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2021-09-20 Silva, Anthony®farmers mutual i ofnebraska 501 South 13th Street PO Box 81529 Lincoln, NE 68601 DECLARATIONS Named Insured(s) SILVA, ANTHONY B & HOLLY 1154 NEBRASKA ST BLAIR NE 68008 Homeowners Form 3 Policy Page 1 Policy Number File Number Eff. Date Exp. Date Billed To Agency and Agent HG603936 558710 09/15/23 09/15/24 Mortgagee 0462-008 NEW FRONTIER/FORT CALHOUN NELSON, RITCHIE A. (402) 704-1813 The residence premises covered hereunder is located at the above address, unless otherwise stated herein: Dwelling Inflation Adjustment 6.6 % This oollcv covers for the term indicated below and will be renewed each term thereafter. Term (months) Policy Form Territory Protection Class Construction Type Reference Policy 12 3 1 Special Frame Y Policy Premium Policy Term Premium Before Discounts $3,016.00 Policy Term Premium Discounts or Charges $873.00- Total Policy Term Premium $2,143.00 Insurance attaches only to those coverages and/or items for which an amount of insurance is shown in the Declarations, and not exceeding said amount. Such insurance is subject to the definitions, coverage provisions, limitations, exclusions and conditions set forth in the policy. Section I Deductible - The deductible shown below will apply per occurrence unless a different amount is shown in these Declarations or in the policy. Basic Deductible Wind/Hail Deductible Dwelling Roof Year $500 $3, 000 2015 Identification Coverage or Item Description Amount of Premium Code Item Insurance Section I Coverages - Limits of Liability 0101 110 A, Dwelling Increased Replacement Cost $271,300 $3,012.00 0232 120 B. Other Structures $27,130 Included 0340 130 C. Personal Property Replacement Cost $189,910 Included 0400 140 D. Loss of Use $54,260 Included Section 11 Coverages - Limits of Liability 0600 150 L. Personal Liability $300,000 $4.00 0640 160 M. Medical Payments to Others $1,000 Included 140 R 10201-0520 08/15/23 Insured Copy - Continued - Page 2 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 of Blair 9 218 S 16th St e 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, 2024 Owner Name: 1444A,9o,iy Owner Address: / 16-1 City/State/Zip: Blair, NE 68008 Phone # -J6X -- 61 � - 731( 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 3/15/2024. 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. 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 T # . Dog ❑ Cat ( Spayed/N utered License Fee $ 11,616) Pet Name 6d /l- Birt date �Me Sex M Color qck Breed** a tj, Replacement $ 0 ** 31.1 1 Declared Dangerous or Potentially Dangerous Dog: ❑ Y I N MICROCHIP # (If applicable) SUBTOTAL: $ P 0o RABIES VACCINATION DATE: 62-3 A3 (3 yr) - X (1 yr) City Tag # 0 lq T #2 4 Dog ❑ Cat Spayed/N utered License Fee $ 11 , Pet Name ,i are ' Birt date a 3o Sex 44 Color Cyoeo at Breed** �/r,.✓�� ����ar Replacement $ 4 ** I t�� Declared Dangerous or Potentially Dangerous Dog: (;$ Y ❑ N MICROCHIP # (If applicable) SUBTOTAL: $ It," RABIES VACCINATION DATE: GZ;Z 9Z A,-) (3 yr) -- K (1 yr) City Tag # 015 3l `� 6 PET #3 Pd Dog ❑ Cat Spayed/Neutered License Fee $ 11 06' Pet Name Birt date x3�o Sex YK Color 61a,*(� i ,,,vwA Breed** ;�,��1 44'x Replacement $ 0 ** Declared Dangerous or Potentially Dangerous Dog: ❑ Y ❑ N MICROCHIP # 49 �; 14 i da,-4-f-4 1 + 1 (If applicable) SUBTOTAL: $ (IrD o RABIES VACCINATION DATE: IAof x\ _ (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 Mai/ TOTAL NCL®SE 3l� `, If you have questions, please contact Blair Police Department at (402) 426-4747 +++++++++++++++++++++++++++++++++++++++.