: Home/Auto Discount Claim Record Discount Loyal Customer Total Premium $251.00 Prepared OCT062021 �j /J Page 1 of 4 un �nnn / {711N1(.S'�oCQ}.i�J� uR�C�IYfP Gf�1'.(._. Il�lllf:°.IC:6 IIII'�S�Ulf�lf:°.IC:6 IICIf�"IIfCCIf::.If::. II�IC:6 IC:61C:611"IIfIICII�II... IIII�"Ilflf::.If�lf:°.S"IIfS POWERS, BENJAMIN T & KENDRA J Mortgagee CITIZENS BANK NA Loan Number: I SAOA/ATI MA 12M B2105016267 PO BOX 202060 FLORENCE SC 29502-2060 SIf::.C"IIfIICII� II • If�If�Clf�lf::.lf�"Ilf CCIf::.If�ACIf::.S II�IC:6 IL..IIIIII"IIfS Coverage Limit of Liability A Dwelling $ 183,900 Other Structures $ 18,390 B Personal Property $ 137,925 C Loss of Use $ 55,170 Additional Coverages Arson Reward $1 ,000 Credit Card, Bank Fund Transfer Card, Forgery, and Counterfeit Money $1 ,000 Debris Removal Additional 5% available/$1,000 tree debris Fire Department Service Charge $500 per occurrence Fuel Oil Release $10,000 Locks and Remote Devices $1 ,000 Trees, Shrubs, and Landscaping 5% of Coverage A amount/$750 per item II:::.IIfIICII� II II .. IL..IIII::�IIIL..II Ilf CII:::.II�CII:::. 11�11..6 IL..IIIIII Ilf Coverage Limit of Liability L Personal Liability (Each Occurrence) $ 500,000 Damage to the Property of Others $ 1 ,000 M Medical Payments to Others (Each Person) $ 5,000 II II�If 'IL.."IIfII CII� Inflation Coverage Index: 322.7 IC:61f::.IC:6 �U "Ilf II If:� Il...lf:°.S Section I Deductible Deductible Amount All Losses 1/2% (MIN) $ 1,000 IL..CSS Slf:°(:'Ilf"Ilfll...lf::.11lf::.11�"Ilf If�If�CIISIICII'�S Ai Replacement Cost -Similar Construction Bi Limited Replacement Cost -Coverage B un �nnn U O 27-CC-6875-0 '���� ^���� If'DIftIISw Dlf�"IIfIIDII�Sw AII�IC:6 If:°.II�II::6DIftSlf:°.Illf::.II�"IIfS HW-2127 Homeowners Policy Option ID Increase Dwlg up to $36,780 Option OL Ordinance/Law 10%/ $18,390 Option JF Jewelry and Furs $1 ,500 Each Article/$2,500 Aggregate HO-2288 Ho Amendatory Endorsement HO-2356 Amendatory End -Liability AIf:61C:611"Ilfll DII�AII... III If::.SSAB lf:°.S State Farm® works hard to offer you the best combination of price, service, and protection. The amount you pay for homeowners insurance is determined by many factors such as the coverages you have, the type of construction, the likelihood of future claims, and information from consumers reports. Other limits and exclusions may apply -refer to your policy Your policy consists of these Declarations, the Homeowners Policy shown above, and any otherforms and endorsements that apply, including those shown above as well as those issued subsequentte the issuance of this policy. This policy is issued by the State Farm Fire and Casualty Cempany. Participating Policy You are entitled to participate in a distribution of the earnings of the company as determined by our Board of Directors in accordance with the Company's Articles of Incorporation, as amended. In Witness Whereof, the State Farm Fire and Casualty Company has caused this policy to be signed by its President and Secretary at Bloomington, Illinois. �m �- ���� Secretary President Prepared OCT062021 Page 3of 4 un �nnn 0112612021 12:29 4024260101 HOLSTEIN VET CLINIC PAGE 02102 VE�I�I� T� ICI BUT N(1 MORE Th1AN Failure to da Th I# shall be unlawful fc�r any dog NEW PET LI�ENSIN� Must b� NI=W RF'S1bENT5 TCl BLAIfi M �,1��1 R'Ei LI�FiVE TIN/AP'I�LIr�AiI�IN �F�II� +�I�"Y �F �LA��t, i_J,VE IN GLAIR CITY LIMITS ANa CJWfV A dOG(S) ANC1 /C�Et !*AT(�), N1!?LETE THIG FC3itM AND RETURN W1iH A GHEC1� PAYABLE Tc�: �� �LATFt — �1$ . i6T" 5�T — �L�ATR, NE C>I���$ MAY LEGALLY OWN A �OM��N,ATION C!F f'Ql1R (4) AdULT PETS, E (�) AL7t�LT BOGS OR THREE (�) ADULT CAT5 C�ER RESIDENTIAL C1R DWELLING UNIT'. �**P"IIEASE R.EA,a +�AFtEFULlY�"��' YOU ARE REQ.Uif;E� BY LAW TO LICENSE Y[IUR PETS. t vlgiatlon of City Ordin�ri�es 6,iQ3 and can'je� � penalty of a fine up #�x $150.00 per pek. PET LICENSE RENEW/aL5 ARE DUE i3Y � 15 2021. �y shill recognize � microchip la number �s the license numka�r. �t to wear any License ar ath��r ril:y ID other than that Issued �►y the City of Blair for such slag or cat. 5nse+d within �.0 days cif ownership (�R} �t � months ttf age if R#+ppy a>' kitten regi�Cel' pets within �.