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GL+t + Vi 4 �' � CaAl— C� 1/5 -15 CITY OF BLAIR - 2019 PET LICENSE VERIFICATION If you live in Blair City limits and own a dog(s) and/or cat(s), complete/verify this form and return with check made payable to: City of Blair * 218 S 16th St. * Blair, NE 68008 You may legally own a combination of four (4) adult pets, but no more than three (3) adult dogs or three (3) adult cats per residential or dwelling unit. LICENSE RENEWALS ARE DUE: March 15, 2019 LICENSE FEES: Dog or Cat: $16.00 Owner Name: Harley Gabriel Spayed/Neutered Dog or Cat: $11.00 Replacement Fee for Lost Tag: $5.00 Owner Address: 243 N 20th St Fee includes $1.25 for the Nebraska Dog and Cat City/State/ZIP: Blair, NE 68008 Operator Inspection Program Phone #: (402) 208-2253 11 1 Drivers License #: or Date of Birth: Name: Hershey Color: Red Spayed/Neutered: True Mirochip # Vaccination Date: 1/24/20`15 13— -? —/ P N-.S P,Vq / Subtotal licensed pets from below: Replacement Tags from below: DOB: 10/19/2007 Sex: Female Breed: Miniature Pinscher Duration: 3 year vaccine Vaccine Exp: 1/24/2018 License Fee $ Replacement: ❑Y ON City Tag # 1996 Total: CITY OF BLAIR - 2019 PET LICENSE VERIFICATION If you live in Blair City limits and own a dog(s) and/or cat(s), complete/verify this form and return with check made payable to: City of Blair * 218 S 16th St. * Blair, NE 68008 You may legally own a combination of four (4) adult pets, but no more than three (3) adult dogs or three (3) adult cats per residential or dwelling unit. LICENSE RENEWALS ARE DUE: March 15, 2019 LICENSE FEES: Dog or Cat: $16.00 Owner Name: GARCIA, RODNEY M & LISA M Spayed/Neutered Dog or Cat: $11.00 Owner Address: 1245 VOSS DR Replacement Fee for Lost Tag: $5.00 Fee includes $1.25 for the Nebraska Dog and Cat City/State/ZIP: BLAIR, NE, 68008--0000 Operator Inspection Program Phone #: (402) 689-2208 Drivers License #: Name: White Sox Color: Black[White Spayed/Neutered: True Mirochip # Vaccination Date: 12/29/2016 or Date of Birth: 6/4/1970 Subtotal licensed pets from below: Replacement Tags from below: DOB: Not on File Sex: Female Breed: Domestic Shorthair Duration: 3 year vaccine Vaccine Exp: 12/29/2019 License Fee $ Replacement: ❑Y ON City Tag # 1171 Total: 1d� CITY OF BLAIR - 2019 PET LICENSE VERIFICATION -- - i If you live in Blair City limits and own a dog(s) and/or cat(s), complete/verify 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 dog' or three (3) adult cats per residential or dwelling unit. LICENSE RENEWALS ARE DUE: March 15, 2019 LICENSE FEES: Dog or Cat: $16.00 Owner Name: GARCIA, RODNEY M & LISA M Spayed/Neutered Dog or Cat: $11.06 Owner Address: 1245 VOSS DR Replacement Fee for Lost Tag: $5.00 Fee includes $1.25 for the Nebraska Dog and Cat City/State/ZIP: BLAIR, NE, 68008--0000 Operator Inspection Program Phone #: (402) 689-2208 Drivers License #: Name: Shadow Color: Black/Brown Spayed/Neutered: True Mirochip # 98612/101306951 Vaccination Date: 12/16/2016 or Date of Birth: 6/4/1970 Subtotal licensed pets from below: Replacement Tags from below: DOB: Not on File Sex: Male Breed: Dachshund Duration: 3 year vaccine Vaccine Exp: 12/16/2019 License Fee $--Ib Replacement: ❑Y ON City Tag # 1174 Total:. i CITY OF BLAIR - 2019 PET LICENSE VERIFICATION If you live in Blair City limits and own a dog(s) and/or cat(s), complete/verify this form and return with check made payable to: City of Blair* 218 S 16th St. * Blair, NE 68008 You may legally own a combination of four (4) adult pets, but no more than three (3) adult dogs or three (3) adult cats per residential or dwelling unit. LICENSE RENEWALS ARE DUE: March 15, 2019 LICENSE FEES: Dog or Cat: $16.00 Owner Name: Izabella Genoways Spayed/Neutered Dog or Cat: $11.00 Replacement Fee for Lost Tag: $5.00 Owner Address: 526 S 11 th St. Fee includes $1.25 for the Nebraska Dog and Cat City/State/ZIP: Blair, NE 68008 Operator Inspection Program Phone #: (402) 426-5200 Drivers License #: or Date of Birth: 11/27/2002 Subtotal licensed pets from below: Replacement Tags from below: Name: Spotted Leaf DOB: 8/1/2017 Sex: Female License Fee $ Color: Calico Breed: Domestic Shorthair Replacement: Spayed/Neutered: True ❑Y ❑N Mirochip # City Tag # 2353 Vaccination Date: 3/22/2018 Duration: 1 year vaccine Vaccine Exp: 3/22/2019 Total: ,t CITY OF BLAIR - 2019 PET LICENSE VERIFICATION If you live in Blair City limits and own a dog(s) and/or cat(s), complete/verify this form and return with check made payable to: City of Blair * 218 S 16th St. * Blair, NE 68008 You may legally own a combination of four (4) adult pets, but no more than three (3) adult dogs or three (3) adult cats per residential or dwelling unit. LICENSE RENEWALS ARE DUE: March 15, 2019 LICENSE FEES: Dog or Cat: $16.00 Owner Name: Izabella Genoways Spayed/Neutered Dog or Cat: $11.00 Owner Address: 526 S 11th St. Replacement Fee for Lost Tag: $5.00 Fee includes $1.25 for the Nebraska Dog and Cat City/State/ZIP: Blair, NE 68008 Operator Inspection Program Phone #: (402) 426-5200 Drivers License #: or Date of Birth: 11/27/2002 4/ Subtotal licensed pets from below: Replacement Tags from below: Name: Lilly Color: Black/Grey Spayed/Neutered: True Mirochip # OA02394832 Vaccination Date: 7/26/2016 DOB: Not on File Sex: Female Breed: Miniature Schnauzer Duration: 3 year vaccine Vaccine Exp: 7/26/2019 License Fee $ Zj` Replacement: ❑Y ❑N City Tag # 1819 Total: / CITY OF BLAIR - 2019 PET LICENSE ADDITIONS If you live in Blair City limits and own a dog(s) and/or cat(s), complete/verify this form and return with check made payable to: City of Blair * 218 S 16th St. * Blair, NE 68008 You may legally own a combination of four (4) adult pets, but no more than three (3) adult dogs or three (3) adult cats per residential or dwelling unit. LICENSE RENEWALS ARE DUE: March 15, 2019 Owner Name: Izabella Genoways Owner Address: 526 S 11th St. City/State/ZIP: Blair, NE 68008 LICENSE FEES: Dog or Cat: $16.00 Spayed/Neutered Dog or Cat: $11.00 Replacement Fee for Lost Tag: $5.00 Fee includes $1.25 for the Nebraska Dog and Cat Operator Inspection Program Phone #: (402) 426-5200 Drivers License #: or Date of Birth: 11/27/2002 Subtotal licensed pets from below: Replacement Tags from below: Total: x� Dog ❑ Cat Spayed/Neutered License Fee $ y Pet Name e : Pet DOB / Sex w Col µ < " '4 zBreed A Q Declared Dangerous or Potentially Dangerous Dog? ❑ Y`FI N Microchip # P `�- // OiO �Tt- Rabies Vaccination Date j-� 1713 yr 1 yr ❑ Dog ❑ Cat ❑ Spayed/Neutered Pet Name Color Age Sex Breed Declared Dangerous or Potentially Dangerous Dog? ❑ Y ❑ N Rabies Vaccination Date Pet Name Pet DOB Color Breed Declared Dangerous or Potentially Dangerous Dog? ❑ Y ❑ N Sex License Fee $ 03 yr 01 yr License Fee $ I'' Microchip # Rabies Vaccination Date 03 yr 01 yr CITY OF BLAIR - 2019 PET LICENSE VERIFICATION If you live in Blair City limits and own a dog(s) and/or cat(s), complete/verify this form and return with check made payable to: City of Blair * 218 S 16th St. * Blair, NE 68008 You may legally own a combination of four (4) adult pets, but no more than three (3) adult dogs or three (3) adult cats per residential or dwelling unit. LICENSE RENEWALS ARE DUE: March 15, 2019 LICENSE FEES: Dog or Cat: $16.00 Owner Name: GENTZLER, TIMOTHY P & JEANNE S Spayed/Neutered Dog or Cat: $11.00 Owner Address: 806 N 13TH ST Replacement Fee for Lost Tag: $5.00 Fee includes $1.25 for the Nebraska Dog and Cat City/State/ZIP: BLAIR, NE, 68008--0000 Operator Inspection Program Phone #: (402) 533-3128 Drivers License #:G08044048 or Date of Birth: 8/31/1961 / Subtotal licensed pets from below: �h Replacement Tags from below: Name: Cinnamon Color: Black/Brown/Tan Spayed/Neutered: True Mirochip # 981020019061211981 Vaccination Date: 3/17/2016 DOB: Not on File Sex: Female Breed: Domestic Longhair Duration: 1 year vaccine Vaccine Exp: 3/17/2018 License Fee $ Replacement: ❑Y ❑N City Tag # 766 Total: d. 0 6 Blair Small Animal Clinic PC David E. Johnson DVM 1734 Front Street Blair, Nebraska, 68008 (402) 533-2722 Tim & Jeanne Gentzler 806 N 13th St Blair, NE 68008 Page 1 / 1 Client ID: 5428 Invoice #: 150863 Date: 3/7/2019 Patient ID: 4576 Weight: 6,87 pounds Patient Name: Cinnamon Birthday: 10/06/2010 Species: Feline Sex: Spayed Female Breed: Domestic Longhair Description Staff Name Quantity Total 3/7/2019 Examination General David E. Johnson DVM 1.00 $24.45 Rhino-Calici-Flu-PanLeu-Annual 1.00 $28.87 Advantage Multi Cat 