++++++++++++++++++++++++++++++++++++++ NEW PET/NEW RESIDENT LICENSING REQUIREMENTS (March .t5late fee date not applicable for newpely1newresidenLs) Newly Acquired Pets: New Residents to Blair: ® Must be licensed within 10 days of ownership ® Must register pets within 10 days of 0 <OR> at 6 months of age if puppy/kitten residency. farmers mutual �► of nebraska DECLARATIONS Named Insured(s) SILVA, ANTHONY B & HOLLY 1154 NEBRASKA ST BLAIR NE 68008 Homeowners Form 3 Policy 501 South 13th Street PO Box 81629 Lincoln, NE 68601 Page 1 Policy Number File Number Eff. Date Exp. Date Billed To Agency and Agent HGO03936 558710 09/15/22 09/15/23 Mortgagee 0462-008 NEW FRONTIER/FORT CALHOUN NELSON, RITCHIE A. (402) 704-1813 The residence premises covered hereunder is located at the above address, unless otherwise stated herein: Dwelling Inflation Adjustment 15.1 This Policv covers for the term indicated below and will be renewed each term thereafter. Term (months) Policy Form Territory Protection Class Construction Type Reference Policy 12 3 1 Special Frame Y $2,533.00 Policy Premium Policy Term Premium Before Discounts $2,537.00 Policy Term Premium Discounts or Charges $761.00 Total Policy Term Premium $1,776.00 Insurance attaches only to those coverages and/or items for which an amount of insurance is shown in the Declarations, and not exceeding said amount. Such insurance is subject to the definitions, coverage provisions, limitations, exclusions and conditions set forth in the policy. Section I Deductible - The deductible shown below will apply per occurrence unless a different amount is shown in these Declarations or in the policy. _. Basic Deductible Wind/Hail Deductible Dwelling Roof Year $500 $2,000 2015 Identification Code Item Coverage or Item Description Amount of Insurance Premium Section I Coverages - Limits of Liability 0101 110 A. Dwelling Increased Replacement Cost $254,500 $2,533.00 0232 120 B. Other Structures $25,450 Included 0340 130 C. Personal Property Replacement Cost $178,150 Included 0400 140 D. Loss of Use $50,900 Included Section II Coverages - Limits of Liability 0600 150 L, Personal Liability $300,000 $4.00 0640 160 M. Medical Payments to Others $1,000 Included 91. 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 lairs 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 E: March 1 2023 Owner Name: 74 a;% V // Owner Address: � C b�-4-6 k 4 sf . City/State/zip: Blair,, NE 68008 Phone # `-OA -5'' 3 - 5 - LICENSE FEES: • or $16.00 Replacement Feefor c $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 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 renuires Proof of rabies vaccination to be submitted with your license application. PET # Dogg Cat ;5Spayed/Neutered License Fee $ /!, 0-o Pet Name ?U) /;e Ll Birthdate 2ool Sex fm It it Color 6ge-k Breed" i2gsAuA( Re 1acement$ 5,°`a ** Declared Dangerous or Potentially Dangerous Dog: ❑ Y �X N MICROCHIP # (If applicable) SUBTOTAL: RABIES VACCINATION DATE: 5 I 2.G (3 yr) --,X, (1 yr) City Tag # 7 T #2 �4 Dog ❑ Cat Spayed/Neutered License Fee $ Pet Name Kar Birtda*e 3o r Sex* �`e Color Gee A � Breed 4 /'o oQor Rep/acement $ Declared Dangerous or Potentially Dangerous Dog: ❑ Y ❑ N MICROCHIP # I f // 2,0zo (If applicable) SUBTOTAL: $ RABIES VACCINATION DATE: 22- (3 yr) C' (1 yr) City Tag # ? 'i` #3 Cd Dog E3Cat I Spayed/Ne tered License Fee $ 11,06 Pet Name Fr�cn g �.i Birthdate S a3 2 Sex /14,!e Color Ale, 1 {- yawn Breed" Replacement e5',-06 Declared Dangerous or Potentially Dangerous Dog: ❑ Y LYN MICROCHIP # (If applicable) SUBTOTAL: $ 1440 RABIES VACCINATION DATE: ax " Zi (3 yr) V (1 yr) City Tag *11 *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 Sena Cash by Mail TOTAL ENCLOSED $ 4$ , oo 0 If you have questions, please contact Blair Police bepartment at (402) 426-4747 +++++.++++++....++++.+++++++++++.++++++++++++++++++++++++......+.++++++.++.... NEW PET/ NEW RESIDENT LICENSING REQUIREMENTS (March 15/ate fee date not applicable fornewpets/newresidentV Newly Acquired Pets: New Residents to Blair: • Must be licensed within 10 days of ownership N Must register pets within 10 days of • <OR> at 6 months of age if puppy/kitten residency. ebraska -:a" w ne _ x Join the Harnian.e Race. October 19, 2021 To Whom It May Concern: Anthony Silva attended required Owner Responsibility class on Monday, October 18th, 2021. Dawn Thrapp Behavior Specialist Project Pet Safe Coordinator Nebraska Humane Society 402-905-3420 8929 Fort Street Omaha NE 681 34 402.444.7800 Fax 402.546.1476 www.nehumanesociety.org Court Copy Uniform Citation and Complaint Citation Number: M1207590 Date of Offense: Time of Offense: IR/Case#: 2011 0000W 