() days of residency �7wvn�r�N�m� ! Kr�ndlr� Paw�r'B f pause � �t�n j +�5� N i�tit �t���t i +Dwr��lr A,ddresB �i�y/��tr�t+�/zrp � Blair,, NE 6�Ota#� Rhan� � ., j 4��-���-4$4� � . # Or ��g I i . >P�+at Namc: H�trnut Agra: 3Y E�re��i: pit Bull Microchip � '�815►14 FtABIE� VA���NATIr�]N R�I�i�� D�scriptic�;nr t��uter�d Male ENE �M 0$-��-�,g 1 YF�1t� � �1�+�in V�, ,xin�ry l��i� ,dr. Lisa Scttrcrm L?�1,t1� :',I�r ICrista H'olst�r`r� pVM 7�.� Sc�utY� 19th , r��i �I�ir, NE ��t�0� 4t��-4��-7��7!;4C���426-4��� Fax hc�ls��incliricgrr�ail.�+�tr� �afor: Whi#�/�+'$Y Raai�es� Tag � ����7 � YEAR FAXED 01-�6-2�. �Y L1��N�E FEES lntaet Dvg �r Cat: 16.t�Q „,�"�Alt�r��! , C�c� cr gat: ��. �� Tcrt2�1 , �`� o\� � o� City of Blair, 218 S. 16t�' St, Blair, NE 68008 �a° (402) 426-4191 Fax (402) 426-4195 __ ,at � promise www.blairnebraska.or� NOTICE POTENTIALLY DANGEROUS DOG DECLARATION NOTICE DATE: October 19, 2020 Effective date of Declaration: October 30, 2020 TO: Kendra Powers 854 N 16th St. Blair, NE 68008 Pursuant to City of Blair Municipal Code 6-128 the following animals) has been declared a Potentially Dangerous Dog: Helmut —Pit Bull ` �, ! � 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. 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. Kendra Powers October 19, 2020 i'/� Page 2 .�� � � 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 spayin� 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 if 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 a�°e only offered eveNy 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 successfil completion.) NOTE: A copy of the verification letter must be provided to the City. You have a right to appeal this declaration 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 beheld 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 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 Blai1, Attu: Brenda Wheeler, CitSr Clerk, 213 S. 16t1i Street, Blair, NE 60008, 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 Recldess 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 animals) and Kendra Powers October 19, 2020 Page 3 you will be required to surrender the animals) 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 Potentially Dangerous Dog may be found in Section 6-128. The procedure for determination of a Reckless Owner may be found in Section 6-138. BRENDA WHEELER, CITY CLERK CITY OF BLAIR, NEBRASKA �� �.�l�ii������� else of d DATE LETTER PREPARED: October 19, 2020 I have received a letter addressed to: Kendra Powers 854 N 16th St. Blair, NE 68008 RE: Helmut —Potentially Dangerous Dog Signature of person receiving letter �� Printed name of person receiving letter Signature of person aeiivering letter �� / , 2..��- ,1 Date --------------------------------------------------------------------------------------------------------------------- 218 S 16th Street •Blair, Nebraska 68008 •402.426.4191 •FAX 402.426.4195 • E-mail: cityofblair@blairnebraska.org ,O�c 'F fir � , , � t .�;� lair ®lice epaen� =„'� ��€�: i73 Lint®ln Street e R� f7 lairs �� ,� �. 6, .,. ,. �®seph sager (( �®���26�'���� (fax) phi®f ®f P®lice � � �('v1 i � b I a � r r e � to 5 �d ` � r� www.blairiaolice.org �nin�al �arantine ®���� Owner: �� �U t `� �� W � � S BPD Incident Report #: 2G� 6 0� 0 � Sd � Animal's Name: �.�� `� � Description: �/ Cat Breed: u �^�� 6'� ,� Date of Bite: � � 1 � 5 ao �.a In accordance with Blair Municipal Ordinance: 6-119(2) the owner of the above -described animal agrees to: �.. Ensure that the animal will not be removed from or leave the premises for a minimum of �.0 days from the above listed date;, 2. The animal will not be allowed to have contact with other persons or animals; 3. If the animal displays symptoms of any illness, it shall be transported to and treated by a licensed doctor of veterinary medicine immediately; 4. The owner agrees to permit observation and examination of the animal by a doctor of veterinary medicine and Animal Control, both during and at the completion of the quarantine period to insure compliance with this order; 5. In the event the owner violates the conditions of this Quarantine Order, the animal shall immediately be seized by Blair Animal Control or the Blair Police Department and placed in the Blair Animal Shelter for no less than 10 days; and, 6. The cost of any examination, care and/or boarding by a licensed veterinarian or the Blair Anima( Shelter shall be borne by the owner. I agree to the conditions of this Quarantine Order: Owner Signature: � `' � Date: 0 S `�o a.b To be eornpleted after Quarantia�e period ®xpires: Veterinarian: �►s� �r!s�t� Examination Date: �D�"/ `�/`Z-c� Condition of Animal: Integrity Service Vigilance- � Excellence � Respect Incident ID: 20200000500 Page: 4 Narratives Narrative Title BLAIR POLICE DEPARTMENT Incident Data Sheet Report Narrative The dog "Helmat" was seen on 10/14/2020. The dog was neurologically normal. ORI Number: Printed On: Created On Created By Updated On Updated By 10/16/2020 08:45 BGUNbBRSON 10/16/2020 08:45 BGUNDERSON NB0890100 10/16l2020 09:53 (Fri) ❑Locked r i , ') 11 � i • � � 1 is ,. _�> .