5.1-9# x tube 6.00 $100.56 T Patient Subtotal: $153.88 Instructions Your cat has had the final dose in the series, and may be considered fully protected from Panleukopenia, Rhinotracheitus, and calicivirus infection. We will notify you when it is time for booster vaccinations and other health maintenance needs. P-minder 17/2020 Rhino-Calici-Flu-PanLeu-Annual u,/ 14/2020 Rabies Vaccination -Feline Invoice Total: default Tax Rate: Total: Balance Due: Previous Balance: Balance Due: VISA Card Number: ... XXXX3412: Less Payment: Balance Due: Order your pets supplies online now through our website www.blairsmallanimalclinic.vetsfirstchoice.com For questions contact us at 402-533-2722. $153.88 $7.04 $160.92 $160.92 $0.00 $160.92 ($160.92) ($160.92) $0.00 jll'� P� 1 a)6 CITY OF BLAIR - 2019 PET LICENSE VERIFICATION If you live in Blair City limits and own a dog(s) and/or cat(s), complete/verify this form and return with check made payable to: City of Blair * 218 S 16th St. * Blair, NE 68008 You may legally own a combination of four (4) adult pets, but no more than three (3) adult dogs or three (3) adult cats per residential or dwelling unit. LICENSE RENEWALS ARE DUE: March 15, 2019 LICENSE FEES: Dog or Cat: $16.00 Owner Name: Sara Getty Spayed/Neutered Dog or Cat: $11.00 Replacement Fee for Lost Tag: $5.00 Owner Address: 2238 Jackson St. Fee includes $1.25 for the Nebraska Dog and Cat City/State/ZIP: Blair, NE 68008 Operator Inspection Program Phone #: (402) 426-7129 Drivers License #: 1 '� or Date of Birth: Name: Sammy Color: Liver Spayed/Neutered: False Mirochip # OA02004845 Vaccination Date: 1/4/2018 Subtotal licensed pets from below:__ Replacement Tags from below: (9 DOB: 1/1/2014 Sex: Female Breed: German Shorthaired Pointer Duration: 3 year vaccine Vaccine Exp: 1/4/2021 f µl License Fee $ Replacement: ❑Y ON City Tag # 1368 Total: FROM :BSAC Dec, 26, 2D18 2,53PM FAX 1,19. :402-533-2722 CITY QR BLAIR Feb. 16 2019 11:06AM P1 No, 8225 P. 1 CITY OF BL„AIR i 2019 PET LICENSE APPLICATION It• yoU live In Blair City limits and own a dog(s) and/or cat(s), complete thla foray and return with check mil de payable to; City of Blair a 218 S.16th St. 6 Make NE 68008 YOU may' lewally own a combination of four (4) adult pets, but no more than t➢lroa ($) adullt dogs or three (3) adult cob per res➢dentisl *r dwelling uanit, LICeNSE RENE ILS A 1.190. M r Owner Name; Owner Address. arty/Stal;e0p: Blair", NE 58008 Ibrivers License 0 air aatrs of nllth 1-11CIENSE FIEFS: IDog or l0av $lcoo Altered Dog or cat: $11,00 R4 pPlArAment fte for Lost'l ag: $S.o() An —adfrotiOnO.SlAbs F61 of $1.251s belnu coliectk5d to ilund *'1PL E l CAnFUL y YOU A0 REQUIRM UY LAW TO "CENBB YOUR PATS. laHnre t!a Qb 60 IS A VIQIfAtj6h or. Qty 6>'d111MArAe 6,103 and carries R peneity of R tine up to 0130m per pot, PET MINNIIS UNsWAI.s APE DUB OY AbALZ=. T►tiG City frholl reC69nize a MICWlVp Identlllratlon number as the license 11uniber• it theli be uniewaul for any duly nr cat, to wolar any llcanaa or Other city ldantikakan ether man i:llat issued by 010 City of Blair fnr iivch dog or rAt,'file cttyoftlalr requlaw proof of rablo$ VA&Ittatlplt, � .:�, PET EAW� etSpay Jlvput�re � Pet NA e ? x ,� � Color Breed** �Y- ��Re lacement$Declared Dangerous ofPotentially Dal7gerQus Do, MICROCHIP applicaiale S� BrOTALi $ RABIES VACCINATi0N DATE: _.(3 yr) U Yl') -_ City Tog . PET #2 � l� o � ca t CI Spay /Neutered � Licarrae Fear $ Pet Na a .t t A�e hex irefQr _Breed 1: Rep/acr�ment$ � Declared Dangerous r Potentially Dangerous Deg, Q Y N - MICROCHIP #�(If applicable) SUBTOTAL„ RABzPS VACCZNATfrJN DATA ,,��.'� yr) m (I Yl')city Tag C PET 0:3 0 D09 IJ Cat U Sp,nyed/Neutered Pets Name Sex Color Breed Declared Dal�. erous or potentially Dagerous borp, w ❑ y ❑ N MTC;ROCHIP # (IPzippllr$hle) Wlrx VACCINATION DATE: __ (3 yr) , Replacement $ SUBTOTAL.- $ _ (t yr) city Tang *PLUSE INCWnE TIJE CM tt'Ao NUMBPR• IFTFl15IS A RENEWAL ** (This fee is due Along with LICeInge Me if requegtln.p at the kltrxe Of Ikeiri a refloWa;l.) Donation to mre for an➢imiAls: $3 $S $10 Other"*5EE SACK OF FORM FOR SnIEED SPECIFIC LICENSE RNQ—Ultt M9NTS 00NofSand Cash by 0011 TOTAL ENCLO ED VISA, /illy # Explres' � Se carlty Code: Signatum IfyoU NAve question.5, please contact City Mall at (402) 420.4191 or by Fax: (402) 426-4os �'F•. ......+'1'.....'f'.'1"I^'F"I"F. .+..^}....t.•F... fto NeWprr//NNRt{+jN�➢ XD)EN'rLXCL+t4SINGIRFQiUxRtMENTS (Ms�rth��"l te> �daCurlat�pplic;bl� rnel>rp��filn�yWr�siiie�il� b� Iwllt� n 20 rays -o!'csvvne�s{�ip XW^L 0 I�A6 to Ala➢r� _- . le <0R> at e� manths at � e if u PI Must M9l r pet r W1thI1t XO day; r f �� q p pPY/kin mgdency, E .. CITY OF BLAIR - 2019 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 RENEWALS ARE DUE: March 15, 2019 Owner Name: kL> f I I ` � I!) Owner Address: .- ililt City/State/Zip: Blair, NE 68008 Phone # Drivers License # or Date of Birth LICENSE FEES: Dog or Cat: $16.00 Altered Dog or Cat: $11.00 Replacement Fee for Lost Tag: $5.00 ***PLEASE READ CAREFULLY*** YOU ARE REQUIRED BY LAW TO LICENSE YOUR PETS. Failure to do so is a violation of City ordinances 6.103 and carries a penalty of a fine up to $150.00 per pet. PET LICENSES RENEWALS ARE DUE BY 3/15/2019. The City shall recognize a microchip identification number as the license number. It shall be unlawful for any dog or cat to wear any license or other city Identification other than that Issued by the City of Blair for such dog or cat. The City of Blair requires proof of rabies vaccination. Included is a State Fee of $1.25 being collected to fund the Nebraska Dog & Cat PET # 1 Dog ❑ Cat ASpayed/Neutered License Fee $ Pet Name C'> .� ' �a ° Aqe Sex i' 4 Color �.o` a� r / �� - Breed** _ Replacement $ Declared Dangerous or Potentially Dangerous Dog: ❑ Y ❑ N MICROCHIP # (If applicable) SUBTOTAL: $ 1 I (-M' RABIES VACCINATION DATE: 11-- 14 —1 k (3 yr) (1 yr) City Tag # ,4,) q3 m ** PET #2 ❑ Dog ❑ Cat ❑ Spayed/Neutered License Fee $ Pet Name Agge Sex Color Breed** Rep/acement $ ** Declared Dangerous or Potentially Dangerous Dog: ❑ Y ❑ N MICROCHIP # (If applicable) SUBTOTAL: $ RABIES VACCINATION DATE: (3 yr) (1 yr) City Tag # PET #3 ❑ Dog ❑ Cat ❑ Spayed/Neutered Pet Name Agge Sex Color Breed** Declared Dangerous or Potentially Dangerous Dog: ❑ Y MICROCHIP # (If applicable) RABIES VACCINATION DATE: (3 yr) License Fee $ Replacement $ ❑N 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.) Donation to care for animals: $1 $3 $5 $10 Other ***SEE BACK OF FORM FOR BREED SPECIFIC LICENSE REQUIREMENTS VISA / MC # Signature Do Not Send Cash by Mail TOTAL ENCLOSED $ ** Expires: Security Code: * If you have questions, please contact City Hall at (402) 426-4191 or by Fax: (402) 426-4195 ++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ NEW PET/NEW RESIDENT LICENSING REQUIREMENTS(March 15late fee date not applicable for newpets/new residents) Newly Acquired Pets: New Residents to Blair: ■ Must be licensed within 10 days of ownership ■ Must register pets within 10 days of ■ <OR> at 6 months of age if puppy/kitten residency. fta'�D tt CITY OF BLAIR - 2019 PET LICENSE VERIFICATION If you live in Blair City limits and own a dog(s) and/or cat(s), complete/verify this form and return with check made payable to: City of Blair * 218 S 16th St. * Blair, NE 68008 You may legally own a combination of four (4) adult pets, but no more than three (3) adult dogs or three (3) adult cats per residential or dwelling unit. LICENSE RENEWALS ARE DUE: March 15, 2019 LICENSE FEES: Dog or Cat: $16.00 Owner Name: GILLILAND,*bkRACM-'( OK �e Spayed/Neutered Dog or Cat: $11.00 Owner Address: 555 N 16TH ST Replacement Fee for Lost Tag: $5.00 Fee includes $1.25 for the Nebraska Dog and Cat City/State/ZIP: BLAIR, NE, 68008--0000 Operator Inspection Program Phone* <NO PRIMARY PHONE> Drivers License #: or Date of Birth: Name: Maggie Color: White/Grey Spayed/Neutered: True Mirochip # Vaccination Date: 7/18/2016 Subtotal licensed pets from below: Replacement Tags from below: DOB: Not on File Sex: Female Breed: Havanese Duration: 3 year vaccine Vaccine Exp: 7/18/2019 License Fee $ `. 