2 Troop/District/Sector: Plaintiff: State of Nebraska inthe county court Court Case #: Defendant Information: Last Name; First Name: M. I.: Suffix: Telephone Number: ❑ Cell II02 y 2 Street Address: r4 Sr CI : 1 State; Zip Code; Country: U ;k D08.i— z� )•�� �� Gender; Height; , i Weight; Eyes; Hair: j) ILLI Race/Eth: Language if interpreter needed; DL State: N160,6111.)9 DL Country: DL Number: Liq Exp. Date: 2-1'- 2D41 DL Class: Restrictions; DL Endorsements: M Vehicle Year: Vehicle Type; Vehicle Style: Vehicle Make; Vehicle Model: Vehicle Color: Vehicle VIN: Vehicle License; State; Country: Reg. Year: Plate Type: CMV: Y /N/E HazMat: Y/N Carrier Name: US DOT Number: ICC Number: Business/ Address; City: State: Zip Code; Country: The undersigned being duly sworn, says the defendant, at the time and date shown, did unlawfully commit the following offense(s): In the County of: In the City of; Hwy Type; Hwy No.; Hwy Sfx: Mile Marker: Violation Wkq.. i rdtj I b lLAP-1- I cti r - Location i Location at or near: / Ej Ll h 1p Latitude: I Longitude: Did unlawfully commit the following offense: PRS: A ❑ Speeding MPH in _Zone D ❑ No Valid Registration J ❑ Follow Too Closely V A C R M E ❑ other K ❑ Improper Passing F ❑ Violated Traffic Signal L ❑ No Operator's License B ❑ D.U.I. G ❑ Violated Stop Sign M ❑ On Person C ❑ Negligent Driving (City Ordinance H ❑ Failure to Yield ROW ❑ Veh ❑ Ped N ❑ No Seat Belts Violation): 0 ❑ No Proof Insurance OTHER OFFENSE STATUTE/ORD. 'Reporting Officer 1/Agency: Date: Badge No.: Reporting Officer 2/Agency: Date: Badge No.: Prosecutor Your Court Appearance: ❑ To be determine X Date: I 11 / 19I3/ c Time: C/ `, 66 prn Court Address: 2,1 S . vi 5 T 14 Room No. This is an appearance bn1y, not a trial date. I promise that I will appear in court at the above time and place. X Your Signature is not an admission of guilt, but a promise to appear. Failure to comply with the terms of this citation is punishable by jail or fine or both and may result in suspension of your operator's license. *Optional Contact Information: Cell Phone Number; Carrier: E-mail Address: *By providing this optional contact information you acknowledge that the court may contact you by text message or by e-mail. ULou MUST appear in court as directed above ❑ Waiver Allowed. —You have the right to a trial and may appear in court as directed above. OR You are allowed to plead guilty to this offense without appearing In court. If you choose to plead guilty, you may pay a fine of $ costs of $ and liquidated damages of: $ for a total of $ �@farmers mutual � ofnebraska DECLARATIONS 501 South 13th Street PO Box 81529 Lincoln, NE 66501 Page 1 Named Insured(s) SILVA, ANTHONY B & HOLLY 1154 NEBRASKA ST BLAIR NE 68008 Homeowners Form 3 Policy Policy Number File Number Eff. Date Exp. Date Billed To Agency and Agent HG603936 558710 09/15/21 09/15/22 Mortgagee 0462-008 NEW FRONTIER/FORT CALHOUN NELSON, RITCHIE A. (402) 468-4544 The residence premises covered hereunder is located at the above address, unless otherwise stated herein: Dwelling Inflation Adjustment 7.7% This policy covers for the term indicated below and will be renewed each term thereafter. Term (months) Policy Form Territory Protection Class Construction Type Reference Policy 12 3 1 Special Frame Y $2,099.00 Policy Premium Policy Term Premium Before Discounts $2,103.00 Policy Term Premium Discounts or Charges $462.00 - Total Policy Term Premium $1,641.00 Insurance attaches only to those coverages and/or items for which an amount of insurance is shown in the Declarations, and not exceeding said amount. Such insurance is subject to the definitions, coverage provisions, limitations, exclusions and conditions set forth in the policy. Section I Deductible - The deductible shown below will apply per occurrence unless a different amount is shown in these Declarations or in the policy. Basic Deductible Wind/Hail Deductible $500 $1,500 Identification Code Item Coverage or Item Description Amount of Insurance Premium Section I Coverages - Limits of Liability 0101 110 A. Dwelling Increased Replacement Cost $221,100 $2,099.00 0232 120 