�. - • •• To: Rod Storm, City Administrator From: Joseph Lager, Chief of Police Date: October, 6 2020 Subject: Potentially Dangerous Dog Designation Mr. Storm, 402-426-4747 (office) 402-426-7144 (fax) www.blairpolice.org On October, 5 2020 our department investigated a report of a dog bite at 854 N 16 St in Blair (BPD Incident Report #20200000500). Through our investigation we learned that the incident was unprovoked. It is our determination that the animal, "Helmut", owned by Kendra Powers of Blair, NE is Potentially Dangerous Dog as defined by Blair Municipal Ordinance 6-125(3)(a)(1). "Potentially Dangerous dog" shall be defined as one who meets one or more of the following conditions: a. Any dog that, when unprovoked: 1. Inflicts an injury on a human that does not require medical treatment, or injures a domestic animals) either on public or private property; or, 2. Chases or approaches a person upon streets, sidewalks, or any public grounds in a menacing fashion or apparent attitude of attack; or, 3. Any specific dog with a known propensity, tendency, or disposition to attack when unprovoked, to cause injury, or to threaten the safety of humans or domestic animal(s). The Blair Police Department respectfully requests that this dog be designated as a Potentially Dangerous Dog. Respectfully Submitted, Joseph M. Lager Chief of Police Integrity • Service Vigilance • Excellence • Respect BLAIR POLICE DEPARTMENT Incident ID: 20200000500 Incident Data Sheet Report ORI Number: NB0890100 Panay 1 Printed On: 10/7/2020 10;21 (Wed) Incident ID; 20200000500 Offense Code: AC/DoglCat Bite (80P) Occurred Address: 854 N 16 ST BLAIR, NB 68008 District: BLPD Post: Source: Log#: File#: Case#: Situation Found: Animals, Alt Other Dis osition: ACTIVB p Date Reported: 10/5/2020 16:40 Disp Date: 10/S/2020 16:40 Date Occurred: 10/5/2020 14:30 TO 10/5/2020 14:30 Case Status: ACTIVE Status Date: 10(5/2020 16:40 Shooting: ❑ Domestic Violence; ❑ Hate Crime: ❑ Foilow-Up: ❑ Reclassify; ❑ Date Approved By Supervisor: 10/7/2020 08:22 Supervising Officer: THALLAS, AMY # 1195 Division: Reporting Officer: BYRNE, THOMAS # 1160 Date Assigned To Investigator: Investigator Assigned: Rem arks 1730 LINCOLN ST cFs#: Disp Recd: Dispatched: Arrived: Cleared: CFS#; Disp Recd: Dispatched: Arrived: Cleared; Dispatcher; zo2ooao059s2 10/5/2020 16:40 10/5/2020 16:40 10/5/2020 16:40 10/5/2020 17:23 TORI SWAN 202000005982 10/5/202016:40 10/51202016:40 1015/2020 16:40 10/5/2020 17:23 TORT SWAN Call Codes: ANIMAL PROBLEM•DOMESTIC Call Codes; ANIMAL PROBLEM -DOMESTIC c�tricers Division: Unit Officers) THOMAS DAVID BYRNE Supervisor: AMY THALLAS BLAIR POLICE DEPARTMENT Incident ID: 20200000500 Incident Data Sheet Report ORI Number: N130890100 Page: 2 Primed on: 10/7/2020 10:21 (Wed) r*I.�,.�,rAni,e Infnrm�tinn UIGQAQII\,G ,u,v„Ilu�w�� Clearance Date Incident Reference Cleared By Clearance Type 20200000500 Not Applicable Incident ID; 20200000500 Page: 3 A c•�nni�#nr�l IVamc�¢ BLAIR POLICE DEPARTMENT Incident Data Sheet Report ORI Number; Nso8soloo Printed On: 10/7/2020 10:21 (Wed) ,r1�7 �7V VAN 4�.rN ■wa.i•a... involved �. Vlct/Susp Rel: Name: ANDERSEN, JOAN R DOB 10/14/1934 Age/Time: 85 Juv: Sex: F SSN: Race: White Home Phone: (402) 426-8104 Work Phone: Other Phone: Arrest# FBI: SBI: State Appr Appr By: Charges: Circumstance: Visitor: ❑ Military: ❑ Police Dept Associate: ❑ Justif. Homicide: Follow -Up: Weap: Reasons for Treatment: Treated: ❑ Voluntary: ❑ Injured: ❑ Hospital: Physician: Transported By. Confined: ❑ Refused Admission: ❑ Sent Home: Condition: Other Action: Injuries Blood Test: ❑ Refused Test: ❑ 7est Results: Breath Test: ❑ Drivers License State: NE Expiration: Number: G29010215 Clothing: Primary Address: 750 N 16 