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2020-12-09 Buckley, RaymondC�9 � a), CITY OF BLAIR - 2023 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 a Blair, NE 68008 Y 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 150 2023 Owner Name; Owner Address: Wlt" city/state/zip; Blair, NE 68008 Phone # `-I('III)- (r, r-1)rl 16 LICENSE FEES: Dog or Cat: $16.00 Altered Dog or Catm. 4;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 3/15/2023. 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 reaulres proof of rabies vaccination to be submitted with your license application. 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 #'f C" Dog ❑ Cat ❑(Spayed%Neutered License Fee $ P , CSC; Pet Name lJ\s i Birthdate l►'4 Sex Color'Breed** Breed** ► c,L�, Replacement$ ** Declared Dangerous or Potentially Dangerous Dog: ❑ Y ®'N MICROCHIP # (If applicable) SUBTOTAL: $ , L OL RABIES VACCINATION DATE:(3 yr) (1 yr) City Tag # 1 PET #2 0 Dog ❑ Cat ❑ Spayed/K�e6 er License Fee $ 60 Pet Name &\c/—, Birthdate Sex t ** Color C�+ c,J� Breed** Replacement $ Declared Dangerous or Potentially Dangerous Dog: ❑ Y ❑ N MICROCHIP # (If applicable SUBTOTAL: $ C1. , C0 RABIES VACCINATION DATE: t - 3 ^ 2 o � (3 yr) (1 yr) City Tag # � 1 * PET #3 , ❑ Dog ❑ Cat ❑ Spayed/Neutered Pet Name Birthdate Sex — Color Breed** Declared Dangerous or Potentially Dangerous Dog: ❑ Y ❑ N MICROCHIP # (If applicable) RABIES VACCINATION DATE: (3 yr) License Fee $ Replacement $ SUBTOTAL; $ (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 $ ,-9),00 If you have questions, please contact Blair Police Department at (402) 426-4747 +++++++...........+++++++++.++.....++++++...........++++.++.++......k.++.*... NEW PET/ NEW RESIDENT LICENSING REQUIREMENTS (March 15/ate fee date notappllcable fornewpetylnewre5ldenis) Newly Acquired Pets; New Residents to Blair: ■ Must be lioensed within 10 days of ownership ■ Must register pets within 10 days of - ■ <OR> at 6 months of age If puppy/kitten residency, Date of Rabies Vaccination: 12-03-20 Next Rabies Vaccination On: 12-03-23 VETERINARY CLINIC Countryside Small Animal 1306 Stevenson Fort Calhoun, NE 68023 402-468-4060 This is to certify... Certificate No: 0 Previous Rabies Vaccination: OWNER OF ANIMAL y a 10 g.-)- Blair, NE !� County: yo '- �, cl- 1�4�f�►u� THAT 1 HAVE VACCINATED AGAINST RABIES THE ANIMAL DESCRIBED BELOW. Patient information... PATIENT: Zeke SPECIES: Canine SEX: M BREED: Boxer Color and markings... Tan and White Signed Kaycee Points Vaccinations done... TAG NO: 20-0969 WEIGHT: 72,50 AGE: 3 years Microchip Number: License: 12-03-20 KNP Canine Rabies Vaccn, 3 yr, #20-0969 12-03-23 12-03-20 KNP Canine DA2PPL 12-03-21 09-21-19 KNP Canine Rabies Vaccn, 1 yr, #19-0936 Rabies Vaccine Information... MFG BY: ZOET SER.NO: 367269B LOT EXP: 02FEB21 ADM: Sq State Fenn Fire and Casualty Company A Stock Company With Home Offices in Bloomington, Illinois Po Box 853907 Richardson, 7X75085-3907 AT1 H-06-9CBE-FB2D F HW 3201 BUCKLEY, RAYMOND 940 N 27TH 5T BLAIR NE 68008-1013 HOMEOWNERS POLICY Location of Residence Premises 940 N 27TH ST BLAIR NE 68008-1013 Construction: Frame Year Built: 1977 DECLARATIONS AMENDED NOV 4 2021 AMOUNT DUE None Payment is dRie by T€1 BE PAID BY MORTGAGEE Policy Number: 27-135-1-694-6 Policy Period: 12 Months Effective Dates: SEP 28 2021 to SEP 28 