B. Other Structures $22,110 Included 0340 130 C. Personal Property Replacement Cost $154,770 Included 0400 140 D. Loss of Use $44,220 Included Section II Coverages - Limits of Liability 0600 150 L. Personal Liability $300,000 $4.00 0640 160 M. Medical Payments to Others $1,000 Included R 10201-0520 08/17/21 Insured Copy - Continued - Page 2 Date of Rabies Vaccination: 04-20-19 Certificate No: 0 Next Rabies Vaccination On: 04-19-22 Previous Rabies Vaccination: VETERINARY CLINIC OWNER OF ANIMAL Countryside Small Animal Tony Silva 1306 Stevenson 1154 Nebraska Fort Calhoun, NE 68023 Blair, NE 68008 402-468-4060 County: This -is -to certify... - Canine Parvovirus Vaccination (CPV) THAT I HAVE VACCINATED AGAINST RABIES THE ANIMAL DESCRIBED BELOW. Patient information... PATIENT: Harley TAG NO: 19-0402 SPECIES: Canine WEIGHT: 55.00 SEX: N AGE: 18 months BREED: Retriever, Labrador Color and markings... Chocolate Signed Kaycee Points License: Vaccinations done... 04-20-19 KNP Canine Rabies Vaccn, 3 yr, #19-0402 0449m22 04-20-19 KNP Canine DA2PPL 04-19-20 02-09-18 KNP Canine Rabies Vaccn, I yr, #18-0166 12-16-17 KNP Canine Parvovirus Vaccination (CPV) Rabies Vaccine Information... MFG BY: ZOET SER.NO: 288181 LOT EXP: 24SEP19 ADM: Sq VETERINARY CLINIC Countryside Small Animal 1306 Stevenson Fort Calhoun, NE 68023 402-468-4060 OWNER OF ANIMAL Tony Silva 1154 Nebraska Blair, NE 68008 County: THAT y -YNEUTERED THE ANIMAL;tip BELOW 0 6 PATIENT: Harley AGE: 9M SPECIES: Canine EIGHT: 55.00 SEX: Neutered Male REED: Retriever, Labrador Color and markings: Chocolate Kaycee Points L 02-09-18 KNP Canine Rabies Vaccn, 1 yr, 18-0156 02-09-18 KNP Canine DA2PPL 02-09-19 12-16-17 KNP Canine Parvovirus Vaccination (CPV) DATE LETTER PREPARED: September 20, 2021 have received a letter addressed to: Anthony Silva 1154 Nebraska St. Blair, NE 68008 RE: Harley — Potentially Dangerous Dog Designation Signature of �Obrson receiving letter Is, Printe"ame of person receiving letter Signature of person delivering letter �)ZZ2 z Date 218 S 16th Street • Blair, Nebraska 68008 •402.426.4191 • FAX 402.426.4195 • E-mail: cityofblair@blaimebraska.org City of Blair, 218 S. 16" St, Blair, NE 68008 '9 promlao otQJ (402) 426-4191 Fax (402) 426-4195 ww-vv.bl airnebraska. gig NOTICE POTENTIALLY DANGEROUS DOG DECLARATION NOTICE DATE: September 20, 2021 Effective date of Declaration: September 30, 2021 TO: Anthony Silva 1154 Nebraska St. Blair, NE 68008 Pursuant to City of Blair Municipal Code 6-128 the following animal(s) has been declared a Potentially Dangerous Dog: Harley — Chocolate Lab 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. Harley is currently licensed — Tag 9,2977 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. Anthony Silva September 20, 2021 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, 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 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 Anthony Silva September 20, 2021 Page 3 you will be required to surrender the animals) to any City Law Enforcement Officer or Animal Control Officer within 24 hours. An anneal of such declaration can be heard by the City Council Police Committee. The filing fee for such anneal 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. B NDA WHEELER, CITY CLERK CITY OF BLAIR, NEBRASKA brwheelerkblairnebraska.org 402-426-6694 Date of Rabies Vaccination: 04-20-19 Certificate No: 0 Next Rabies Vaccination On: 04-19-22 Previous Rabies Vaccination: VETERINARY CLINIC OWNER OF ANIMAL Countryside Small Animal Tony Silva � �) � 33 - 1306 St 1154 Nebraska evenson Fort Calhoun, NE 68023 Blair, NE 68008 402-468-4060 County: This is to certify... THAT I HAVE VACCINATED AGAINST RABIES THE ANIMAL DESCRIBED BELOW. Patient information... PATIENT: Harley TAG NO: 19-0402 SPECIES: Canine WEIGHT: 55.00 SEX: N AGE: 18 months BREED: Retriever, Labrador Color and markings... Chocolate Signed Kaycee Points Vaccinations done... License: 04-20-19 KNP Canine Rabies Vaccn, 3 yr, #19-0402 04-19-22 04-20-19 KNP Canine DA2PPL 04-19-20 02-09-18 KNP Canine Rabies Vaccn, 1 yr, #18-0156 12-16-17 KNP Canine Parvovirus Vaccination (CPV) Rabies Vaccine Information... MFG BY: ZOET SER.NO: 288181 LOT EXP: 24SEP19 ADM: Sq on • To: Rod Storm, City Administrator From: Joseph Lager, Chief of Police Date: September 7,2021 Blair Police Department 1730 Lincoln Street Blair, NE • 11 Subject: Potentially Dangerous Dog Designation Mr. Storm, 402-426-4747 (office) 402-426-7144 (fax) www.blairpolice.org On September 6, 2021, our department investigated a report of a dog attack at 1250 Nebraska St in Blair (BPD Incident Report #20210000403). Through our investigation we learned that the incident was unprovoked. It is our determination that the animal, "Harley", owned by Anthony Silva at 1154 Nebraska St 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, 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, 4V Jos M. Lager Chief of Police Integrity 0 Service a Vigilance 0 Excellence 0 Respect BLAIR POLICE DEPARTMENT ROUTING SHEET R . i.� EPORT# �y� UOi1l� l0_3 Date: — Copies td: Detective City Prosecutor Case Status; Activex Cleared Officer County Attorney Unfounded Inactive DMV Sheriff's Office Cleared non -criminal Exceptionally Cleared Other HHS Prosecution Request Cleared Juvenile Animal Control Probation Signature:. 01 L City Hall Case Management -eV Ll 1 e If,(0A f edia �bi/44 ✓�d-i-�1111 C` Copies to; Investigator ty Prosecutor Case Status; cttve eared Officer County Attorney Unfounded Inactive DMV Sheriff s Office Cleared non -criminal Exceptionally Cleared HHS Prosecution Request Cleared Juvenile imal Contro i� Probation Signature;Cf GGt L City Hall Case Management Media }� V Ir f: Ok5 ii 44- W1l' 19 666 Date; Q Q`0MA P" Copies to: Detective City Prosecutor Case Status: Active Cleared Officer County Attorney Unfounded Inactive DMV Sheriff's Office Cleared non -criminal Exceptionally Cleared Other HHS Prosecution Request Cleared Juvenile Animal Control Probation Signature: City Hall Case Management Media Date: Copies to; Detective City Prosecutor Case Status: Active Cleared Officer County Attorney Unfounded Inactive DMV Sheriff's Office Cleared non -criminal Exceptionally Cleared Other HHS Prosecution Request Cleared Juvenile Animal Control Probation Signature: City Hall Case Management Media Date; Copies to: Detective City Prosecutor Case Status: Active Cleared Officer County Attorney Unfounded Inactive DMV Sheriffs Office Cleared non -criminal Exceptionally Cleared Other HHS Prosecution Request Cleared Juvenile Animal Control Probation Signature: City Hall Case Management Media Date: Copies to; Detective City Prosecutor Case Status; Active Cleared Officer County Attorney Unfounded Inactive DMV Sheriff's Office Cleared non -criminal Exceptionally Cleared Other HHS Prosecution Request Cleared Juvenile Animal Control Probation Signature: City Hall Case Management Media Date: Copies to: Detective City Prosecutor Case Status: Active Cleared Officer County Attorney Unfounded Inactive DMV Sheriff's Office Cleared non -criminal Exceptionally Cleared Other HHS Prosecution Request Cleared Juvenile Animal Control Probation Signature; City Hall Case Management Media Court Copy Uniform Citation and Complain y'itation Number: M 12 0 7 5 Date of Offense; Time of Offense: IR/Casetf: Troop/uistnct/z)ector: 01-66—. 161,18OZ r_SCt N In the County Court Court Case It: Plaintiff: State of Nebraska /,1Aeji.,,,, A I r% f- .rinn+ InfnrMatI1nn* 'he undersigned tieing aury swcuu, scys L11. First Name; M.I.: Suffix: Telephone Number: ❑ Cell Last Name: Hwy Sfx: Mile Marker: �I®z. -3 z Street Address; Cit . State: Zip Code; Country; Lf� DOB.; Gender: Height; Weight: i Eyes: Hair: R,© Race/Eth: Language If Interpreter needed: 17 /q DL State; DL Country: DL Number: 'J 13 R, Exp. Date; DL Class: Restrictions; DL Endorsements; /:`I �V' t3cpe p!J t� C 6) 0 L-14 r q q 6Z- f 7—;z 'f Vehicle Year; Vehicle Type; Vehicle Style; Vehicle Make: Model; Vehicle Col hi Vehi e VIN: Vehicle License: State; Country: Reg. Year; Plate Type; CMV; HazMat; Y/ N/ E Y/ N F ❑Violated Traffic Signal L ❑ No Operator's License US DOT Number: D.U.I. G ❑ Vlolated Stop Sign M ICC Number: Carrier Name: ❑ No Seat Belts ❑ No Proof Insurance Violation): 