0( Replacement: ❑Y EA City Tag # 1090 Total: 0.00 CAJ- CITY OF BLAIR - 2019 PET LICENSE VERIFICATION If you live in Blair City limits and own a dog(s) and/or cat(s), complete/verify this form and return with check made payable to: City of Blair * 218 S 16th St. * Blair, NE 68008 You may legally own a combination of four (4) adult pets, but no more than three (3) adult dogs or three (3) adult cats per residential or dwelling unit. LICENSE RENEWALS ARE DUE: March 15, 2019 LICENSE FEES: Dog or Cat: $16.00 Owner Name: GLASER, DAVID J & PAMELA S Spayed/Neutered Dog or Cat: $11.00 Owner Address: 775 N 3RD ST Replacement Fee for Lost Tag: $5.00 Fee includes $1.25 for the Nebraska Dog and Cat City/State/ZIP: BLAIR, NE, 68008--0000 Operator Inspection Program Phone #: (402) 426-5782 Drivers License or Date of Birth: 11/15/1956 Subtotal licensed pets from below: Replacement Tags from below: Name: Millie DOB: Not on File Sex: Female License Fee $ Color: Red Breed: Dachshund Replacement: Spayed/Neutered: True ❑YN Mirochip # 985121005094362 City Tag # 134 Vaccination Date: 3/1/2018 Duration: 3 year vaccine I Vaccine Exp: 3/1/2021 Total: 2019 PET LICENSE VERIFICATION /APPLICATION FOR CITY OF BLAIR IF YOU LIVE IN BLAIR CITY LIMITS AND OWN A DOG(S) AND /OR CAT(S), COMPLETE THIS FORM AND RETURN WITH A CHECK PAYABLE TO' CITY OF BLAIR — 218 S. 16TH ST — BLAIR, NE 68008 YOU MAY LBGALLY OWN A COMBINATION OP POUR (4) ADULT PET$, BUT NO MORE THAN THREE (3) ADULT DOGS OR THREE (3) ADULT CATS PER RESIDENTIAL OR DWE41_IN0 UNIT, ***PLEASE READ CAREFULLY*** YOU ARE REQUIRED BY LAW TO LICENSE YOUR PETS, VaIlUre to do so is a violatlon of City Ordinances 6.103 and carries a penalty of -a fine up to $150.00 per pet, PET LICENSE RENEWALS ARE DUE BY 3/ IV?919. The city shall recognize a Microchip ID number as the license number. It shall be unlawful for any dog or cat to wear any license or other city I0 other than that issued by the City of Blair for such dog or cat, NEW PET LICENSING Must be licensed within 10 days of ownership (OR) at 6 Months of age if puppy or kitten NEW RESIDENT$ T6 BLAIR Must register pets within 10 days of residency Owner Name Jennifer Globe Spouse Jesse Basch Owner Address 1140 Park St city/state/zip B16ir,, NE 68008 4- PhoneO ----------- 402-237-9613 DL # or DOB 7piT Pet Name: Freckles -k—ale Age. 51114 sex- Neutered Color: White Breed: Terrier X (Declared Pa ngerous/ Potentially Dangerous Dog NO'\ 7 YES Microchip Ci�'ty Tag INIffil Rabies Tag :WSI.7 Rabies Description: J F YEA 3 YEAR Holstein Veterinary Clinic Dr, Lisa Schrum DVM & Dr. Krista Holstein DVk 718 South 19ti' Street Blair, NE 68008 402-426-7387 402-426-0101 Fax holsteinclinic@gmail.com LICENSE FEES Intact Dog or Cat- $16,00 Altered Dog or cat: $11,00 Replacement Tag $5,00 1100 Total _FAX E _D -1 R 2- 1 M8 .9 '_ 37 3 2 jq­ BY TOTAL PAGES TO/TO 39Vd DIFII10 13A NI31510H TOTO971v3ov 6b:bT 6TOZ/90/30 CITY OF BLAIR - 2019 PET LICENSE VERIFICATION If you live in Blair City limits and own a dog(s) and/or cat(s), complete/verify this form and return with check made payable to: City of Blair * 218 S 16th St. * Blair, NE 68008 You may legally own a combination of four (4) adult pets, but no more than three (3) adult dogs or three (3) adult cats per residential or dwelling unit. LICENSE RENEWALS ARE DUE: March 15, 2019 LICENSE FEES: Dog or Cat: $16.00 Owner Name: Tim and Maria Goede Spayed/Neutered Dog or Cat: $11.00 Replacement Fee for Lost Tag: $5.00 Owner Address: 2812 Larsen Drive Fee includes $1.25 for the Nebraska Dog and Cat City/State/ZIP: Blair, NE 68008 Operator Inspection Program Phone #: (402) 841-9513 Drivers License #: or Date of Birth: 11/7/1951 Name: Betty Color: Yellow Spayed/Neutered: True Mirochip # _ Vaccination Date: 3,19f2'16 Subtotal licensed pets from below: Replacement Tags from below: DOBA Not on File Sex: Female Breed: Labrador Retriever Duration: year vaccine Vaccine Exp: 319/2(S1Y9 License Fee $ It . 0® Replacement: ❑Y ON City Tag # 1828 Total:-U Red Barn Veterinary Clinic & Farmacy, PC 101 E. 10th Oakland NE.68045 (402) 685-5202 Rabies Certificate Client ID: 6775 Patient ID: 102332 Client Name: Tim & Maria Goede Patient Name: Betty Address: 2812 Larsen Drive. Species: Canine Blair NE 68008 Breed/Color: Retriever, Labrador, Sex: Spayed yellow Female Phone: (402) 841-9513 Date of Birth: 12/15/2012 Weight: 47.9 Microchip ID: Rabies Vaccine Information: Vaccine Date: 7/19/2018 Date Due: 7/19/2019 Tag Number: 181496 Lot Number: 12640 MFG By: Merial - IMRAB 3 Lot Exp: 4/27/2019 ADM: - Subcutaneous) I have vaccinated against rabies for the specified animal as described above. Drs. Stewart Hartwell, James Unwin, Pat Maline, & Kellie Wise CITY OF BLAIR - 2019 PET LICENSE VERIFICATION If you live in Blair City limits and own a dog(s) and/or cat(s), complete/verify this form and return with check made payable to: City of Blair * 218 S 16th St. * Blair, NE 68008 You may legally own a combination of four (4) adult pets, but no more than three (3) adult dogs or three (3) adult cats per residential or dwelling unit. LICENSE RENEWALS-AREDUE: March 15, 2019 LICENSE FEES: Dog or Cat: $16.00 Owner Name: Dick an�Nanc Goeken Spayed/Neutered Dog or Cat: $11.00 ` Replacement Fee for Lost Tag: $5.00 Owner Address: 644 N 11th St Fee includes $1.25 for the Nebraska Dog and Cat City/State/ZIP: Blair, NE 68008 Operator Inspection Program Phone #: (402) 990-1865 Drivers License #: C y d 0 g.� 6 or Date of Birth: Name: Buddy Color: White/Grey Spayed/ eutered:(True) Mirochip # yl 0 Vaccination Date: 312-3/2017 -- Subtotal licensed pets from below: Replacement Tags from below: DOB: 3/22/2006 Sex: Male Breed: Domestic Shorthair Duration: 1 year vaccine Vaccine Exp: X23/20'f8rv' " - License Fee $ Replacement: ❑Y MN City Tag # 235 Total• 3 - P"(f CITY OF BLAIR - 2019 PET LICENSE VERIFICATION If you live in Blair City limits and own a dog(s) and/or cat(s), complete/verify 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 RENEWAL ARE. UE: March 15, 2019 LICENSE FEES: Dog or Cat: $16.00 Owner Name: Dick an c1SNancy oeken Spayed/Neutered Dog or Cat: $11.00 Owner Address: 644 N 11th St Replacement Fee for Lost Tag: $5.00 Fee includes $1.25 for the Nebraska Dog and Cat City/State/ZIP: Blair, NE 68008 Operator Inspection Program Phone #: (402) 990-1865 Drivers License* or Date of Birth: Subtotal licensed pets from below: Name: Tia Color: pay /Neutered:Cfrue) Mirochip # K o Vaccination Date: 10/31/2017 Replacement Tags from below: DOB: 8/19/2010 Sex: Female Breed: Domestic Shorthair Duration: 3 year vaccine Vaccine Exp: 10/31/2020 License Fee $ Replacement: ❑Y ON City Tag # 236 Total: J,e,tlj, -�' yf CA CITY OF BLAIR - 2019 PET LICENSE VERIFICATION If you live in Blair City limits and own a dog(s) and/or cat(s), complete/verify this form and return with check made payable to: City of Blair * 218 S 16th St. * Blair, NE 68008 You may legally own a combination of four (4) adult pets, but no more than three (3) adult dogs or three (3) adult cats per residential or dwelling unit. LICENSE RENEWALS A DUE: March 15, 2019 LICENSE FEES: Dog or Cat: $16.00 Owner Name: Dick an N- n%Goeken Spayed/Neutered Dog or Cat: $11.00 _- Replacement Fee for Lost Tag: $5.00 Owner Address: 644 N 11th St Fee includes $1.25 for the Nebraska Dog and Cat City/State/ZIP: Blair, NE 68008 Operator Inspection Program Phone #: (402) 990-1865 Drivers License #: &,,2�DQ 834 3 or Date of Birth: lq - / 9 S1% Name: Zoey Color: Tan �paye /Neutered: True Miir-ochip # 985112003300742 ye 5 Vaccination Date: 12/18/2017 Subtotal licensed pets from below: Replacement Tags from below: DOB: 4/30/2013 Sex: Female Breed: Mix Breed Duration: 3 year vaccine Vaccine Exp: 12/18/2020 License Fee $ Replacement: ❑Y1AN City Tag # 1353 Total: CITY OF BLAIR - 2019 PET LICENSE VERIFICATION If you live in Blair City limits and own a dog(s) and/or cat(s), complete/verify this form and return with check made payable to: City of Blair * 218 S 16th St. * Blair, NE 68008 You may legally own a combination of four (4) adult pets, but no more than three (3) adult dogs or three (3) adult cats per residential or dwelling unit. LICENSE RENEWALS ARE DUE: March 15, 2019 LICENSE FEES: Dog o'�6a't $16.00 Owner Name: Jeffrey Goeken Spayed eut Dog or Cat: $11.00 Owner Address: 951 Iowa Ave #3 Replacement Fee for Lost Tag: $5.00 Fee includes $1.25 for the Nebraska Dog and Cat City/State/ZIP: Blair, NE 68008 Operator Inspection Program Phone #: (402) 237-1291 Drivers License or Date of Birth: AhccA,� a 7� / P f 0 ,, 0 Subtotal licensed pets from below: Name: Color: White/Grey Spayed/Neutered: True Mirochip # `iVo Vaccination Dat742412017 Replacement Tags from below: DOB: 7/1/2004 Sex: Male Breed: Domestic Shorthair Duration: 1 year vaccine Vaccine Exp. 7124/2W8-' License Fee $ Replacement: ❑Y ON City Tag # 1801 Total: 