2022 The policy period begins and ends at 12:01 am standard time atthe residence premises. Your State Farm Agent PELESKA INSURANCE AGCY INC 1829 WASHINGTON ST BLAIR NE 68008-1561 Phone: (402) 426-2320 Roof Material: Composition Shingle Roof Installation Year: 2014 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- holder written notice in compliance with the policy provisions or as required by law. IMPORTANT MESSAGES Your policy is amended NOV 4 2021 INSURED NAME AND/OR ADDRESS CHANGE Endorsement Premium NONE Your premium has already been adjusted by the following. Home/Auto Claim Record Loyal Customer Prepared NOV052021 Page 1 of 3 Un IA— ^StateFarw NAMED INSURED MORTGAGEE AND ADDITIONAL INTERESTS BUCKLEY, RAYMOND FM�ort�jageee � g a q Nutt MORTGAGEOAN DE�ARTMNTA O$2093126er: OMAHA NE 68197 0002 166 SECTION I - PROPERPI PROPERCDYLBABLS AND LIMITS Coverage Limit of Liability A Dwelling $ 167,000 Other Structures $ 16,700 B Personal Property $ 125,250 C Loss of Use $ 50,100 Additional Coverages $1,000 Arson Reward 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 SECTION 11- LIABILITY COVERAGES AND LIMITS Coverage Limit of Liability L Personal Liability (Each Occurrence) $ 100,000 Damage to the Property of Others $ 1,000 M Medical Payments to Others (Each Person) $ 1,000 Inflation Coverage Index: 322.7 Section I Deductible Deductible Amount All Losses 1 % $ 1,670 LUSS SETTLEMENT PROVISIONS Al Replacement Cost - Similar Construction B1 Limited Replacement Cost - Coverage B UA - ^StateFartn 27-65-L694.6 , FORMS, tiMONS, AND ENDORSEMENTS HW -2127 Homeowners Policy HO -2288 Ho Amendatory Endorsement HO -2356 Amendatory End - Liability HO -2444.2 Back -Up Of Sewer Or Drain - 10% of Coverage A/$ 16,700 Option JF Jewelry and Furs $1,500 Each Article/$2,500 Aggregate Option ID Increase Dwlg Up to $ 33,400 Option OL Ordinance/Law 10'/0/$ 16,700 Other limits and exclusions may apply - refer to your policy Your policy consists of these Declarations, the Homeowners Policy shown above, and any other forms and endorsements that apply, including those shown above as well as those issued subsequent to the issuance of this policy. This policy is issued by the State Farm Fire and Casualty Company. 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 policyto be signed by its President and Secretary atBloomington, Illinois. Secretaiy � President Prepared NOV052021 Page 3 o 3 un Donn '2I'', 12U20 CUSS. 4 X0392 Date of Rabies Vaccination: 12-03-20 Certificate No: 0 Next Rabies Vaccination On: 12-03-23 Previous Rabies Vaccination: VETERINARY CLINIC0,(, OWNER OF ANIMAL Countryside Small Animal ��W16VI Danielle Buckley 1306 Stevenson �j� � 2233 Colfax Fort Calhoun, NE 68023 Blair, NE 402-468-4060 County: This is to certify... THAT I HAVE VACCINATED AGAINST RABIES THE ANIMAL DESCRIBED BELOW. Patient information... PATIENT: Zeke TAG NO: 20-0969 SPECIES: Canine WEIGHT: 72.50 SEX: M AGE: 22 months BREED: Boxer Microchip Number: Color and markings... Tan and White Signed Kaycee Points License: Vaccinations done... 12-03-20 KNP Canine Rabies Vaccn, 3 yr, #20-0969 12-03-23 12-03-20 KNP Canine DA2PPL 12-03-21 09-21-19 KNP Canine Rabies Vaccn, 1 yr, #19-0936 Rabies Vaccine Information... MFG BY: ZOET SER.NO: 367269B LOT EXP: 02FEB21 ADM: Sq Owner Information NAME — ADDRESS CITY � ��� �. CELL PHONE (required) STATE