ST BLAIR, NE 68008 Primary Mailing: Second Address; Second Mailing: Advice of Victims Rights Provided❑ How Notified Comment: Employer Occupation Phone Number Employed From Employed To ' � � BLAIR POLICE DEPARTMENT Incident ID: 20200000500 Incident Data Sheet Report ORI Number: NB0890100 Page: 4 Printed On: 10/7/2020 10:21 (Wed) Associated Names Animal Owner Vict/Susp Rel: Name: POWERS, KENDRA JANINE DOB 7/11/1976 Age/Time: 44 Juv; N Sex: F SSN: Race; White Home Phone: (402) 426.4805 Work Phone: Other Phone: Arrest# FBI: I SBI: State Appr Appr By: Charges: Circumstance: Visitor: ❑ Military: ❑ Polfce Dept Associate: ❑ Justif, Homicide: Follow -Up. Weap: Injured: ❑ Reasons for Treatment: Treated: ❑ Voluntary: ❑ Hospital; Physician: Transported By: Confined: ❑ Refused Admission: ❑ Sent Home: ❑ Condition: Other Action: Injuries Breath Test: ❑ Blood Test: ❑ Refused Test; ❑ Test Results: Drivers License State: NE Expiration: 7/11/2021 12:00 Number: H12546621 Clothing; Primary Address: 854 N 16 ST BLAIR, NE 68008 Primary Mailing: Second Address: Second Mailing: Advice of Victims Rights Provided❑ How Notified Comment: Employer Occupation Phone Number Employed From Employed To Incident ID; 20200000500 Page: 5 r — ,h � y B�A1R POLICE DEPARTMENT Incident Data Sheet Report ORI Number: NB0890100 Printed on: 10/7/2020 10:21 (Wed) Hssocla>c�u wa���ca Animal Owner VicdSusp Rel: Name: CURTIS, BRIDGETT L DOB 4/711982 Age/Time: 38 Juv: N Sex: F SSN: Race: White Home Phone: (402) 350-6694 Work Phone: Other Phone: Arrest# FBI. SBI: State Appr Appr By: Charges: Circumstance: Visitor: ❑ Military: ❑ Police Dept Associate: ❑ Justif, Homicide: Follow -Up: Weap: Treated: ❑ Voluntary: ❑ Injured: ❑ Reasons for Treatment; Hospital: Physician: Transported By: Confined: ❑ Refused Admission: ❑ Sent Home: ❑ Condition: Other Action: Injuries Breath Test: ❑ Blood Test: ❑ Refused Test: ❑ Test Results: Drivers License State; NE Expiration: Number: H13531868 Clothing: Primary Address: 750 N 16 ST BLAIR, NE 68008 Primary Mailing: Second Address: Second Mailing: n a.;...,. ,.F\/in+imc Rinhfs PrnVIrlPdn HOW NOtlfled ___ comment: Employer Occupation Phone Number Employed From Employed To � Associated Businesses Arrests Expunged Arrests Juvenile Contacts Expunged Juvenile Contacts Vehicles Incident ID: 20200000500 Page: 6 Stolen Vehicles Property Evidence/Custodial Citations Ticket# Date _ �_,, I BLAIR POLICE DEPARTMENT Incident Data Sheet Report Ordinance Amount ORI Number: NB0890100 Printed On: 10/7/2020 10;21 (Wed) Officer =field IntervNews Field Interview # Date/Time Occurred Action Taken Tvpe Vehicle Plate Vehicle VIN Accidents Report Number Date Description Suspects (Unknown Victim to Suspect Relationships Victim # Victim Name Suspect # Suspect Name Drugs Incident ID: 20200000500 Page: 7 il�F�ns�c*n (*nrinc ' '� � � BLAIR POLICE DEPARTMENT Incident Data Sheet Report ORI Number: NBOII90100 Printed On: 10/7/2020 10:21 (Wed) V ■�v■ aVv .+.. ...�� Code: AC/Dog/Cat Bite Rank: Attempt Completed Dom Violence: Date Occurred (FROM ): 10/5/2020 14:30 Date Occurred (TO ): 10/5/2020 14:30 Date Reported: 10/5/2020 16:40 Code Section: Bias; None Statute: Location: Residence/Home Finai Location: Rape Location: Entry Type: Entry Area; Instrument Used; # Premises Entered: Entry Method: Entry Point 1: Entry Point 2: Exit Point 1: Exit Point Method Of Exit; Area Target: Property Target 1: Property Target 2: Property Target 3: Victim Target: Time Of Day: Circumstance: Security 1; Security 2: Weapon 1: (Automatic: Weapon 2: Automatic: Weapon 3: Automatic: Criminal Act 1: Criminal Act 2: Criminal Act 3: Suspected Use 1: Not Applicable Suspected Use 2: Suspected Use 3; Susp. Action to Prem. 1: Susp. Action to Prem, 2: Susp. Action to Prem. 3: Susp. Action on Vict. Susp, Action on Vict. 2: Susp. Action on Vict. 3: Susp, Other Action 1: Susp, Other Action 2: Susp. Other Action 3: Susp. Solicit/Offered 1: Susp, Solicit/Offered 2: Susp, SolicitlOffered 3: Victim Use 1: Victim Use 2: Victim Use 3; Victim Activity, Vehicle Locked: Victim Condition: Keys in Ignition: Precip. Circumstance: #Louvers Removed; Photographed: usting: Arson: Identity Theft: Remarks: Workflow Action Approval Logged On 1015/2020 16:55 Logged ev XMLCADToRMS Incident ID; 20200000500 Page: 8 {mages Description 'LUNA' NECK INJURY Description 'HELMUT' BLAIR