3- CITY OF BLAIR - 2019 PET LICENSE VERIFICATION If you live in Blair City limits and own a dog(s) and/or cat(s), complete/verify this form and return with check made payable to: City of Blair * 218 S 16th St. * Blair, NE 68008 You may legally own a combination of four (4) adult pets, but no more than three (3) adult dogs or three (3) adult cats per residential or dwelling unit. LICENSE RENEWALS ARE DUE: March 15, 2019 LICENSE FEES: Dog or Cat: $16.00 Owner Name: Jeffrey Goeken Spaye ' Neutere �Qg or Cat: $11.00 Owner Address: 951 Iowa Ave #3 Replacement Fee for Lost Tag: $5.00 Fee includes $1.25 for the Nebraska Dog and Cat City/State/ZIP: Blair, NE 68008 Operator Inspection Program Phone #: (402) 237-1291 Drivers License #: �A o b i e or Date of Birth: �A.U� V 7U Subtotal licensed pets from below: Replacement Tags from below: VLy— Name: Rowdy Color: Browne- h Spayed/ eute e.: True Mirochip # yN'0 Vaccination Date: 3/29/2016 DOB: 5/21/2007 Sex: Male Breed: Chihuahua Duration: 3 year vaccine Vaccine Exp: 3/29/2019 License Fee $ // ou Replacement: ❑Y ON City Tag # 1802 Total: CITY OF BLAIR - 2019 PET LICENSE VERIFICATION If you live in Blair City limits and own a dog(s) and/or cat(s), complete/verify this form and return with check made payable to: City of Blair * 218 S 16th St. * Blair, NE 680.08 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, 2019 LICENSE FEES: Dog or Cat: $16.00 Owner Name: Jeffrey Goeken Spayed/Neutered Dog or Cat: $11.00 Owner Address: 951 Iowa Ave #3 Replacement Fee for Lost Tag: $5.00 Fee includes $1.25 for the Nebraska Dog and Cat City/State/ZIP: Blair, NE 68008 Operator Inspection Program Phone #: (402) 237-1291 Drivers License #: 0 yu— or Date of Birth: e� Subtotal licensed pets from below:l 1. Name: Tawny Color: vj paye / eutered:(t e, Mirochip # n p Vaccination Date: 3/29/2016 Replacement Tags from below: VW DOB: 10/20/2009 Sex: Female Breed: Chihuahua Duration: 3 year vaccine Vaccine Exp: 3/29/2019 License Fee $ Replacement: ❑Y ON City Tag # 1803 Total: CITY OF BLAIR - 2019 PET LICENSE VERIFICATION If you live in Blair City limits and own a dog(s) and/or cat(s), complete/verify this form and return with check made payable to: City of Blair * 218 S 16th St. * Blair, NE 68008 You may legally own a combination of four (4) adult pets, but no more than three (3) adult dogs or three (3) adult cats per residential or dwelling unit. LICENSE RENEWALS ARE DUE: March 15, 2019 LICENSE FEES: Dog or Cat: $16.00 Owner Name: Neal & Georgia Goeken Spayed/Neutered Dog or Cat: $11.00 Replacement Fee for Lost Tag: $5.00 Owner Address: 1326 Jackson St Fee includes $1.25 for the Nebraska Dog and Cat City/State/ZIP: Blair, NE 68008--0000 Operator Inspection Program Phone #: (402) 681-4367 Drivers License #: Name: Lincoln Color: Black/White Spayed/Neutered: True Mirochip # Vaccination Date: 07/02/2018 or Date of Birth: Subtotal licensed pets from below:_ , Replacement Tags from below: DOB: 01/01/2016 Sex: Male Breed: Poodle - Standard Duration: 3 year vaccine Vaccine Exp: 07/02/2021 License Fee Replacement: ❑Y I City Tag # 2422 D Total:_ FAX NO. :402-533-2722 Feb. 01 2019 05:47PM P2 CITY OF BLAIR - 2019 POET 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 b 218 S.16tb St. a Blair, NE 68008 You may legally owns a combinlation of four (4) adult pets, but no moea than three+, (3) adult dogs or three (3) adult oats per residential gr dweiling unit. LICENSE RENEWALS ARE DUE: IMarch 1% 2019 Owner Name: �r n--_. l _�.1r n --- __... Owner Address: A fq-tr�j�QLV cit'y,/sat'ateaip: Blair, NE 68008 Phone ,# A©, %, -- t �71yD Drivers License # or Date of Birth ....... - /Q a .. `] LXCENSE FEES., Dog or Cat: $16.00 Altered bog or Cat: $il.00 Replacement Fee for Lost Tag: $5.00 W fund the ***PLEASO OW CAREFULLY*** YOU ARE REQUIRED BY 4AW TO I-MINSF YOUR, PETS, Failure to do so is a violation of City ordinances 6.103 and carries a pehalty of a fink up to *130.00 par pet. PET LICENSES IRENEWALS ARE NE BY ALIV,2M. The City Shall rAc6§hiz0 6 Micr6thip idorltiPtbtloh huenb@r at the Ilcenre number. it shall be unlbwful for tiny doff or tht to wear 6hy license or other city Identification other than that issued by the City off fah, for such dog or cat. The City of Blair requires proof of rabies vaccination. PET ##1 DQg 0 Cat WSpayed/Neutered License Fee $ 1 /„ Pet Name `-1 " Age 2,J—, Sex Color 'tom Breed*" r a - -- �a Replacement $_ Declared Dangerous or Potentially Dangerous Dog: ❑ Y N MICROCHIP # (If applicable) SIJOTOTAL: $ RABIES VACCINATION DATE: ;` (3 yr) (1 yr) City Tag # FT,n .... PET #3 ❑ Dog ❑ Cat ❑ Spayed/Neutered License Fee $� Pet Name- ­Color re ve -- ... hex — ... Replacement $_--. - .. Doclared Dangerous or Potentially Dangerous Dog: ❑ Y ❑ N MICROCHIP # (If applicable) SUBTOTAL: $ RABIES VACCINATION GATE, _ .._ _ _ ._ .. (3 yr) T (i yr) City Tag #�* PET #3 El Dog 0 Cat © Spayed/Neutered License Fee $� Pet Name Aqe Sex Color _-- Breed" Replacement$ _ ** Declared Dangerouus or Potentially Dangerous dog: U Y ❑ N MICROCHIP # of applicable) SUBTOTAL: $ RABIES VACCINATION DATE (3 yr) _ (I yr) _ City Tag *PLEASE INCI„UK THE +tiM TAG NUMEIER IF THIS IS A RENEWAi, ** (This fee is due along with License Fee if requesting at the time of license renewal.) Donation to care for animals; $I $3 ,�,�, $$ $10 Other ***SEE BACK OF FORM FOR BLEED SPECIFIC LICENSE REf,'�i IRMENTS Do Not Send Cash by MaH TOTAL ENCLOSED $ ViSA / MC # Expiros: _-_...., Security Code: Signature If you have questions, please contact City Mall at (402) 426.4191 or by Fax.- (402) 426-4195 ..............+++tit.... .....++++............ .............................................. NEW PET/NEW 119$IDENT LICENSING REQUIREMENTS (Marla �� late tee datenatapplic�blef+�rnaw/�el�/newr�ir�en�.) NQWN Acquired Pats: NEt�► Rer<,siLl Oi to Blair. al Must be Ib sed wldirn 10 days of ownership ■ Must regisket poi within 10 days of ei <0115 at 6 monft of age if puppy/kl nn residency. .N FROM :BSAC FAX NO. :402-533-2722 Feb. 01 2019 05:46PM P1 CITY OF GLAIR - 2019 PET LICENSE APPLICATION If YOU live in Blair Clty limb br)d own a dogs) and/or cat(s), complete this form and return with check made payable to: City of Blair 0 218 S.16th St. a Blair, NE 68008 YOU May legaliy oWn a combination of four (4) adult pets, but ran more than three (3) adult slogs or throe (3) adult cats per residential or Owelling unit. LICENSE RENEWAL$ ARE DUE: ftrCh 15, 2W Owner Name-. Owner Address: c1ty/stalte/zip. Blair, NE 68008 Phone, # 40, ,;� .-- '- -D6 Drivers License # or Crate of Birth LICENSE FEES: Dog or Oat: $16.00 Altered log or Cat: $11.00 Replacement fee for Lost Tag: $5.00 ***PLFASV READ CAREFULLY*** YOU ARE REQUIRED BY LAW TO LICENSE YOUR PU9, Failure to da 94 is a rllbl3Uon of City ordinances 6.103 and carries a penaity of a flee up to $150,011) par plat. PET i,ICENSES RENEWALS ARE DUE BY ALIALZM, The Oty shall recognize a microchip identification number as the license nurabor. it shall be unlawful for any (long or cat to wear any Ileensc or ukher city idenuf1catlon other than that icsued by the City of Blair for such dog or cat. The CIty of Blhir rdqulres proof of rabies vatelnptltin, to fund the Nebraska Don & Cat PE'T #1 )P( Peg ❑ Cat 05payed/Neutered License Fete $.. d, 00 Pet Name Lam.__-m ._.� Abe Sex `-govr' Color -r L C Breed * Replacement $ * Declared Dangerous or Potentially Dangerous [dog: ❑ Y MICROCHIP # (If applicable) SUBTOTAL; $ RABIES VACCINATION DATE: r (3 yr) (1 yr) _ City Talg * FM - PET #2 U Dog ❑ Cat Q Spayed/Neutered License Flee $� Pet Name An Sex Color 'Breed * Replacement$_,_ ** Declared Dangerous or Potentially Dangerous Dog, ❑ Y ❑ N MICROCHIP # (If applicable) SUBTOTAL: $ RAWS VACCINATION DATE: (3 yr) (I yr) City Tag 4t* PET #3 ❑ Dog 0 Cat ❑ Spayed/Neutered License Fee Pet Name .. Aqe Sex Color Breed * Rep/aeenaent $ ** Declared Dangerous or Potentially Dangerous Dog: ❑ Y ❑ N MICROCHIP # (If applicable) SUBTOTAL, $ RABIES VACCINATION DAfE: -.... , (3 yr) (I yr) _.. City Tag *PLEASE INCLUDE YNE +CIiYTAG NUMBERIP'THIS IS A RENEWAL ** (This fee is duo along with License Free it requesting at the time of license renewal.) Donation to carte for animals. $1 _ $3 $5 --... $10 Clther ***SEE BACK of FORM FOR BREED SPECIFIC LICENSE REQUIREMENTS VISA / MC # Signature Qo Not Send cash by Mail TOTAL ENCLOSED $ Expires: W�_ .. . . Security Code: If you have questions, please contact City Mall at (402) 426-4191 or by Fax: (402) 426-4195 ..... h...........t4.....