t�K IiAICROCHIP FORAM DATE I Pkl APT ZIP ,, In case we cannot contact you, please list as many alternate phone numbers as possible. This gives your pet the best chance of being reunited with you! ALTERNATE PHONE #1 EMAIL ADDRESS (required) important Notices You will receive an email to t into your name. You must provide a valid email. Pet #1 Information NAME .w AGE Female BREED PHONE #2 emailed listed above directing you to transfer the microchip Altered? FDX8 ISO 11784 & 11785 932001000661915 Cat Pet #2 Information Place Sticker Here Reuniting lost or stolen pets with their owners is a top priority at the Jeanette Hunt Blair Animal Shelter. In addition to standard identification tags worn on a collar, we strongly recommend that your pet be permanently identified with a microchip. A microchip is the size of a grain of rice, and is implanted between the animal's shoulder blades. The microchip is encoded with a one -of -a -kind number that will be kept on file at the Jeanette Hunt Blair Animal Shelter and also registered in a national database at no additional cost to you. Once a lost pet arrives at an animal shelter or veterinary clinic, a handheld scanner is used to identify the unique number on the implanted microchip and the owner is identified and contacted. The implantation procedure takes only a few seconds and is relatively painless to the animal. Pets of all species, breeds and ages can be microchipped. A microchip is not a tracking device or a GPS transmitting device. Animals with microchips cannot be tracked or monitored from a remote location. JHAS offers chip implantation and registration for $25. I hereby authorize and direct the Jeanette Hunt Blair Animal Shelter to implant a microchip in my pet listed above. I fully release the Jeanette Hunt Blair Animal Shelter, its employees, and its agents from any legal and financial responsibilities, claims, demands, damages or actions arising from microchipping. L)t signature Date © o 0 m rLn 0 Lo -+ o a� v Z U w ar State Farm Fire and Casualty Company A Stock Company With Home Owes in Bloomington, Illinois Po Box 853907 Richardson, TX75085-3907 AT1 H-06-906E-FB2D F HW 3201 BUCKLEY, RAYMOND & DANIELLE 2233 COLFAX ST BLAIR NE 68008-1821 HOMEOWNERS POLICY Location of Residence Premises 2233 COLFAX ST BLAIR NE 68008-1821 DECLARATIONS AMENDED MAY 27 2020 AMOUNT DUE: None Payment is due by None Policy Number: 27-130-11338-6 Policy Period: 12 Months Effective Dates: JUN 19 2020 to JUN 19 2021 The policy period begins and ends at 12:01 am standard time at the residence premises. Your State Farm Agent PELESKA INSURANCE AGCY INC 1829 WASHINGTON ST BLAIR NE 68008-1561 Phone: (402) 426-2320 Construction: Frame Roof Material: Composition Shingle Year Built: 1966 Roof Installation Year: 2020 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- holder written notice in compliance with the policy provisions or as required by law. V1101 liffillit hl:K'1:TO Your policy is amended MAY 27 2020 PREMIUM ADJUSTMENT Other items shown are effective with the policy's 2020 renewal PREMIUM Endorsement Premium DECREASE $ 486.98 Your premium has already been adjusted by the following: Hail Resistive Roof Home/Auto Prepared JUN302020 Page 1 of 3 un Donn NAMED INSURED MORTGAGEE AND ADDITIONAL INTERESTS BUCKLEY, RAYMOND & DANIELLE Mortgagee FIRST NATIONAL BANK OF OMAHA