0 OTHER OFFENSE STATUTE/ORD. 01 6 rIJ66SColl city; State: Zip Code: Country; Business/ Address; Reporting Officer 1/Agency: Date: Badge No.: Reporting Officer 2/Agency: Date: Badge No.: 1 J_�_ _.._,.,- a1a ,,..i, ... f ,m, —.Y mit the fnilnwine offense(SI: 'he undersigned tieing aury swcuu, scys L11. In the City of: =Type:HwyNo.: Hwy Sfx: Mile Marker: in the County of: Violation Location Location at or near; j Latitude: Longitude: Did unlawfully commit the following offense: PRS: A ❑ Speeding MPH In _Zone D ❑ No Valid Registration J ❑ Follow Too Closely V A C R M E ❑ other K ❑ Improper Passing F ❑Violated Traffic Signal L ❑ No Operator's License D.U.I. G ❑ Vlolated Stop Sign M ❑ on Person A C ❑ Negligent Driving (City Ordinance H ❑ Fallure to Yield ROW Veh El N ❑ No Seat Belts ❑ No Proof Insurance Violation): 0 OTHER OFFENSE STATUTE/ORD. 01 6 rIJ66SColl l Reporting Officer 1/Agency: Date: Badge No.: Reporting Officer 2/Agency: Date: Badge No.: 1} p%-4 0 '��-2 Z i Your Court Appearance: ❑ To be determined Prosecutor X Date: /1] / 73l N 'A l Time: `/ ', iX PM Court Address:! i �T b kiIc c.r'r °2 "�� Room No. This is an appearance only, not a trial date. I promise that I will appear in court at the above time and place. Your Signature is not an admission of guilt, but a promise to appear. Failure to comply with the terms of this citation is punishable by jail or fine or both and may result In suspension of your operator's license. * Optional Contact Information: Cell Phone Number: Carrier: E-mail Address: *By providing this optional contact information you acknowledge that the court may contact you by text message or by e-mail. ;41(ou MUST appear In court as directed above ❑ Waiver Allowed. -You have the right to a trial and may appear in court as directed above. OR You are allowed to plead guilty to this offense without appearing In court. If you choose to plead guilty, you may pay a fine of $ costs of $ and liquidated damages of: $ for a total of $ BLAIR POLICE DEPARTMENT Incident ID: 20210000403 Incident Data Sheet Report ORI Number: N80890100Printed on: 9/7/2021 15:36 (Tue) Page: 1 Incident ID: 20210000403 Offense Code: AC/Dog/Cat Bite (80P) Occurred Address: 1250 NEBRASKA ST BLAIR, NE 68008 District: BLPD Post: Source: Log#: File#: Case#: Situation Found: Animals, All Other Disposition: ACTIVE Date Reported: 9/6/202110:39 Disp Date: 9161202110:39 Date Occurred: 916/2021 10:18 TO 916/202110:38 Case Status: ACTIVE Status Date: 916 10:39 Shooting: ❑ Domestic Violence: ❑ Hate Crime: ❑ Follow -Up: ❑ Reclassify: ❑ Date Approved By Supervisor: 917/202114:08 Supervising Officer: LAGER, JOSEPH # 1118 Reporting Officer: WATTENBACH, AARON # 1187 Division: Date Assigned To Investigator: Investigator Assigned: Remarks 1250 NEBRASKA ST CFS#: 202100005263 Call Codes: Disp Recd: 9/6/2021 10:18 ANIMAL BITE Dispatched: 9/6/2021 10:18 JUST OCCURRED Arrived: 9/612021 10:29 Cleared: 9/6/2021 10:38 Dispatcher: JACOB SALSBURY Officers officers) Unit Division: AARON LLOYD WATTENBACH Supervisor: JOSEPH M LAGER Clearance Information Clearance Type Clearance te nce DaIncident Reference Cleared ev 20210000403 Not Appllcable Incident ID: 20210000403 Page: 2 Accr%f-iatar1 NamAS BLAIR POLICE DEPARTMENT Incident Data Sheet Report ORI Number: NBOB90100 Printed On: 9/7/2021 15:36 (Tue) Victim Vict/Susp Re[: Name: WACHTER, NICOLE M DOB 9!411971 Age/Time: 60 Juv: N Sex: F SSN: Race: White Home Phone: (402) 720-3462 Work Phone: Other Phone: Arrest# FBI: SBI: State Appr Appr By: Charges: Circumstance: Visitor: ❑ Military: ❑ Police Dept Associate: ❑ Justif. Homicide: Weap: Follow -Up: Treated: ❑ Voluntary: E] Injured: F] Reasons for Treatment: Hospital: Physician: Confined; F] Refused Admission: Sent Home: ❑ Transported By: Condition: Good Other Action: Injuries N Breath Test: ❑ Blood Test: ❑ Refused Test: ❑ Test Results: Drivers License State: NE Expiration; Number: 601156188 Clothing: Primary Address: 1260 NEBRASKA ST BLAIR, NE 68008 Primary Mailing: Second Address: Second Mailing: A,ixar.A nf Victims Riohts Provldedn How Notified Comment: Offense 1 : AC/Dog/Cat Bite Employer Occupation DOUGLAS