POLICE DEPARTMENT incident Data Sheet Reporfi Description 'LUNA' HEAD INJURY Description 'HELMUT' Description 'HELMUT' MOUTH INJURY ORI Number: NBOII90100 Printed On: 10/7/2020 10;21 (Wed) Description 'LUNA' EYE INJURY Description 'HELMUT' Description HOLE IN FENCE OF 854 N 16 ST Incident Supplement Incident ID: 20200000500 Page: 9 Officer Hours BLAIR POLNCE DEPARTMENT Inc[denfi Data Sheet Report ORI Number: NB0890100 Printed On: 10/7/2020 10:21 (Wed) 5 ; )� BLAIR POLICE DEPARTMENT Incident ID; zoz0000050o Incident Data Sheet Report ORI Number; Nsossoloo Page: 10 Printed On: 10/7/2020 10:21 (Wed) Narratives Narrative Title ❑Locked Narrative On 10/OS/2020 I was working uniform patrol for the Blair Police Department driving unit 118. At approximately 1640 hours i met with a female party in the vestibule of the police department. The female, who identified herself as Bridgett L. Curtis (DOB; 04/07/1982), said that she needed to report a dog bite. Curtis explained that while she was at work, her grandmother Joan R. Andersen (DOB: 10/14/1934) had taken Curtis' female 10 year old chug (chihuahua/pug}'Luna' for a walk near their residence at 750 N 16 St. When Andersen walked through the alley to the east of N 16 St, a large dog escaped from the backyard of the residence of 854 N 16 St and attacked 'Luna'. Curtis said that a nearby worker had to come assist Andersen in getting 'Luna' head out of the dogs mouth and putting it back in its yard, resorting to kicking the dog to get it to let go. Curtis was notified by Andersen and came home to take 'Luna' to the vet at Thone Animal Clinic. Curtis also said that the dog is licensed in the city of Blair. I followed up at Thone Animal Clinic and obtained several photos of'Luna' and her injuries. The injuries consisted of a puncture wound on the top of the dogs head, a small puncture wound on the right side of the dogs neck, and an injury to the dogs right eye. After obtaining photos, I spoke with Dr. Kamala Preeman at the clinic who provided mare information about the injuries. She said she believed the dog will live and recover. She said that the dogs eye concerned her because of possible muscle damage from her head being bitten by the other dog, She believed the eye will not need to be removed but that the dog will likely have permanent eye damage. I followed up at the residence of Curtis and Andersen where I spoke with Andersen about the incident, Andersen said that she had taken 'Luna' on a walk up N 16 St to Adams St. She then walked to the alley directly east of N 16 St and walked back south through the alley toward her house. As she got to the backyard of 854 N 16 St, a large black dog crawled out from a hole in the chain link fence and attacked 'Luna'. Andersen estimated she screamed for help for five minutes before a man who had been cutting a tree nearby came to help. The man helped get the black dog to release 'Luna' and attempted to get the dog back in the yard, but it kept coming at them. Andersen said the man had to kick the dog in the head to get it to leave. Curtis also provided the medical history form for'Luna', which is included in the report, I followed up at 854 N 16 St and spoke with Kendra 1. Powers (DOB; 07/11/1976) in her front yard. When 1 told Powers why I was there she looked surprised and said she had no idea the incident had occurred. Powers said she had been home during the time frame of the incident but didn't think anything of it because her dogs bark all the time when someone walks by, I explained to Powers the details of the incident and she was immediately apologetic. I said that I would need to photograph her dog and issue a quarantine order. She went inside and returned with her dog 'Helmut', a male 2 year old pit bull. 'Helmut' is mostly black with some white fur throughout and is quite a large dog. 