Loan Number: ITS SUCCESSORS AND/OR ASSIGNS N/A 1620 DODGE ST STOP 3166 OMAHA NE 68197-0002 Coverage Limit of Liability A Dwelling $ 170,700 Other Structures $ 17,070 B Personal Property $ 128,025 C Loss of Use $ 51,210 Additional Coverages Arson Reward Credit Card, Bank Fund Transfer Card, Forgery, and Counterfeit Money Debris Removal Fire Department Service Charge Fuel Oil Release Locks and Remote Devices Trees, Shrubs, and Landscaping AMA ILI]1: In 1 IAA IIIII $1,000 $1,000 Additional 5% available/$1,000 tree debris $500 per occurrence $10,000 $1,000 5% of Coverage A amount/$750 per item Coverage Limit of Liability L Personal Liability (Each Occurrence) $ 100,000 Damage to the Property of Others $ 1,000 M Medical Payments to Others (Each Person) $ 1,000 INFLATION Inflation Coverage Index: 257.4 DEDUCTIBLES Section I Deductible Deductible Amount All Losses 1/2% $1,000 LOSS SETTLEMENT PROVISIONS Al Replacement Cost - Similar Construction B1 Limited Replacement Cost - Coverage B un onnn J%StateFa 27-BO-0338-6 r FORMS, OPTIONS, AND ENDORSEMENTS HW -2127 Homeowners Policy HO -2444 Back -Up Of Sewer Or Drain - 10% of Coverage A/$ 17,070 HO -2288 Ho Amendatory Endorsement Option JF Jewelry and Furs $1,500 Each Article/$2,500 Aggregate Option ID Increase Dwlg Up to $ 34,140 Option OL Ordinance/Law 10%/$ 17,070 Other limits and exclusions may apply - refer to your policy Your policy consists of these Declarations, the Homeowners Policy shown above, and any other forms and endorsements that apply, including those shown above as well as those issued subsequent to the issuance of this policy. This policy is issued bythe State Farm Fire and Casualty Company. 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. Secretary President Prepared JUN 30 2020 Page 3 of 3 un — �- r�"7rse 01 DATE LETTER PREPARED: December 9, 2020 I have received a letter addressed to: Raymond Buckley 2233 Colfax St. Blair, NE 68008 RE: Zeke — Potentially Dangerous Dog Designation Signature of p6rson receiving letter Printed name of person r6ceiving letter Signature of person delivering letter 6 Date 218 S 16th Street • Blair, Nebraska 68008 •402.426.4191 • FAX 402.426.4195 • E-mail: cityofblair@blairnebraska.org 1 City of Blair, 218 S. 16th St, Blair, NE 68008 A Promis°° QJo (402) 426-4191 Fax (402) 426-4195 www.blairnebraska. org NOTICE POTENTIALLY DANGEROUS DOG DECLARATION NOTICE DATE: December 9, 2020 Effective date of Declaration: December 21, 2020 TO: Raymond Buckley 2233 Colfax St. Blair, NE 68008 Pursuant to City of Blair Municipal Code 6-128 the following animal(s) has been declared a Potentially Dangerous Dog: Zeke — Boxer 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). IMMEDL4TELY 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. Zeke is currently licensed — Tag #2712 IMMEDL4TELY. 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. Raymond Buckley December 9, 2020 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 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, Nehraska 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 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 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, Attn: Brenda Wheeler, City Clerk, 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 Raymond Buckley December 9, 2020 Page 3 you will be required to surrender