++..++++.........+++++*......t++....*+++ih......•h-t....t NEW PETINEW RESIDENT LICENSING REQUIREMENTS (Mar0 ,i!5 /at`V fey date notapob�a&e fornewpels/newnaside7ts) Itwly Amui P0. New_Ft ldents tp $iairi 1s Wd be 11terwd within 10 days of pwrloip ■ Must reglsber pet$ within 1.0 days of i 40R> at C months of age if puppy/kltban residency. 03/28/2019 13:54 4024260101 HOLSTEIN VET CLINIC PAGE 01/02 2019 PET LICENSE VERIFICATION/APPLICATION FOR CITY OF BLAIR IF YOU LIVE IN BLAIR CITY LIMITS AND OWN A DOD(S) AND JOR CAT(S), COMPLETE THIS rORM AND RETURN WITH A CHECK PAYABLE TO; CITY OF BLAXR — 218 S. JGTH 5T — GLAIR, NIE 68008 YOU MAY LEGALLY OWN A COMBINATION OF FOUR (4) ADULT PETS, BUT NO MORE THAN THREE (3) ADULr DOGS OR THREE (3) ADULT CATS PER RESIDENTIAL OR DWELLING UNIT, 'PLEASE DEAD CAREFULLY' YOU ARE REQUIRED BYLAW TO LICENSE YOUR PETS. Failure to do so is a vie lation of City Drdinances 6.103 and carries a penalty of a flne Up to $150.00 per Pet. PET LICENSE RENEWALS ARE DUE BY 3115/2019 The city shall recognize a microchip ID number as the license number, It shall be unlawful for any dog or cat to wear any license or Qther city Ib other than that issued by the city of Blair for such dog or cat. NEW PET LICENSING Must be licensed within 10 days of ownership (OR) at 6 months of age if puppy or kitten NEW RESIDENTS TO BLAIR Must register pets within 10 days of residency Pet Name: Dawson Age: By Sex: Neutered Male Iereed: MiX !Color: Whig Declared Dangerous/potentially Dangerous Dog Microchip # Rabies Description: (r 1 Holstein Veterinary Clinic Dn Usa schrurn DAM & Dr, 9rista HNstein DVM "18 South 19th Street Blair, NE 68008 02-426-7387 402-426-0101 Fax hoisteinclinic@gmail.com ND' I YES City Tag # 1 .D Rabies Tag # 16839 3 YEAR LICENSE FEES Intact Dog or Cat: $16.00 or cat: $11,00 Replacement Tpg, $500 Total $ 11 FAXED 03-28-19 1:26p BY TOTALPAGES l 03/28/2019 13:54 4024260101 HOLSTEIN VET CLINIC PAGE 02/02 2019 PET LICENSE VERIFICATIONJAPPLIcATION FOR CITY OF BLAIR IF YOU LIVE IN BLAIR CITY LIMITS AND OWN A DOG(S) AND /OR CAT(S), COMPLETE THIS FORM AND RETURN WITH A CHECK PAYABLE TO: CM OF BLAIR — 218 S. 16TH ST — BLAIR, NE 6800E 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, ***PLEASE READ CAREFULLY*** YOU ARE E U(RED BY W TO LICENSE YOUR PETS. Failure to db so is a violation of City Ordinances 6,103 and carries a penalty of a fine up to $150.00 per pet PET LiGENSE RENEWALS ARE bUE BY 3 15 2p19. The city shall recognize a microchip III number as the license number. It shall be unlawful for any dog or cat to wear any license or other city 10 other than that issued by the City of glair for such dog or cat. NEW PET LICENSING Must be licensed within 10 days of ownership (OR) at 6 months of age if puppy or kitten NEW RESIDENTS TO BLAIR Must register pets Within 10 days of residency I— - ,T Pet Name: Bronley Age: S Y Sex: Neutered Male Brood: Sheba Enu Color: Tarr Declared Dangerous/potentially Dangerous Dreg Microchip # Rabies Description: 1 YEAR Holstein. Veterinary Clinic Dr Lisa Schrum.DVM & T)r. Krista Holstein ,DVM -718 South 19th Street Eclair, NE 68008 02-426-7387 402-426-0101 Fax holsteinclinic@gma1I.com { n YES City Tag # Ratbies Tag # Y�,AR 5tivwu Am- LICENSE FEES Intact Dog Or Cat; $16.00 Dog or cat: $11.00 $5.00 Total $ 11 FAXW 03-28-191:24p BY TOTAL PALLS Thone Animal Hospital 902 S Hwy 30 Blair, NE 68008 402-426-3630 Printed: 10-07-19 at 1:28p CLIENT INFORMATION Name Chantel Gravedoni (6126) Address 2732, Larsen Dr Spouse Dennis Blair, NE 68008 Phone 402 426-8698 Balance 0.00 PATIENT INFORMATION Name Jake Species Canine Sex Male, Neutered Breed Shep Mix Birthday 05-23-13 Iw # Age 6y ID Rabies 005023 Color Black and Tan Weight 49.00 Ibs Reminded (none) Codes MEDICAL HISTORY Date By Code Description Patient Chart Qty (Variance) Photo 07-24-19 KF R3 Rabies Vaccination (3 Year), #005023 B1 Bordetella Oral AC6 Check up, DA2PPV+L Thone Animal Hospital 902 S Hwy 30 Patient Chart Blair, NE 68008 402-426-3630 Printed: 10-07-19 at 1:28p CLIENT INFORMATION Name Chantel Gravedoni (6126) Address 2732 Larsen Dr Spouse Dennis Blair, NE 68008 Phone 402 426-8698 Balance 0.00 PATIENT INFORMATION Name Lady Species Canine Sex Female, Spayed - Breed Australian Shepherd Birthday 11-14-07 i Age Illy ID Rabies 005046 Color Blu Merle Weight 42.00 Ibs Reminded (none) Codes MEDICAL HISTORY Date By Code Description Qty (Variance) Photo . 07-31-19 KF CARP100 Carprofen 100mg #13744 14 Give 1/2 tablet orally up to twice daily as needed for pain. Refill as needed. 8CEPH6 Cephalexin (Rilexine) 300mg Chewable #13 20 Give 1 tablet. twice daily for ten days by mouth. R3 Rabies Vaccination (3 Year), #005046 B1 Bordetella Oral AC10 Check up, DA2PPV 07-01-09 OTC 8HTGD6 Heartgard + 26-50# Pkg of 12 called Or Gochenour in Logan - he okayed dispensing heartguard MM Your Receptionist is Marla Thone Animal Hospital 902 S Hwy 30 Blair, NE 68008 402-426-3630 Printed: 10-07-19 at 1:28p CLIENT INFORMATION Name Chantel Gravedoni (6126) Address 2732 Larsen Dr Blair, NE 68008 Phone 402 426-8698 PATIENT INFORMATION Name Lucy Sex Female, Spayed Birthday 10-31-08 ID Color Blu Merle Reminded (none) MEDICAL HISTORY Date By Code 07-31-19 KF R3 B1 AC 10 Spouse Dennis Balance 0.00 Species Canine Breed Min Aussie Age 10y Rabies 005047 Weight 33.00lbs Codes Description Qty (Variance) Photo Rabies Vaccination (3 Year), #006047 Bordetella Oral Check up, DA2PPV w l N of CITY OF BLAIR - 201-8 PET LICENSE VERIFICATION If you live in Blair City limits and own a dog(s) and/or cat(s), complete/verify this form and return with check made payable to: City of Blair * 218 S. 16th St. * Blair, NE 68008 You may legally own a combination of four (4) adult pets, but no more than three (3) adult dogs or three (3) adult cats per residential or dwelling unit. LICENSE RENEWALS ARE DUE: March 15,201`$ LICENSE FEES: Dog or Cat: $16.00 Owner Name: Mary Green a, Spayed/Neutered Dog or Cat: $11.00 Replacement Fee for Lost Tag: $5.00 Owner Address: 1211 Park St. Fee includes $1.00 for the Nebraska Dog and City/State/ZIP: Blair, NE 68008 Cat Operator Inspection Program Phone #: (402) 208-6823 Drivers License #:H13566604 or Date of Birth: Not on file Subtotal licensed pets from below: Replacement Tags from below: Name: Curley DOB: Not on File Sex: Female License Fee $ Color: Brindle Breed: Mix Breed Replacement: Spayed/Neutered: True Dangerous Dog: OY ON Mirochip # 074890376 Potentially Dangerous: City Tag # 1082 Vaccination Date: 6/4/2016 Duration: 3 year vaccine Vaccine Exp: 6/4/2019 Total: P CITY OF BLAIR - 2019 PET LICENSE VERIFICATION If you live in Blair City limits and own a dog(s) and/or cat(s), complete/verify this form and return with check made payable to: City of Blair * 218 S 16th St. * Blair, NE 68008 You may legally own a combination of four (4) adult pets, but no more than three (3) adult dogs or three (3) adult cats per residential or dwelling unit. LICENSE RENEWALS ARE DUE: March 15, 2019 LICENSE FEES: Dog or Cat: $16.00 Owner Name: GREEN, PHYLLIS Spayed/Neutered Dog or Cat: $11.00 Replacement Fee for Lost Tag: $5.00 Owner Address: PO BOX 196, 290 N 23RD ST Fee includes $1.25 for the Nebraska Dog and Cat City/State/ZIP: BLAIR, NE, 68008--0000 Operator Inspection Program Phone #: (402) 426-2856 Drivers License #: Name: Gus Color: White/Black Spayed/Neutered: True Mirochip # 490411007E Vaccination Date: 5/17/2016 or Date of Birth: C10/4/1932 -J Subtotal licensed pets from below: Replacement Tags from below: DOB: Not on File Sex: Male Breed: Shih Tzu Duration: 3 year vaccine Vaccine Exp: 5/17/2019 License Fee co Replacement: ❑Y ON City Tag # 417 Total: P "" 03/01/2019 16:35 4024260101 HOLSTEIN VET CLINIC PAGE 01/02 2019 PET LICENSE VERIFICATION/APPLICATION FOR CITY OF BLAIR IF YOU LIVE IN BLAIR CITY LIMITS AND OWN A DOG(S) AND /OR CAT(S), COMPLETE THIS FORM AND RETURN WxTH A CHECK PAYABLE TO: CITY OF BLAIR - 218 S. 167n ST - BLAIR, NE 68008 YOU MAY LEGALLY OWN A COMBINATION 05 FOUR, (4) ADULT PETS, BUT NO MORE THAN THREE (3) ADULT DOGS OR THREE (3) ADULT CATS PER RESIDENTIAL OR DWELLING UNIT. ***PLEASE READ CAREFULLY*** YOU ARE REQUIRED BY LAW TO LICENSE YOUR PETS. Failure to do �o Is a violation of City Ordinances 6.103 and carries a penalty of a fine up to $150,00 per pet. PET LICENSE RENEWALS ARE DUE BY 15 2019. The cityshall recognize a microchip ID number as the license number. It shall be unlawful for any dog or cat to wear any license or other city ID