'Helmut' was not aggressive toward me and did not bark as I photographed him, I mentioned that'Helmut' was kicked by the man who assisted in getting him to release the other dog and Powers mentioned that she wondered where the mark on his lip came from. I photographed the small abrasion on the dogs upper lip. I read and issued Powers an animal quarantine order and asked if I could inspect her backyard fence to see where 'Helmut' escaped from, In the southeast corner of the chain link fenced backyard was a section offence approximately 1.5 feet wide that had been pulled up and the dirt dug out where 'Helmut' likely crawled out. Powers said she had not noticed the fence and would immediately fix it to prevent future escapes. I photographed the fence and asked Powers if she could email her dogs veterinarian information to me. I also asked if her dogs were licensed with the city of Blair and she said they are not. I told her she would have to get that done soon. After Powers emailed me the veterinarian information, she also mentioned that she felt sorry for the incident and wanted to get in contact with the owner of the other dog to apologize and offer to pay the vet bill. I explained the proper procedures in obtaining that information through the police department. I request this case be forwarded to ACO Gunderson for further follow up and investigation. Created On Created By Updated On Updated By 10/7i2020 08:22 TBYRNE 10/7/2020 08;22 TBYRNE � � � �� BLAIR POLICE DEPARTMENT Incident ID: 20200000500 Incident Data Sheet Report ORI Number: N130890100 Page: 3 Printed on; 10/8/2020 14:04 (Thu) Narratives Narrative Title ❑Locked Narrative On 10/06/2020 I was informed Kendra wanted to tall<to me. I called her cell (402-427-3214) and spoke to her about the dog bite. She informed me she wanted to help with the vet bills the other owner may have incurred. 1 told her I would contact them and give them her name and number. I told herthat was between them. She then asked me several questions about what would take place now. I informed her that I have not seen the report yet. I told her depending on what happened the dog may be declared potentially dangerous or dangerous. If that happened, she would receive a letter from the city declaring that. She also asked if her dog was considered at large. I told her it was because it was not confined in the back yard and was "at large". I told her that I did not see any city license for the dog. She told me she Just had licensed both dogs today at the vet. I then told her about the pit bull ordinance the city had. I told her the city dose not ban them, but there were specific ordinance pertaining to pit bull breeds. I also told her at the end of the quarantine period the dog had to be seen by a vet. She told me she had already set up an appointment for that. I let her know if she had any more question to give me a call. Created On Created i3y Updated On Updated ay 10/8/2020 08:53 BGUNDERSON 10/8/2020 08:53 BGUNDERSON 1@!@612@2@ 12:00 402426@101 HOLSTEIN VET CLINIC PAGE 01/02 ��,� P"ET' LI�EN�E vE�.IEI�A,iIt�'IV%AP'E'LI�Ai�t�N ��. r�IT'� �+� �LAIt� IF YOU LIVE IlV pLgIR CITY LIMITS AND t7WN A DOGS) ANt� /QR CAT(), CpMPLETE iHz� FORM ANCJ RETUT;<N wITH A GHEC(� PAYA6LE Tt?: CITY' �� �3LAIR ®218 �. 1��iT" ST - FLAIR, N� +��$�$ YaU MAY �,E�ALLY +r1WN A COMBINATIQN Oi= FOUR (4) ADULT PETS; 8UY NQ MDRE THAN 'THREE (3) AC�tJL,T D065 OCt THREE (3) ADULT CATS PER l�ESICI�NTIAL �?R bWELLING UNIT. ***PLEASE Ft£AD rvARESULLY*'�* YOU y1,R� R�OUIRECI BY LAW TO L[CEt�SF YC7UR PETS. Failure tq Rio so is a violation oi' City Ordinantes 6.103 and �atrles a penalty Qf � fili7e up to $1�Q,�� Per pet. pET LI+C�N�E RENEWALS ARE DUE BY 3 i5 zaza. Thy city shall ro�4gnize a mi�rc��hip I[� r�umt��r as tho Ilcens� number. !t shall be unlawful for any dog or cat to wear any license or r�i;her city ID ether than that iasu�d by the Lity of Blair for such �IQg ar cat. NEW PET LlCEN�IN� Mu$t be license{ within �Q d�y� of ownership �oR) at 6 rr�c�nth$ of a�� ii• puppy or kitten NEW F{£.�IDENT� Try GLAIR Must regist�l' pets within �,Q days of rtsiti�ncy �iwrlf�r N�ilx�+� Sp��u�� �wni�r A�#�r��S Ci#�yJ�tat�jz�� PF��t�� # ��nt�r�! P'�w�r� lE��n �54 i� i�th �tr�s�t flair, N� r�+$t30� 40�-4�f -4��a PET # o-� -- ��# Name: H�Irnut ' Agee ��' t��la� �Ii-iX�1�3 ��e�r: N+�ut+�IrC�I Ma1+� C�plor: Whig/+Gray �r�ad: Rlt R�tll >Qe�lar�d E�an+��r�uis/Patron#ially� aan+�er4�� t�a� Nt7 YES Mii�r+��ltlp # City 7"�ig # �-��.� Rabies Va��inatl�n C+at�� �. ..t, � c"� '�i >R.�bl�s Tag � 17157 Rabies Gtf���riptlan: 1, YEAS. Y A.R I��l�tei� `�T��eri��.x� �li�i pr. ,L�sa Schrui�I �iV.M & 1�r: Krisi;'tz .F�alstein l7VMI ��.+� �i�U�it ��th �'�C'E:�:� E�i�ifr•, NE �$��� 4(��-���-7�37 ��-4��-1��.t�1 Fix hQist�inciinic�gm�il.cQm lIEENSE EEE� lnta�t Dt�� or fat: ��.