the animaks) 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 filine 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 brwheeler@blairnebraska.org 402-426-6694 Date of Rabies Vaccination: 12-03-20 Certificate No: 0 Next Rabies Vaccination On: 12-03-23 Previous Rabies Vaccination: VETERINARY CLINIC, fA,C, OWNER OF ANIMAL Countryside Small Animal "4)tAof�Danielle Buckley 1306 Stevenson ovM 2233 Colfax Fort Calhoun, NE 68023 Blair, NE 402-468-4060 County: This is to certify... THAT I HAVE VACCINATED AGAINST RABIES THE ANIMAL DESCRIBED BELOW. Patient information... PATIENT: Zeke SPECIES: Canine SEX: M BREED: Boxer Color and markings... Tan and White Signed Kaycee Points Vaccinations done... TAG NO: 20-0969 WEIGHT: 72.50 AGE: 22 months Microchip Number: License: 12-03-20 KNP Canine Rabies Vaccn, 3 yr, #20-0969 12-03-23 12-03-20 KNP Canine DA2PPl- 12-03-21 09-21-19 KNP Canine Rabies Vaccn, 1 yr, #19-0936 Rabies Vaccine Information... MFG BY: ZOET SER.NO: 367269B LOT EXP: 02FEB21 ADM: Sq Joseph Lager Chief of Police To: Rod Storm, City Administrator From: Joseph Lager, Chief of Police Date: November 11, 2020 PoliceBlair 1 Lincoln Street Blair., NE .:11 Subject: Potentially Dangerous Dog Designation Mr. Storm, 402-426-4747 (office) 402-426-7144 (fax) www. blairpolice.org On November 11, 2020 our department investigated a report of a dog bite at 2242 Colfax St in Blair (BPD Incident Report #20200000576). Through our investigation we learned that the incident was unprovoked. It is our determination that the animal, "Zeke", owned by Raymond Buckley at 2233 Colfax 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 animal(s) either on public or private property; or, Chases or approaches a person upon streets, sidewalks, or any public grounds in a menacing fashion or apparent attitude of attack; or, 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. spe4Lage tted, o eph ief of Police Integrity 0 Service 0 Vigilance 0 Excellence 0 Respect Blair Police epartment 1 730 Lincoln " Street Blair, NE 68008 M1000110AWi NA 1411111,6111 ow -'A'4101" Owner �f _t ;' lf, ,r BPD Incident Report # Animal's Name: ,�,! �' Description: Dog / Cat Breed: Date of Bite In accordance with Blair Municipal Ordinance: 6-119(2) the owner of the above-described animal agrees to: 1. Ensure that the animal will not be removed from or leave the premises for a minimum of 10 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.immed_iately; 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 Animal Shelter shall be borne by the owner. I agree to the conditions of this Quarantine Order: � � I Owner Signature ` `- i % Date: To be completed after Quarantine Period expires: Veterinarian. Examination Date: J DEC 1010 Condition of Animal: AaoaLnft kWik Revised: 25 September 2014 Joseph Lager Chief of Police Owner:I Animal's Name: Zrk-�` Date of Bite: In accordance with Blair Municipal agrees to: Blair Police DepartmenN 1730 Lincoln Street Blair, NE 68008 402-426-4747 (office) 402-426-7144 (fax) www.blairpolice.org Animal Quarantine Order BPD Incident Report #: f G12a�=-' 5 Description: Dog / Cat Breed: z Ordinance: 6-119(2) the owner of the above-described animal 1, Ensure that the animal will not be removed from or leave the premises for a minimum of 10 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 Animal Shelter shall be borne by the owner. I agree to the conditions of this Quarantine Order: Owner Signature: Date: _ l (bp J To be completed after Quarantine Period expires: Veterinarian: Examination Date: Condition of Animal: Revised: 25 September 2014 O t) .