other than that issued by the City of Blair for such dog or cat. NEW PET LICENSING Must be licensed within 10 days of ownership (CAR) of 6 months of age if puppy or kitten NEW RESIDENTS TO BLAIR Must register pats within 10 days of residency Owner Name Spouse owner Address City/State/Zip Phone # - DL#orDOB X # 1 /' /1 Angie Greer 2068 Park Street Blair, NE 68008 402-830-5458 Pet Name: Hadley Age: i3OY Sex: Sp►ay/ed Female ♦Color: Taln and White Breed: Shih Tzu Mix Declared Dangerous/Potentially oangerous Dog N YES microchip # CI # Rabies Vaccination Date: Rabies Tag # 15849 Rabies Description: 1 YEAR 3 YEA Holstein Veterinary Clinic Dr. Lisa Schrun) ,DVM & Dr, Krj$ta Holstein DVM '18 South 19th Street Blair, NE 68008 402-426-7387 402-426-0101 Fax hoisteinclinir,@gmail.com LICENSE FEES Intact Dog or Cat: $16-00 .,- Altered .' Dog or cat: $11.00 $5.00 Total FAXED 03-01-19 4:21p BY TOTAL PAGES 03/01/2019 16:35 4024260101 HOLSTEIN VET CLINIC PAGE 02/02 2019 PET LICENSE VERIFICATION/APPLICATION FOR CITY OF BLAIR IF YOU LIVE IN GLAIR CITY LIMITS AND OWN A DOG(S) AND /OR GAT(S), COMPLETE THIS FORM AND RETURN WITH A CHECK PAYABLE TO: CITY OF BLAIR W- 2118 S. 16TIl ST — BLAIR, NE 68008 YOU MAY LEGALLY OWN A COMBINATION OF FOUR (4) ADULT PETS, SUT NO MORE THAN THREE (3) ADULT DOGS OR THREE (3) ADULT CATS PER RESIDENTIAL OR DWELLING UNIT. ***PLEASE READ CAREFULLY*** YOU ARE R QUIRED BY LAW T LICENSE YOUR Pr Failure to do so IS a violation of City Ordinances 6.103 and carries a penalty of a fine UP to $150.00 per pet, PET LICENSE RENEWALS ARE DUE BY 3 15 019. The city shall recognize a microchip ID number as the license number. It shall be unlawful for any dog or cat to wear any license or other city ID other than that issued by the City of Blair for such dog or cat. NEW PET UCENSING Must be licensed within 10 days of ownership (OR) at 6 months of age if puppy, or Kitten NEW RESIDENTSTO BLAIR Must register pets within 10 days of residency Owner Name Spouse Owner Address City/State/zip Phone # DL # or DOB Angie Greer 2068 Park Street ltlaliry NE 68008 402-830-5458 T #� Pet Name: Grace Age: 15Y Sex: Spayed Felnnale iCaior: Red Breed: Heeler Declared Dangerous/Potentially Dangerous Dog yF5 Microchip # Rabies Vaccinatioli Date: Rabies Description: 1 YEAR Holstein Veterinary Clinic ,Dr. Lisa Schrum0VM & Dr. Kri$tq Holstein DV.M °i18 South 19th Street Blair, NE 68008 402-426-7887 402-426-0101 Fax hoisteinclinic@gmaii.com city # Rabies Tag # 15850 3 YEAR LICENSE FEES. Intact Dog or Cat: $16.00 Altered Dog or cat: $11.00 Replacement tag $5.00 Total FAXED 03-01-19 4:21p BY TOTAL PAGES 2019 PET LICENSE VERIFICATION/APPLICATION FOR CITY OF E A,IR IF YOU LIVE IN BLAIR CITY LIMITS AND OWN A DOG(G) AND /OR CAT(S), COMPLETE THIS FORM AND RETURN WITH A CHECK PAYABLE TO: (CITY OF BLAIR 218 S. 16TH ST — BLAIRr NE 68008 YOU MAY LEGALLY OWN A COMBINATION OF FOUR (4) ADULT PETS, BUT NO MORE THAN THREE (3) ADULT DOGS OR THREE (3) ADULT CATS PER RESIDENTIAL OR DWELLING UNIT. ***PLEA$E READ CAREFULLY*** YOU ARE ftEQU1RED BY I,AW TO LICENSE YOUR PETS �allurg to do so is a violation of City Ordinances 6.103 and carries a penalty of a fine up to $w.00 per pet. PET LICENSE RENEWALS ARE DUE BY 31/15/2OS9. The city shall recognize a microchip ID number as the license number, It shall be unlawful for any dog or,cat to wear any license or other city ID other than that issued by the City of Blair for such dog or cat_ NEW PET LICENSING Mint be licensed within 10 days of ownership (OR) at 6 months of age if puppy or kitten NEW RESIDENTS TO BLAIR Must register pets within 10 days of residency PET # Pet Name: Oscar Age: 5M Sex: Neutered Male Breed: Dsh Color: Declared Dangerous/Potentially Dangerous Dog Microchip # Rabies Description: Holstein Veterinary Clinic Dr. Lisa Schrurrl DVM & Dr: K'rista Holstein DVM 718 South 19th Street Blair, NE 68008 402-426-7387 402-426--0101 Fax holsteinclinic@gmail.com NO.. YES City `rag #CA Rabies Tag # 3 YEA,R, LICENSE FEES Intact Dog or Cat: $16.00 e 8 or cat. $11.0 Replacement Tag $5.00 Total�J FAXED 02-18-19 2:22p BY TOTAL PAGES ` t T8/T© 39vd DINI-10 i3A NI31S-10H T©T093bZ0b VC:PT 5T03/8T/30 FROM : BSAC FAX t`10. : 402-533-2722 Feb. 15 2019 05: 15PM P2 Dec, 26. 2018 2:53PM CITY OF BLAIR No, 8225 P, ! CITY OF BLAIR - 2019 PET LICENSE APPLICATION If You five in OlOr City limits and yawn a dog(s) and/or cat(s), obrnpinto this form and return with check mado payable to; YOU may' lQualty own a Combination of four (4) Isdult pejtsr but no more than three (3) adult degs or three (3) adult oats per residential pr dwrilllltlg unit. LICENSE RENEW E 71 10 Owner Name: Owner Address', oityl6thte/,zIp: 13 1alr:RKEEa�ft� No 18008 Phone # DOM'S I, MIii9e # ol' bate of Blab LICENSE FEES; lyng or Cot"( $id,OU Altered Dog or iCatp- $moo Replaceme"t Fee ibr WstTage $5.00 p additional sUtA Fee of.U.25 Jig L6inu caliecfxed to fbirid thi ***PLEASE CIEl4le CAREFULLY*** YOU ARP INQUIRED RY LAW -to LICENSE YOUR PETa. rallure to do sb is a violation brClty brdinAviCog 6.rus anri cheries a penalty ofa fine up to Oigo.00 per per. P4T k1G INSES RIE WALL ARV DUIR BY ALL f,2DIR. TNT City shall reragnize a microchip identiRcatian number ns the license nuniber, it shAll bu urllaWrul rqr arly dbg or ra@ r(,i wear any licAll" or other ci(y Idaritiflentibn other thol) that Mded by {ha City of eisir I'nr such ripg or Cat, 11te chy of etalr requirWm proof of rablas vaminatlen, Cat PET # 1 � � Dog Q C A t A Spayed jIN eutered License Fee $Pa iQ Nam D�, _..— A P- bty-hed ,, --Replacement $ �� Declared Darigerous or Potentially Danger s boat t) Y LI'N MICROCHIP .j..� �(�f �pplica�lo SUBTOTAL; $ ..� RAPT�S VACCINATION DATE; , (`r'`i:7 , (3 yr) yr) 'Tc, �]► Tog�. � �g�� PET 02 Ci D09 G3 Cafe ❑ Spayed/NeLltered License Fee Pet Name A e Sex Color _�_ . reedii* __ _ Replacement $ � x� Declared Wngerous or potentlaily Dangerous q - 3 Y g N MICROCHIP # (If applicable) SUOTOTAL; $ RABIF5 VACCINATION DA7rE: �....... (3 yr) — (i yr) . _.. city'rag #- .... P11„ T *3 ❑ Dog L3 Cat ❑ Splayed/Neutered LiceInae Fee $ Pet Name - Color breed** �` Avlacenuwt $ Declared Dmgerous or Potentlally Dangerous Dog.- Ll Y Q N MICROCHIP # �,�,� (If applicable) SUBTOTAL: $ . RABIES VACCIWA-i oN DATLt _ - (I yl) _ (I yr) _ City T0119 # ..................... . *PLEASE INCLUbE TM ( IN TAG, >WtiMW IFTHIS IS A RENEWMAL. ** (hips fees is due along with Licamme Fee If requesting at the tllltl0 of 110a Ve relrloWal.) oration to care for Ahjmjgg,t $� $3 -- - $ $11) Other ***SEE BACK OF FORM FOR WTI) SPECIFIC LICENSE IZEC7U1J:jE L4NTs VISA MC Signature DolViit Seancr cash toy Af,911 TOTAL AL GN��:LOSEb lxpir�,rs: Seourlty Ciaft if you have quaetlan.5, please contact City Hall At (402) 426.4191 or by Fax' (402) 426-41915 t+4-+Hk*+ r+.r.....++++.+a.>a.*.......+..........-ki...tip.................... NEW PiaTINEIA_I RkTOENT LTCI!NSING F OUXREMENTS (Maki 15idte ftdaknot appl)mblefi)rnea+'la&"awt85fdjqnts) 8 9W ltaeidentst B!a _ rr M'u be loan, wl h(n 10 rJeyso!'oWl vp R MUst reglSt r pets w hln 10 t1ay5 of a101i> at 6 months of age if puppy/ktttan nesidan cv. Mar 09 19 07:49a Thone Animal Care 4024266808 p,1 CITY OF BLAIR - 2019 PET LICENSE VERIFICATION If you live in Blair City limits and own a dog(s) and/or cat(s), compietei'verify this form and return with check made payable to: City of Blair * 218 S 16th St. * Blair, NE 68008 You may legally own a combination of four (4) adult pets, but no more than three (3) adult dogs or three (3) adult cats per residential or dwelling unit. LICENSE RENEWALS ARE DUE: March 16, 2019 LICENSE FEES: Dog or Cat: $16.00 Owner Name: GRIM, JOSEPH & APRIL Spayed/Neutered Dog or Cat: $11.00 Replacement Fee for Lost Tag: $5.00 Owner Address: 13�15 GRANT ST Fee includes $1.25 for the Nebraska Dog and Cat City/State]ZIP: BLAIR, NE, 68008--0000 Operatorinspection Program Phone #: <NO PRIMARY PHONE> Drivers License #: or Date of Birth: 4J2/1984 Name: Aj Color: Orange Spayed/Neutered: True Mirochip # Vaccination Date: 812/2017 Subtotal licensed pets from below: Replacement Tags from below: DOB: Not on File Sex: Male Breed: Domestic Shorthair Duration: 3 year vaccine Vaccine Exp: 8/2/2020 License Fee $ Replacement: EIY [IN City Tag # 1415 Thone Animal02 426-3630 lair 9}02S. HWY 30 Blair, NE 68008 Total. Mar 09 19 07:49a Thone Animal Care 4024266808 p,2 CITY OF BLAIR - 2019 PET LICENSE VERIFICATION If you -live in Blair City limits and own a dog(s) and/or cat(s), complete/verify this form