�►.Q(� Altered Qr gat: $i Repl�r�c�ment Tad �5.00l FAXEi� �Q-��-�Q BY TQTAL PACES �- 10/0612©20 12:00 �©242Pi01E�1 HOLSTEIN VET CLINIC PAGE 0�102 IF YOU LIVE IN BLATR CITY LIMITS AND OINN A aOG(S) ANb /OR CAT(G), C0MPLE71= THIS FORM ANa RETURN WITH A CHECK PAYAI�L� TQ: CITY �� BLAT%t �- ��.5 �. if�T" �'rT — B�LA��',, NE �>���� YOU MAY LE��I.LLY t7WN A irOMBINA710N OF FOUR (4) ADULT PEf�, B1J'{' CVO MORE THAN THREE �3) Aa1JLT BOGS 01� TfiREE (3) ADULT CATS PEEL RE�Ti�FNTIAL OR DWi=L4iNG UNIT. ***PLEASE READ �AREFULLY'�** . Yt�u ARE R[QUIRE� BY �Aw TO L(CEN�E YOUR PET5. FaEIUr� to do so is a vioiaCion of City Ordil�at�cea fi.103 and carrl4s a penalty of a flue up to $154.40 Fir pet. IyET LI�EiV$E REN�WAi.'� AR£ DUE BY 3 �5 2U2Q. The city shall recognize a mi�rQchip ii� number as the license r►umbt�r. It shill 6e unlawful fir any dog ar cat to wear any license or other city ID other than that i�suetl by fihe City of Blab far SU�h dog or cat. NEW PET LI�ENSiNta_Mu�t b� li�errsed within 1� days of ownership (OR} at � months �f age if puppy ar Mitten NEW RESIaENT.ST{� BLAIE� Must register pits wiChin 1Q day5+�f residency �'►tn►n+�r N�m+� ����r�E• �ivVn+�lr A�1dr�,�� pity/�t�t+�J�i� Ph�n� � C1L # �r a�� p�T # �'t` Pet Name: R'Wrt��kin Age. '9iY sex: �p��/+�d F�m�le �ree,ds B��*C�t li+t�unti >[�+'�+�iaired 1i�an�$r+ra�u�/F*ot� Micr+o�F>tip # lf���i!natCon Gate: R.�t�tes p►r��,cripti��t: i��n+dra P+�►wer� ��n ��� N 3.6tkr �tr�et �l��r, N� rra�i��� +Col�r� �.ed �ar>td 11Vhite Qangers�us Deg - N� I YES '�,... � l � -- Hc�l���in �T+����in�r��r lini� L?r. Lista �'�Izr•urn 1�VM � �7r. ,Krist<a Hpl.��ein D�VM 7�.� ���ath 1�th �tr��t �lairl N� ��3�}Cl8 402-4��-7��7 q,��.-4���-Ci�.��. ��K h0i�teil�l: iinic c�gm�il.�vrl� Clty Tad # �.abie�c Tag �' 1�72�. � YEAR. LICENSE F�E� ftttp��' Dt�� or hut: �1�.0t� '"� Alt+��'�e� pcsg ter cat: $; �5.0A0 Total � 1 � _ F�,xEa �O.�e-�� >�Y TOTAL PA�E� ,,,. INVOICE Holstein Vet Clinic 718 South 19th Street Blair, NE 68008 402-426-7387 Check out our new website! WWW.HOLSTEINVET.COM Printed: 11-04-20 at 8:56a FOR: Kendra Powers Date: 11-04-20 854 N 16th Street Account: 7083 Blair, NE 68008 Invoice: 113089 (402) 426-4805 Date For Qty Description Net Price 10-21-20 Helmut 1 Home Again (Microchip I.D.) 47.25 MICROCHIP NUMBER : 985141002844514 11-04-20 Mastercard payment -47.25 Old balance Charges Payments New balance 0.00 47.25 47.25 0.00 Reminders for: Helmut (Weight: 74.8 Ibs - 2y) Last done 08-05-22 Denfensor 3 (3 Year Rabies) 08-06-19 04-14-21 Vangard Plus 5 L4 04-14-20 04-14-21 Bronchi Shield -Oral Bordetel 04-14-20 Thanks for choosing us to take care of your pet's health care needs! ,_�, "` � .� �'. I V✓1 tti.'i' Holstein Vet Clinic 718 South 19th Street Blair, NE 68008 402-426-7387 Printed: 09-15-20 at 3:03p CLIENT INFORMATION Name Kendra Powers (7083) Address 854 N 16th Street Spouse Ben 81air, NE 68008 Phone 402 426-4805 Cell 402-427-3214 PATIENT INFORMATION Name Helmut Species Canine Sex Male, Neutered Breed Pit Bull Birthday 01-11-18 Age 2y ID Rabies 17157 Color White/Gray Weight 74.801bs Reminded (none) Codes Reminders for: Helmut Last done 08-05-22 Denfensor 3 (3 Year Rabies) 08-06-19 04-14-21 Vangard Plus 5 L4 04-14-20 04-14-21 Bronchi Shield -Oral Bordetel 04-14-20 Patient Chart ,. >.� �) . � . U. In a Patient History Resort Client: Curtis, Bridget (7650) patient: Luna (9977) Phone: (402) 719-8535 Species: Canine Breed: Chihuahua mix Address: 750 North 16th Age: 10 Yrs. 8 Mos. Sex: Spayed Female Blair, NE 68008 Color; Tan Date Type Staff History 2/4/2020 V HMG Feb 4, 2020 02: 17 PM Staff : HMG Weight 11.18 pounds 2/4/2020 B DEJ 1.00 Examination General (12) by HMG 2/4/2020 B DEJ 1.00 Distemper Hep Lep Parvo-Annual (86) by HMG 2/4/2020 B DEJ 1,00 Intranasal Borde#ellaiParainfluenza (INTRA) by HMG 2/3/2020 CK DEJ Vac Up -date -not on HW Rx Reason for Visit: Vaccinations Date Patienk Checked Out: Feb 04/2020 Practice 1 7/14/2018 C DEJ A Medical Notes -CLOSED Aug 13/2018 -Vaccinations (JGA) Physical exam normal, has no health concerns, D/H/LIP- SQ LF Lateral Shoulder 7/14/2018 V JGA Jul 14, 2018 10:28 AM Staff: JGA Weight 11.11 pounds 7/14/2018 B DEJ 1.00 Examination General (12) by HMG 7/14/2018 B DEJ 1.00 Distemper Hep Lep Parvo-Annual (86) by HMG 7/13/2018 CK DEJ Reason for Visit; Vaccinations Date Patient Checked Out; Jul 14/2018 Practice 1 2/9/2018 C SMM A Medical Notes -CLOSED Mar 1212018 -Back HOWGO (SM) Doing really well, Bridget says she has more herself in the past few days than she has been in weeks. She hasn't noticed any shaking or hunch. 