� Joseph Lager Chief of Police Blair Police Department 1730 Lincoln Street Blair, NE 68008 402-426-4747 (office) 402-426-7144 (fax) www.blairpolice.org Animal Quarantine Order Owner: BPD Incident Report #:�� Animal's Name: In Description. i�1/Cat Breed: Date of Bite: In accordance with Blair Municipal Ordinance: 6-119(2) the owner of the above-described animal agrees to: 1. Ensure that the animal will not be removed from or leave the premises for a minimum of 10 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 Animal Shelter shall be borne by the owner. I agree to the conditions of this Quarantine Order: Owner Signature: qd— Date: 2s�� To be completed after Quarantine Period expires: Revised: 25 September 2014 � � -2o Veterinarian: Examination Date: Condition of Animal: Incident ID: 20200000576 Pape: 1 BLAIR POLICE DEPARTMENT Incident Data Sheet Report ORI Number: NB0890100 Printed on: 11/19/2020 10:17 (Thu) Incident ID: 20200000576 Offense Code: Animal Control (800) Occurred Address: 2242 COLFAX ST BLAIR, NE 68008 District: Post: Source: Log#: File#: Case#: Situation Found: Animals, All Other Disposition: ACTIVE Date Reported: 11/18/202012:43 Disp Date: 11/16/202017:24 Date Occurred: 11/18/2020 00:00 TO 11/18/2020 00:00 Case Status: ACTIVE Status Date: 11/16/202017:24 Shooting: ❑ I Domestic violence: ❑ I Hate Crime: ❑ I Follow -Up: ❑ Reclassify: ❑ Date Approved By Supervisor: 11119/202008:26 Supervising Officer: LAGER, JOSEPH # 1118 Division: Reporting Officer: FLYNN, JACOB # 1134 Date Assigned To Investigator: Investigator Assigned: Remarks 2242 COLFAX ST CFS#: 202000006873 Call Codes: Disp Recd: 11/16/2020 16:52 ANIMAL BITE Dispatched: 11/16/2020 16:53 OCCURRED 30 MINUTES AGO OR LONGER Arrived: 11/1612020 16:68 Cleared: 11/1612020 17,24 Dispatcher: TY JOHNSON Officers Unit Officer(s) Division: JACOB RYAN FLYNN Supervisor: JOSEPH M LAGER f'_Iaarant- a Infnrmnfinn -ff. .... Clearance Date Incident Reference Cleared By Clearance Type 20200000576 Not Applicable 20200000576 Not Applicable Incident ID: 20200000576 Page: 2 Accrw in+exril NAmL1C BLAIR POLICE DEPARTMENT Incident Data Sheet Report ORI Number: NB0890100 Printed On: 11/19/2020 10:17 (Thu) Animal Owner Vict/Susp Rel: Name: BUCKLEY, RAYMOND M DOB 214/1983 Age/Time: 37 Juv: Sex: M SSN: Race; White Home Phone: (402) 639-8531 Work Phone; Other Phone: Arrest# FBI: SBI: State Appr Appr By: Charges: Circumstance: Visitor: ❑ Military: ❑ Police 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: Number: V03761714 Clothing: Primary Address: 1072 S 13 AVE BLAIR, NE 68008 Primary Mailing: Second Address; Second Mailing: Advice of Victims Rights Provided❑ How Notified Comment: Offense 1 : Animal Control I Employer Occupation Phone Number Employed From Employed To Incident ID: 20200000576 Page: 3 Accnr►iatnri Namp-q BLAIR POLICE DEPARTMENT Incident Data Sheet Report ORI Number: NB0890100 Printed On: 11/19/2020 10:17 (Thu) Animal Owner Vict/Susp Rel: Name: YOST, IAN C DOB 12/29/1999 Age/Time: 20 Juv: N Sex: M SSN: Race: White Home Phone: (402) 507-1704 Work Phone: Other Phone: Arrest# FBI: SBI: State Appr Appr By: Charges: Circumstance: Visitor: ❑ Military: ❑ Police Dept Associate: ❑ Justif, Homicide: Follow -Up: Weap: Injured: ❑ Reasons for Treatment: Treated: ❑ FVoluntary. ❑ Hospital: Physician: By: Confined: ❑ Refused Admission; ElSent Home: ElTransported Condition: Other Action: Injuries Breath Test: ❑ Blood Test: ❑ I Refused Test: ❑ FTest Results: Drivers License State: NE Expiration: Number: H13758704 Clothing: Primary Address: 2242 COLFAX ST BLAIR, NE 68008 Primary Mailing: Second Address: Second Mailing: Advice of Victims Rights Provided❑ How Notified Comment: Offense 1 : Animal Control Employer Occupation Phone Number Employed From Employed To Associated Businesses Arrests Expunged Arrests Juvenile Contacts Expunged Juvenile Contacts Vehicles i i l BLAIR POLICE DEPARTMENT Incident ID: 20200000576 Incident Data Sheet Report ORI Number: N130890100 Page: 4 Printed On: 11/19/2020 10;17 (Thu) Stolen Vehicles Property Evidence/Custodial Citations Ticket# Date Ordinance Amount Officer IGI%A 111 VUR v lar rry Field Interview # Date/Time Occurred Action Taken Type Vehicle Plate Vehicle VIN Accidents Report Number Date Description Suspects (Unknown) Victim to Suspect Relationships Victim # jVicFlm—Name Suspect # ISuspect Name Relationship Drugs Incident ID: 20200000576 Page: 5 rWancn rnrlrac BLAIR POLICE DEPARTMENT Incident Data Sheet Report ORI Number: NB0890100 Printed On: 11/19/2020 10;17 (Thu) Code: Animal Control Rank: Attempt Completed Dom Violence: NO Date Occurred( FROM): 11/16/202016:52 Date Occurred (TO): 11/16/202017:24 jDate Reported; 11/16/202017:24 Code Section: Bias: None Statute: Fighting Location; Residence/Home I Final Location: I Rape Location: Entry Type; I Entry Area: Instrument Used: #Premises Entered: Entry Method: Entry Point 1: Entry Point 2: Exit Point 1: Exit Point I Method Of Exit; Area Target: Property Target 1: Property Target 2: Property Target 3: Victim Target: Time Of Day: Circumstance: Security 1: Isecurity 2: Weapon 1: (Automatic: Weapon 2: 1. 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 Viet. Susp, Action on Viet. 2: Susp. Action on Viet. 3: Susp. Other Action 1: Susp, Other Action 2: Susp, Other Action 3: Susp, Solicit/Offered 1: Susp. Solicit/Offered 2: Susp. Solicit/Offered 3: Victim Use 1: Victim Use 2: Victim Use 3: Victim Activity: Victim Condition: Precip. Circumstance: Vehicle Locked: Keys in Ignition; # Louvers Removed; Photographed:Dusting: Arson: Identity Theft: Remarks: Workflow Action Approval Logged On 11/16/2020 17:25 Logged By XMLCADToRMS Incident ID: 20200000576 Page: 6 Images Incident Sunnlement BLAIR POLICE DEPARTMENT Incident Data Sheet Report ORI Number: NBO890100 Printed On: 11/19/2020 10:17 (Thu) Employee; 1152, BRETT GUNDERSON Submission Date: 11/19/2020 08;26 Created By: BGUNDERSON Created On: 11/19/2020 08:26 Updated On: 11/19/2020 08;26 I Updated By: BGUNDERSON Officer Hours p BLAIR POLICE DEPARTMENT incident ID: 20200000576 Incident Data Sheet Report ORI Number: NB0890100 Page: 7 Printed On: 11/19/2020 10:17 (Thu) Narratives Narrative Title ❑ Locked Narrative On 11/18/2020 1 called Ian Yost (402507-1704) and spoke to him about the dog bite case. I told him since his dog was attacked in his own yard that they did not have to follow the quarantine order. I told him there was nothing else they needed to do. Created On Created By Updated On Updated By 11/19/2020 08:26 BGUNDERSON 11/19/2020 08:26 BGUNDERSON BLAIR POLICE DEPARTMENT Incident ID: 20200000576 Incident Data Sheet Report ORI Number: NBO890100 Page: 8 Printed On: 11/19/2020 10:17 (Thu) Narratives Narrative Title ❑hocked Narrative On November 16, 2020, at approximately 1652 hours, I was working uniformed patrol in marked unit 113. 