COUNTY Work Address: Phone Number Employed From Employed To ,t 3u 1 � ! BLAIR POLICE DEPARTMENT Incident ID: 20210000403 Incident Data Sheet Report ORI Number: NBO890100 Printed On, 9/7/2021 15:36 (Tue) Page: 3 Associated Names Suspect Vict/Susp Rel: Name: SIL A, ANTHONY B DOB 2/17/1962 Age/Time: 59 Juv: N Sex: M SSN: Race: White Home Phone: (402) 633-2996 Work Phone: Other Phone: Arrest## FBI: SBI: State Appr Appr By: Charges: Circumstance: Visitor: ❑ Military: ❑ Police Dept Associate: ❑ Justif. Homicide: Follow -Up: I Weep: Injured: ❑ Reasons for Treatment: Treated: ❑ Voluntary: ❑ Hospital: Physician: Transported By: Confined: ❑ Refused Admission: ❑ Sent Home: ❑ Condition: Other Action: Injuries N Breath Test: ❑ Blood Test: ❑ Refused Test: ❑ Test Results: Drivers License State: NE Expiration: Number: 601044944 Clothing: BLUE JEAN SHORTS, WHITE -SHIRT, ATHLETIC SHOES Primary Address: 1164 NEBRASKA ST BLAIR, NE 68008 Primary Mailing: Second Address: Second Mailing: Advice of Victims Rights Provided E] How Notified Comment: Offense 1 : Animal Control Employer Occupation Associated Businesses Arrests Expunged Arrests Juvenile Contacts Expunged Juvenile Contacts Vehicles Phone Number Employed From Employed To Incident ID: 20210000403 Page: 4 Stolen Vehicles Property Evidence/Custodial Citations Ticket#/ Date 1207689 Court Date: 9/6/2021 10:16 11/3/2021 09:00 BLAIR POLICE DEPARTMENT Incident Data Sheet Report ORI Number: NBO890100 Printed On: 9/7/2021 15:36 (Tue) Field Interviews Field Interview # Date/Time Occurred Accidents Report Number Date Ordinance Liability of Owner: Damage to property of others Court Code: Action Taken Type Description Suspects (Unknown) Victim to Suspect Relationships Victim # Victim Name Isuspect# ISuspectName Drugs Amount Officer 1187 Vehicle Plate Vehicle VIN Incident ID: 20210000403 Page: 5 f'*r%r4nc BLAIR POLICE DEPARTMENT Incident Data Sheet Report ORI Number: N80890100 Printed On: 9/7/2021 15:36 (Tue) V9.-..vv—v...v- Code; AC/Dog/Cat Bite Rank: Attempt Completed Dom Violence; NO Date Occurred ( FROM ): 916/2021 10:18 jDate Occurred (TO ): 9/6/2021 10:38 jDate Reported: 9/6/2021 10:39 Section:Bias: Statute: Liability of Owner: Damage to property of Zdeon; ResidencelHome Final Locatio�- Rape Location: Entry Type: 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: ISecurity 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 Viet. 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, Solicit/Offered 3: Victim Use 1: Victim Use 2: Victim Use 3; Victim Activity: Vehicle Locked: Victim Condition: Keys In Ignition: Precip. Circumstance; # Louvers Removed; Photographed:Dusting: Arson: Identity Theft: Remarks: Workflow Action Approval Logged On 9/6/2021 10:46 Logged By XMLCADToRMS Incident ID: 20210000403 Page: 6 Images Incident Supplement Officer Hours BLAIR POLICE DEPARTMENT Incident Data Sheet Report Description CN 20210000402 Vaccination record for Harley PIC 1 ORI Number: NBOB90100 Printed On: 9/7/2021 15:36 (Tue) Description CN 20210000402 Victims dog Hazel PIC 2 } r z g - j g BLAIR POLICE DEPARTMENT Incident ID: 20210000403 Incident Data Sheet Report ORI Number: NB0890100 Page: 7 Printed On: 9/7/2021 15:36 (Tue) Narratives Narrative Title ❑Locked Narrative On 09/06/2021 1 was on duty, conducting uniformed patrol, in marked unit #118.1 was dispatched to 1250 Nebraska St in reference to a dog bite. Upon arrival, I spoke to the victim who was identified as Wachter, Nicole M (09/04/1971). Nicole advised she had been sitting on the front porch with her small grey dog named "Hazel" when an unidentified adult male came walking by, on the sidewalk, with his adult chocolate tab. According to Nicole this male was wearing jean shorts, a white t shirt and athletic shoes. Her dog "Hazel" was on a lead that would only allow her to go to the edge of her yard out front. This unidentified adult male had his dog on a leash. As he passed by,. "Hazel" ran out from the porch to near sidewalk. "Hazel" did not leave the front yard of 1250 Nebraska St. The chocolate lab pulled away from its owner and entered Nicole's yard. It attacked "Hazel" by