2/6/2018 C DJM A Medical Notes -CLOSED Mar OS/2018 - Chiropractic Work (SM) Change dose: 1/4 Tramadol 1/4 pill every 12 hours, using Methocarbamol LPI, L4-L6 P, muscles tight in this region. Call in more Methocarbamol 500mg qty; 2--Give 1/4 tab every 12 hours for 3-5 days, Discussed laser therapy on lumbar HOWGO FRIDAY-Friday afternoon, shaking less? hunched less? CALL DR. MERTZ B:Billing, C:Med note, CB;CaII back, CK:Check-In, CM;Communtcatlons, D:Diagnosis, DH:Declinad to history, E:Examinailon, ES:Esilmates, I:Daparting instr, L:Lab result, M:Image cases, P:Prescrlption, PA:PVL Accepted, PB;problems, PP;PVL Pertormad, PR:PVL Recommended, R:Correspondence, T:Images, TC:Teniative medl note, V:Vilal signs Blair Small Animal Clinic PC Page 1 of 3 Date: 10/5/2020 4:42 PM kaA,jt*7YW CITY OF BLAIR - 2022 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 • 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 RENEW LS ARE DUE: M��a�� Owner Address: grch 15, 2022 V Owner Name: r i� "l �.p i / q J " f fSt city/state/zip: Blair, NE 68008 `► Phone # ,� " Q 27 ` 39 I LICENSE FEES: Dog or Cat: $16.00 Altered Dog 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 3/15/2022. 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. 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 PET # 1. W Dog ❑ Cat Spayed Ne tiered — License Fee $ Pet Na e � _ BirPhdate a I I ex � (- te Color & 4 Uy i ; A Breed** � Se Replacement $ ** Declared Dangerous or Potentially Dangerous Dog: ❑ Y 0 N MICROCHIP # (If applicable) SUBTOTAL: $ RABIES VACCINATION DATE: (3 yr) (1 yr) City Tag # A ,> PET # 2 J2f D o ❑ Cat I SpaIM red License Fee $ Pet Name Birthdate ex '�4-�-P Color Ala.&C �r Wh k Breed** Rep/acement m ** Declared Dangerous or Potentially Dangerous Dog: 0 Y ❑ N MICROCHIP # (If applicable) SUBTOTAL: $ 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 $ If you have questions, please contact Blair Police Department at (402) 426-4747 ++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ NEW PET/NEW RESIDENT LICENSING REQUIREMENTS (March 15/ate fee date not applicable fornewpets/newresidents) 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. Holstein Vet Clinic 718 South 19th Street Blair, NE 68008 402-426-7387 Printed: 03-01-22 at 2:21 p CLIENT INFORMATION Name Kendra Powers (7083) Address 854 N 16th Street Spouse Ben Blair, NE 68008 Phone 402 426-4805 Cell 402-427-3214 PATIENT INFORMATION Name Pumpkin Species Canine Sex Female, Spayed Breed Basset Hound Birthday 08-12-11 Age 10y ID Rabies 18961 Color Red and White Weight 51.00 Ibs Reminded (none) Codes Reminders for: Pumpkin Last done 03-04-24 Denfensor 3 (3 Year Rabies) 03-05-21 08-14-22 Bronchi Shield - Oral Bordetel 08-14-21 08-14-22 Heartworm Test & Prevention 08-14-21 03-05-22 Vangard Plus 5 L4 03-05-21 Patient Chart MEDICAL HISTORY - Vaccination View Date By Code Description Qty (Variance) Photo 09-15-20 LS 410009 Bronchi Shield - Oral Bordetella 03-05-21 LS 4RAB3 Defensor 3 { 3Y RABIES }, #18961 410002 Vanguard® Plus 5 L4 08-14-21 LS 410009 Vanguard® B ORAL { Bordetella } Holstein Vet Clinic 718 South 19th Street Blair, NE 68008 402-426-7387 Printed: 03-01-22 at 2:21p CLIENT INFORMATION Name Kendra Powers (7083) Address 854 N 16th Street Spouse Ben Blair, NE 68008 Phone 402 426-4805 Cell 402-427-3214 PATIENT INFORMATION Name Helmut Species Canine Sex Male, Neutered Breed Pit Bull Birthday 01-11-18 Age 4y ID 985141002844514 Rabies 17157 Color White/Gray Weight 76.90lbs Reminded (none) Codes Reminders for: Helmut Last done 08-14-22 Vangard Plus 5 L4 08-14-21 08-14-22 Bronchi Shield - Oral Bordetel 08-14-21 08-14-22 Heartworm Test & Prevention 08-14-21 08-05-22 Denfensor 3 (3 Year Rabies) 08-06-19 MEDICAL HISTORY - Vaccination View Date By Code Description Patient Chart Qty (Variance) Photo 04-19-19 LS 410009 Bronchi Shield - Oral Bordetella 410002 Vangard Plus 5 L4 08-06-19 LS 4RAB3 Defensor 3 (3 Year Rabies), #17157 04-14-20 KKH 410002 Vanguard Plus 5 L4 410009 Bronchi Shield - Oral Bordetella 08-14-21 LS 410002 Vanguard® Plus 5 L4 { Distemper+Lepto } 410009 Vanguard® B ORAL { Bordetella)