1 was dispatched to 2242 Colfax St. to take a report of a dog bite. I arrived and spoke to Lisa Yost (DOB: 12/12/1968) who informed me the neighbor's Boxer had ran into her yard and attacked her Charcoal Lab, Kash. The chocolate lab had a cut on the left side of his face. She informed me it is not the first time that it has happened, but it is the first time that there has been an injury. I went to 2233 Colfax St. to tall(to Raymond M. Buckley (DOB: 02/04/1983) who is the owner of the Boxer. He informed me he is aware that his dog, Zeke, got out of the yard. He informed me he was not home when Zeke got out and it was his son who let him out. He informed me the shock collar on Zeke was too and was not effective. I issued both owners of the animals Quarantine Orders. Follow up will be done by Animal Control #108. Created On Created By Updated On Updated By 11/19/2020 08:26 JFLYNN 11/19/2020 08:26 JFLYNN Incident ID: 20200000676 Page: 5 Narratives Narrative Title BLAIR POLICE DEPARTMENT Incident Data Sheet Report ORI Number: NB0890100 Printed On: 12/8/2020 10:20 (Tue) ❑ Locked Narrative Dog was seen by the vet on 12/3/2020 and was healthy, No further action needed, Created On Created By Updated On Updated By 12/8/2020 08:20 BGUNDERSON 12/8/2020 08:20 BGUNDERSON Blair Police Department 1730 Lincoln Street Blair, NE 68008 402-426-4747 (office) Joseph Lager 402-426-7144 (fax) Chief of Police www.blairpolice-org Animal Quarantine Order &'IOwner: r. c�,-� . � � f BPD Incident Report #: l Animal's Name: 'Zt `j',e , Description: Dog / Cat Breed: (bO .T::: Date of Bite: r In accordance with Blair Municipal Ordinance: 6-119(2) the owner of the above-described animal agrees to: 1. Ensure that the animal will not be removed from or leave the premises for a minimum of 10 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 Animal Shelter shall be borne by the owner. I agree to the conditions of this Quarantine Order: Owner Signature:/-� �\%`C Date: i J!Ct JU To be completed after Quarantine Period expires: Veterinarian. �— Examination Date: 3 PLC Iotiu Condition of Animal: Aoo&'cn- u Inc�lt.h`1 Revised: 25 September 2014 Date of Rabies Vaccination: 12-03-20 Next Rabies Vaccination On: 12-03-23 VETERINARY CLINIC Countryside Small Animal 1306 Stevenson Fort Calhoun, NE 68023 402-468-4060 Certificate No: 0 Previous Rabies Vaccination: OWNER OF ANIMAL Danielle Buckley 2233 Colfax Blair, NE County: This is to certify,.. THAT I HAVE VACCINATED AGAINST RABIES THE ANIMAL DESCRIBED BELOW. Patient Information... PATIENT: Zeke TAG NO: 20-0969 SPECIES: Canine WEIGHT: 72.50 SEX: M AGE: 22 months BREED: Boxer Microchip Number: Color and markings... Tan and White Signed �} Kaycee Points License: a Vaccinations done... 12-03-20 KNP Canine Rabies Vaccn, 3 yr, #20-0969 12-03-23 12-03-20 KNP Canine DA2PPI- 12-03-21 09-21-19 KNP Canine Rabies Vaccn, 1 yr, #19-0936 Rabies Vaccine Information... MFG BY: ZOET SER,NO: 367269B LOT EXP: 02FEB21 ADM: Sq