and return with check made payable to: City of Blair * 218 S 16th St. * Blair, NE 68008 You may legally own a combination of four (4) adult pets, but no more than three (3) adult dogs or three (3) adult cats per residential or dwelling unit. LICENSE RENEWALS ARE DUE: March 15, 2019 LICENSE FEES: Dog or cat: $16mc Owner Name: GRIM, JOSEPH & APRIL. Spayed/Neutered Dog or Cat: $11.00 Owner Address: 1345 GRANT ST Replacement Fee for Lost Tag: $5.00 Fee includes $2,25 for the Nebraska Dog and Cat City/State/ZIP, BLAIR, NE, 68008--0000 Operator Inspection Program Phone #: ENO PRIMARY PHONE> Drivers license #: or Date of Birth: 412/1984 Subtotal licensed pets from below: Replacement Tags from below: Name: Jax Color: WhitetGrey Spayed/Neutered: True Mirochip #' Vaccination Date: 9113/2017 DOB: Not on File Sex: Male Breed: Domestic Shorthair Duration: 3 year vaccine Vaccine Exp: 9/13f2020 License Fee $ Replacement: ❑Y ON City Tag # 1416 Thone Animal Care of Blair (402) 42&-3630 902 S. Hwy 30 Blair, NE 68008 Total: Mar 09 19 07:49a Thone Animal Care 4024265808 p.3 CITY OF BLAIR - 2019 PET LICENSE ADDITIONS If you live in Blair City limits and own a dog(s) and/or cat(s), complete/verify this form and return with check made payable to -- City of Blair * 218 S 16th St. * Blair, NB G8008 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 16, 2019 Owner Name: GRIM, JOSE:PH & APRIL Owner Address: 1345 GRANT ST City/State/ZIP: BLAIR, NE, 68008--0000 Phone 9: ENO PRIMARY PHONES Drivers License #: LICENSE FEES: Dog or Cat: $16.00 Spayed/Neutered Dog or Cat: $11.00 Replacement Fee for Lost Tag: $5.00 Fee includes $1.25 for the Nebraska Dog and Cat Operator Inspection Program or Date of Birth: 4/2/1984 Subtotal licensed pets from below. Replacement Tags from below: Total: p� Dog ❑ Cat Spayed/Neutered License Fee Pet Name Pet DOB -D Sex 1- Color &A/4(" Breed Declared Dangerous or Potentially Dangerous Dog? ❑ Y ❑ N� Microchip # LA CF)1 SCa 0 0 0c— Rabies Vaccination Date tM yr I -]I yr ❑ Dog ❑ Cat ❑ Spayed/Neutered License Fee $ Pet Name 'Age Sex Color Breed Declared Dangerous or Potentially Dangerous Dog? ❑ Y ❑ N Microchip # Rabies Vaccination Date ❑3 yr ❑ 1 yr ❑ Dog ❑ Cat ❑ Spayed/Neutered License Fee $ Pet Name Pet DOB Sex Color Breed Declared Dangerous or Potentially Dangerous Dog? ❑ Y ❑ N Microchip # Rabies Vaccination Date Thone Animal Care of Blair (402) 426-3630 902 S. Hwy 30 Blair, NE 68008 ❑3 yr 01 yr E 1 j CITY OF BLAIR - 2019 PET LICENSE VERIFICATION � If you live in Blair City limits and own a dog(s) and/or cat(s), complete/verify this form and return with check made payable to: City of Blair * 218 S 16th St. * Blair, NE 68008 You may legally own a combination of four (4) adult pets, but no more than three (3) adult dogs or three (3) adult cats per residential or dwelling unit. LICENSE RENEWALS ARE DUE: March 15, 2019 LICENSE FEES: Dog or Cat: $16.00 Owner Name: Andris & Ann Grinbergs Spayed/Neutered Dog or Cat: $11.00 Owner Address: 2130 Jackson St Replacement Fee for Lost Tag: $5.00 Fee includes $1.25 for the Nebraska Dog and Cat City/State/ZIP: Blair, NE 68008--0000 Operator Inspection Program Phone #: (402) 426-3517 Drivers License #:G29004948 or Date of Birth: 11/26/1946 Name: Boots Color: Black/White Spayed/Neutered: True Mirochip # 986112000939325 Vaccination Date: 5/1/2017 Subtotal licensed pets from below: Replacement Tags from below: DOB: 1/1/2013 Sex: Male Breed: Jack Russell Terrier Duration: 3 year vaccine Vaccine Exp: 5/1/2020 License Fee $ Replacement: ❑Y'�b,N City Tag # 1272 Total: 1/4 >, 2010 PET LICENSE VERIFICATION/APPLICATION FOR CITY OF BLAIR IF YOU LIVE IN BLAIR CITY LIMITS AND OWN A DOG(S) AND /CIF;, CAT(5), COMPLETE THIS FORM AND RETURN WITH A CHECK PAYAOLE TO. CITY OF BLAIR — 218 S. 16TH ST — BLAIR, N0 S$OOB YOU MAY LEGALLY OWN A COMBINATION OF FOUR (4) ADULT PETS, BUT NO MORE THAN THREE (3) ADULT bOGS OR THPrt1 (3) ADULT CATS PER RESIDENTIAL OR PWr=LLING UNIT - ***PLEASE REAL? CAREFULLY*** YOU ARE E UIRED BY LAW r0 LICENSE YO R PETS. Failure to do so is a violation of City Ordinances 6.103 and carries a penalty of a fine up to $150.00 per pet, PET LICENSE RENEWALS ARE DUE BY 3/15/2o1$. The city shall recognize a microchip ID number as the license number. It shall be unlawful for any dog or cat to wear any license or other city ID other than that issued by the City of Blair for such dog or cat, NEW PET LICENSING Must be licensed within 10 days of ownership (tuft) at 6 months of age if puppy or kitten NEW RESIDENTS TO BLAIR Must register pets within W days of residency Owner Name Spouse owner Address City/State/Zips Phone # DL # or DOB Helen Gruber 756 S. 16th Apt. #473 Blair, NE 68008 402-426- 0301 "ET # Pet Name: Winter Age: sex: Spayed Female Color - Breed: Declared Dangerous/ Potentially Dangerous Dag Microchip # Rabies Description: I/I YEA Holstein Veterinary Clinic Dr. Lisa .Schrum DVM & Dr. KrIsta Holstein DVM 718 south 191h Street Blair, NE 68008 402-426-7387 402-426-0101 Fax hoisteinclinic@gmail.com NO 1 YES City Tag # Rabies "fag # 3 YEAR LICENSE FEES Intact Dog or Cat: $16.00 Altered D r cat: $11.0 Replacement Tarr $5.00 Total ��.J FAXED 11-OS-18 9:41a BY TOTAL PAGES Z0/Z0 39dd DINI-10 lift NI3IS-101-1 I0Z097,bZah E9:60 8Z13Z/9e/TZ I CITY OF BLAIR - 2018 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 RENEWALS/ ARE DUE: March 15, 2018 Owner Name: ��h ru �n�t✓�l® Owner Address: /zr19 S/1o11 S�, ;16el2 City/State/Zip: Blair, NE 68008 Phone # G/-1/,e1S-- Drivers License # or Date of Birth o2-1-7 19 ? LICENSE FEES: Dog or Cat: $16.00 Altered Dog or Cat: $11.00 Replacement Fee for Lost Tag: $5.00 ***PLEASE READ CAREFULLY*** YOU ARE REQUIRED BY LAW TO LICENSE YOUR PETS. Failure to do so is a violation of City ordinances 6.103 and carries a penalty of a fine up to $150.00 per pet. PET LICENSES RENEWALS ARE DUE BY 3/15/2018. The City shall recognize a microchip identification number as the license number, It shall be unlawful for any dog or cat to wear any license or other city identification other than that issued by the City of Blair for such dog or cat. The City of Blair requires proof of rabies vaccination. An additional State Fee of $1.25 is being collected to Lund the Nebraska OM & Gat 00 PET #1 Q Dog ❑ Cat ❑ Spayed/Neutered License Fee $ Pet Name de /!,1 Age Sex Color -t� Breed" u/s�,�1�,Replacement$_ ** Declared Dangerous or Potentially Dangerous Dog: ❑ Y L�- N MICROCHIP # If applicable) SUBTOTAL: $ RABIES VACCINATION DATE: - (3 yr) (1 yr) City Tag # PET #2 ❑ Dog ❑ Cat ❑ Spayed/Neutered License Fee $ Pet Name Aye 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 # PET #3 ❑ Dog ❑ Cat ❑ Spayed/Neutered License Fee $ Pet Name Agge 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.) Donation to care for animals: $1 $3 $5 $10 Other. ***SEE BACK OF FORM FOR BREED SPECIFIC LICENSE REQUIREMENTS VISA / MC # Signature Do Not Send Cash by Mai/ TOTAL ENCLOSED $ Expires: Security Code: If you have questions, please contact City Hall at (402) 426-4191 or by Fax: (402) 426-4195 ++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ NEW PET/NEW RESIDENT LICENSING REQUIREMENTS(March 15late fee date not applicable for newpets/new residents) Newly Acquired Pets: New Residents to Blair: ■ Must be licensed within 10 days of ownership ■ Must register pets within 10 days of ■ <OR> at 6 months of age if puppy/kitten residency. ,f > 10 CITY OF BLAIR - 2018 ET LICENSE VERIFICATION If you live in Blair City limits and own a dog(s) and/or cat(s), complete/verify this form and return with check made payable to: City of Blair* 218 S. 16th St. * Blair, NE 68008 You may legally own a combination of four (4) adult pets, but no more than three (3) adult dogs or three (3) adult cats per residential or dwelling unit. LICENSE RENEWALS ARE DUE: March 15"2:01-8- LICENSE FEES: Dog or Cat: $16.00 Owner Name: Jeff Gunderson Spayed/Neutered Dog or Cat: $11.00 Replacement Fee for Lost Tag: $5.00 Owner Address: 758 S 16th St, Unit 192 Fee includes $1.00 for the Nebraska Dog and City/State/ZIP: Blair, NE 68008 Cat Operator Inspection Program Phone #: (402) 426-5914 Drivers License #:Not on file or Date of Birth: Not -on -file- Subtotal licensed pets from below: Replacement Tags from below: Name: Yoda DOB: 5/11/2007 Sex: Male License Fee $ Color: Black Breed: Chihuahua Replacement: Spayed/Neutered: True Dangerous Dog: OY ON Mirochip # 4A11204A6D Potentially Dangerous: City Tag # 28 Vaccination Date: 5/9/2016 Duration: 