biting her around the throat and causing bleeding. The owner of the chocolate lab failed to properly restrain his dog. After the attack the unidentified adult male walked a short distance away from the scene going westbound, with his adult chocolate lab, Nicole yelled at him and told him that his dog had entered onto her property. He yelled back "what am I supposed to do ?" and continued to walk away even after Nicole asked for his name. Nicole recorded this interaction on her cell phone. She provided me with a copy of the video to review, I observed an injury to the neck of "Hazel" and some bleeding was visible. Nicole advised she would take "Hazel" to the emergency vet in Omaha and provide me with a copy of the paperwork for the dogs care at a later time. I photographed the injury to "Hazel" and it is attached to this report. I gave Nicole the police report number for this incident and advised I would follow up with her later. I checked the area for the suspect and the suspects dog with negative results. I spoke to several residents in the area with negative results. About 1330 hours, Nicole informed me that her daughter had posted the video she recorded on Facebook and a friend identified the suspect as Silva, Anthony b (02/17/1962). 1 responded to his address at 1154 Nebraska Street. I spoke to Anthony in his front yard and asked him if he knew why I was there, and he advised yes. Anthony was wearing the same clothing showed in video recorded by Nicole. Anthony admitted to me that his dog, an adult chocolate lab named "Harley," had left the sidewalk in front of 1250 Nebraska St as they were walking by. Anthony admitted that "Harley" had bitten the other dog around the neck. When I asked him why he didn't stop and call the police, he told me his dog was agitated and he needed to get him home, Anthony told me he thought the small dog belonging to Nicole was going to run out of her yard and attack him, I asked him if her dog did indeed leave her yard and he advised no. I advised him it was his responsibility to keep his dog "Harley" under control and out of her yard, Anthony advised he did have a leash on "Harley." As "Harley" had bitten and injured "Hazel" I issued a animal quarantine order to Anthony. I also issued Anthony citation #M1207589 for violating Blair City Code 6-115 liability of owner -damage to property of others, "Harley" had damaged Nicole's property or dog named "Hazel" by biting her around the neck and causing the dog to bleed. Anthony was given a court date of 11/03/2021 and advised to contact Blair City Hall for the disposition of the citation. Anthony signed both the animal quarantine order and citation. He was given a copy. Anthony provided me with a copy of the vaccination record for "Harley" and advised he did have the dog registered with the City of Blair. This picture of "Harley's" shot record is attached to this report. Anthony advised he was familiar with the quarantine order as he has been served with such an order in the past, Upon returning to BPD, I reviewed the call record for Anthony Silva at 1154 Nebraska Street. It does show several other incidents or reports taken by BPD of animal bites involving a dog owned by Anthony. I recommend this case be reviewed by BPD Animal Control Officer Gunderson to determine if further action is necessary. I also recommend this incident be listed as cleared by adult citation but ask that it be further reviewed by BPD Animal Control to determine if further action is warranted. Wattenbach 09/06/2021 Created On Created By Updated On Updated By 9/7/202114:08 AWATTENBACH 9/7/202114:08 AWATTENBACH 5 as .. as 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: 04' A&"Aq BPD Incident Report #:I. a HCl �lD Animal's Name: 4Ak' — Description Cat Breed: 61ih O I Date of Bite: q-- &' 2.42 In accordance with Blair Municipal Ordinance: 6-1.9(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; S. 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: 0-06 To be completed after Quarantine Period expires: Veterinarian: Examination Date: Condition of Animal: Integrity Service Vigilance • Excellence Respect