3 year vaccine Vaccine Exp: 5/9/2019 Total: CITY OF BLAIR - 2018 PET LICENSE VERIFICATION If you live in Blair City limits and own a dog(s) and/or cat(s), complete/verify this form and return with check made payable to: City of Blair* 218 S. 16th St. * Blair, NE 68008 You may legally own a combination of four (4) adult pets, but no more than three (3) adult dogs or three (3) adult cats per residential or dwelling unit. LICENSE RENEWALS ARE DUE: March 15,2018 LICENSE FEES: Dog or Cat: $16.00 Owner Name: GUNDERSON, WESLEY R & ESTHER M Spayed/Neutered Dog or Cat: $11.00 Replacement Fee for Lost Tag: $5.00 Owner Address: 909 N 26TH AVE Fee includes $1.00 for the Nebraska Dog and City/State/ZIP: BLAIR, NE, 68008--0000 Cat Operator Inspection Program Phone #: (402) 426-5956 Drivers License #:Not on file or Date of Birth: Not on file Subtotal licensed pets from below: Name: Puga Color: Black Spayed/Neutered: True Mirochip # Vaccination Date;..5/5/2D16 � �cNa�.cnicu� aaJ.a vnvc.wr. DOB Not on File Sex: Female License Fee Breed: Mix -Breed— (?, Dangerous Dog: Potentially Dangerous: Duration: 1 year vaccine Vaccine Exp: .515/20117—' Replacement: ❑Y ON City Tag # 1910 °X"Y Total: CITY OF BLAIR - 2018 PET LICENSE VERIFICATION If you live in Blair City limits and own a dog(s) and/or cat(s), complete/verify this form and return with check made payable to: City of Blair* 218 S. 16th St. * Blair, NE 68008 You may legally own a combination of four (4) adult pets, but no more than three (3) adult dogs or three (3) adult cats per residential or dwelling unit. LICENSE RENEWALS ARE DUE: March 15,2018 LICENSE FEES: Dog or Cat: $16.00 Owner Name: GUNDERSON, WESLEY R & ESTHER M Spayed/Neutered Dog or Cat: $11.00 Replacement Fee for Lost Tag: $5.00 Owner Address: 909 N 26TH AVE Fee includes $1.00 for the Nebraska Dog and City/State/ZIP: BLAIR, NE, 68008--0000 Cat Operator Inspection Program Phone #: (402) 426-5956 Drivers License #:G29004917 or Date of Birth: 8/17/1946 Subtotal licensed pets from below: Rnnlnrmmdmn+ Tnnc from hAIMAP Name: Bella Mae DOB: Not on File Sex: Female License Fee $ Color: Fawn Breed: Pug Replacement: Spayed/Neutered: True Dangerous Dog: ❑Y ON Mirochip # 985112004608003 Potentially Dangerous: City Tag # 1763 Vaccination Date: 7L8/2016 Duration; year vaccine Vaccine Exp:, 7/€12017 Total: CITY OF BLAIR - 2019 PET LICENSE VERIFICATION If you live in Blair City limits and own a dog(s) and/or cat(s), complete/verify this form and return with check made payable to: City of Blair * 218 S 16th St. * Blair, NE 68008 You may legally own a combination of four (4) adult pets, but no more than three (3) adult dogs or three (3) adult cats per residential or dwelling unit. LICENSE RENEWALS ARE DUE: March 15, 2019 LICENSE FEES: Dog or Cat: $16.00 Owner Name: Tahni Gustin Spayed/Neutered Dog or Cat: $11.00 Owner Address: 915 N 31st St Replacement Fee for Lost Tag: $5.00 Fee includes $1.25 for the Nebraska Dog and Cat City/State/ZIP: Blair, NE 68008 Operator Inspection Program Phone #: (402) 426-2698 Drivers License #: or Date of Birth: Subtotal licensed pets from below: Replacement Tags from below: Name: Bell DOB: Not on File Sex: Female License Fee $ Color: Black Breed: Siamese Replacement: Spayed/Neutered: True ❑Y ON Mirochip # City Tag # 2058 Vaccination Date: 8/28/2017 Duration: 3 year vaccine Vaccine Exp: 8/28/2021 Total: ) I CITY OF BLAIR - 2019 PET LICENSE VERIFICATION If you live in Blair City limits and own a dog(s) and/or cat(s), complete/verify this form and return with check made payable to: City of Blair * 218 S 16th St. * Blair, NE 68008 You may legally own a combination of four (4) adult pets, but no more than three (3) adult dogs or three (3) adult cats per residential or dwelling unit. LICENSE RENEWALS ARE DUE: March 15, 2019 LICENSE FEES: Dog or Cat: $16.00 Owner Name: Tahni Gustin Spayed/Neutered Dog or Cat: $11.00 Replacement Fee for Lost Tag: $5.00 Owner Address: 915 N 31st St Fee includes $1.25 for the Nebraska Dog and Cat City/State/ZIP: Blair, NE 68008 Operator Inspection Program Phone #: (402) 426-2698 Drivers License* N5269559 or Date of Birth: Name: Samdee Color: Black Spayed/Neutered: True Mirochip # Vaccination Date: 3/23/2018 Subtotal licensed pets from below: Replacement Tags from below: DOB: Not on File Sex: Male Breed: Mix Breed Duration: 3 year vaccine Vaccine Exp: 3/23/2021 License Fee $ Replacement: ❑Y ❑N City Tag # 1831 Total: I l CITY OF BLAIR - 2019 PET LICENSE VERIFICATION If you live in Blair City limits and own a dog(s) and/or cat(s), complete/verify this form and return with check made payable to: City of Blair * 218 S 16th St. * Blair, NE 68008 You may legally own a combination of four (4) adult pets, but no more than three (3) adult dogs or three (3) adult cats per residential or dwelling unit. LICENSE RENEWALS ARE DUE: March 15, 2019 LICENSE FEES: Dog or Cat: $16.00 Owner Name: GUTOWSKI, MARK A & JORIS K Spayed/Neutered Dog or Cat: $11.00 Owner Address: 638 IN 14TH AVE Replacement Fee for Lost Tag: $5.00 Fee includes $1.25 for the Nebraska Dog and Cat City/State/ZIP: BLAIR, NE, 68008--1229 Operator -Inspection Program Phone #: <NO PRIMARY PHONE> Drivers License #: Name: Buddy or Date of Birth: 'J Subtotal licensed pets from below: Replacement Tags from below: DOB: 10/22/2016 Sex: Male Color: Tri-Color Breed: Shetland Sheepdog Spayed/ eutere - False IN-4 L Mirochip # Vaccination Date: 2/16/2018 Duration: 3 year vaccine Vaccine Exp: 2/16/2021 License Fee $ \,\.,O Replacement: ❑Y ❑N City Tag # 2384 Total: .. INVOICE ,-it/ Creatures Veterinary Clinic 8626 Frederick St Omaha, NE 68124 402-399-8224 Welcome to our family! Your Pets Are Our Passion! FOR: Doris Gutowski 638 N. 14th Ave Blair, NE 68008 (402) 650-9015 Date For Qty Description Printed: 03-15-19 at 4:27p Date: 03-15-19 Account: 8556 Invoice: 75819 Net Price 03-15-19 Bear 1 Dr Roelofs - Exam 2-Complete Exam 51.00 03-15-19 1 Technician Today Was - Adina 0.00 03-15-19 1 Intestinal Parasite Test - Diarrhea 38.17 03-15-19 0.50 Nail Trim - Technician 7.72 03-15-19 20 Metronidazole 500mg #7032 29.70 Old balance Charges Payments New balance 0.00 126.59 0.00 126.59 d Reminders for: Bear (Weight: 52.4Ibs - 6m) Last done 02-01-20 Lepto - Cgip Vax (4 Way) 02-01-19 01-11-20 Dhp-Parvo (No Lepto) 1 Yr 01-11-19 1,6,4 01-11-20 Bordetella 1 year 01-11-19 12-22-19 Rabies - 1 Yr 12-22-18: 09-13-19 Biannual Exam 03-15-19 07-12-19 Deworm - Drontal Canine 68mg 01-11-19 06-22-19 Intestinal Parasite Test Centr 12-22-18 Client's Instructions Dr Roelofs - Exam 2-Complete Exam IF Bear conts. to have loose stool- can give 1 tablet of Immodium (Loperamide 2 mg), do not repeat unless stools are still liquidy, can cause constipation. Stop Kaopectate. Start Metronidazole tonight. Feed only homemade bland diet 91/4 cooked hamburger to 3/4 cooked rice, 2 cups 3-4x/day), or at least mix 1 cup rice into small amts of puppy food, 3-4x/day if stools are already improving today. Bear's weight history (in Ibs) 03-15-19 52.90 02-01-19 41.90 01-11-19 36.20 12-22-18 28.20 CITY OF BLAIR - 2019 PET LICENSE ADDITIONS If you live in Blair City limits and own a dog(s) and/or cat(s), complete/verify this form and return with check made payable to: City of Blair * 218 S 16th St. * Blair, NE 68008 You may legally own a combination of four (4) adult pets, but no more than three (3) adult dogs or three (3) adult cats per residential or dwelling unit. LICENSE RENEWALS ARE DUE: March 15, 2019 Owner Name: GUTOWSKI, MARK A & JORIS K Owner Address: 638 N 14TH AVE LICENSE FEES: Dog or Cat: $16.00 Spayed/Neutered Dog or Cat: $11.00 Replacement Fee for Lost Tag: $5.00 Fee includes $1.25 for the Nebraska Dog and Cat Operator Inspection Program City/State/ZIP: BLAIR, NE, 68008--1229 Phone #: <NO PRIMARY PHONE> �. Drivers License #: or Date of Birth: Subtotal licensed pets frorn below: Replacement Tags from below: Total: 'Dog ❑ Cat 4Spaye entered License Fee $ Pet Name 1e .�.G>Z Pet DOB \ Sex 0-\ Color Breed _C IL) Wu &Eh1 �Nk' boll Declared Dangerous or Potentially Dangerous Dog? ❑ Y, TN Microchip # Rabies Vaccination Date r� 0��3 yr /V/lyr to rc�C,.�p�A /w. 1�i-iS __ r\PA 1,,,. ❑ Dog ❑ Cat ❑ Spayed/Neutered Pet Name Color Age Sex Breed Declared Dangerous or Potentially Dangerous Dog? ❑ Y ❑ N Rabies Vaccination Date ❑ Spayed/Neutered Pet DOB Sex Breed Declared Dangerous or Potentially Dangerous Dog? ❑ Y ❑ N License Fee $ 03 yr 01 yr License Fee $ Microchip # Rabies Vaccination Date 03 yr 01 yr