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02/28/2019 12:45 4024260101 HOLSTEIN VET CLINIC PAGE 01/02 2019 PET LICENSE VERIFICATION/APPLICATION FOR. CITY OF BL.AIR. 'IF YOU LIVE IN BLAIR CITY LIMITS AND OWN A DOG(S) AND /OR CAT($), COMPLETE THIS FORM AND RETURN WITH A CHECK PAYABLE TO: CITY OF BLAIR 218 S. 16711 8T 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, ***PLEASE READ CAREFULLY*** YOU ARE REQUIRED BY I.AW TO LICENSE YOUR PETS. Failure to do to Is a vlolation of City Ordinances G.1p-3 and carries a Penalty of a flne up to $15D.00 per pat. SE REtJEWACs PET LICENARE DUE BY 3 15 Z019. The city shall recognize a microchip ID numbor 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 (OR) at 6 months of age if puppy or kitten NEW RESIDENTS TO BLAIR Must register pets within 10 days of residency Owner Name Sandra Jack Spouse 'Owner Address 2054 Washington Street City/Mate/zip Blair, NE 68008 Rhone # 402-278-4301 DL al# or DOB A29009005 Pet Name: Tiffy ,Age: 4Y sex: Spayed Female Color: Tarn White Breed: Chi/Terr Declared Dangerous/Potentially Dangerous Dog NO YES Microchip) # 985112010030677 Clty # - ,,., e, M rr �: ? ;I ' ", ,;+ :,�: Rr3bies Tag # i4407 .{ 1 i �lS�iv mf . U! K Pabies Description: i YEAR 3 YEAR Holstein Veterinary Clinic Dr. Msa Schrum DVM & Dr. Krista Ho1stefn DVM "18 South 19th Street Bla,'ir,-. NE,.68008 402-426-7387 402-4,,•6.:0 'O.1 ' Fa�c holsteindinic aDgmail.com','.. ' LICENSE FEES Intact Dog or Cat: $16.00 - Altered •-: Dag or cat: $11.00 $5.00 60 Total FAXED 02-28-1911:43a BY TOTAL PAGES 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. 16t" 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 D E: March 15, 2019 Owner Name:.r� Owner Address: city/state/zip: Blair, NE 68008 Phone# h-2 L421 -30r,2- I Drivers License # or Date of,Birth I H- UL LICENSE FEES: Dog or Cat: $16.00 Altered Dog or Cat: $11.00 Replacement Fee for Lost Tag: $100 ***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 3/1512018, Tne City shall recognize a microchip Identification number as the license nsmoen 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. Incl lded is a State Fee of $1,25 being collected to fund the Nebraska Dog& Cat Operator Ins pec "on Program PET #1 Dog ❑ Cat L] Spayed Neutered License Fee $ Pet Narne 1 1400 A( _ Sex Color �"L.,=; -ca,oBreed" Replacement$ ** Declared Dangerous or Potentially Dangerous Dog: ©Y N MICROCHIP # (If applicable) SUBTOTAL: $ \lLO , RABIES VACCINATION DATE: _ 1 t73-1 q (3 yr) (1 yr) _ City Tag # PET # 2 'I( Dog ❑ Cat a Spayed/Neutered License Fee Pet Name 0.4. Aye Sex -m Color fIa c'V_ Breed* v inui hu � Replaceement$_ ** Declared Dangerous or Potentially Dangerous Dog: ❑ Y OXN o0 MICROCHIP # (If applicable) SUBTOTAL: $ RABIES VACCINATION DATE: !/— LU — 1�4 (3 yr) (1 yr) City Tag # PET #3 ❑ Dog ❑ Cat ❑ Spayed/Neutered License Fee $ Pet Name Acie Sex Color Breed" Replacement$ ** Declared Dangerous or Potentially Dangerous Dog: ❑ Y ❑ N MICROCHIP # (If applicable) SUBTOTAL: $ RABIES VACCINATION DATE: (3 yr) (I yr) City Tag # *PLEASE INCLUDE THE; CITY TAG NUMBER IF THIS IS 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 Nor Send Cash byMaH TOTAL ENCLOSED $ Expires: Security Code: it you have questions, please contact City Hall at (402) 426-4191 or by Fax. (402) 426-4195 ++++++++4•++++++++++++a--r++++++++++++++.+-r++++++•I-++++++-r+++++.+++++++++++ * •F+++++ NEW PET/NEW RESIDENT LICENSING REQUIREMENTS (March ISiatefee date not appliwblefor new pets/newraidentsJ New IyAcARked Pets: New. Residents to Blair: • Must be l',ca-sed within 10 days of ownershlp ■ Must register pets within 10 days of v <OR> at 6 months of age if puppy/kitten residency. I'd 909997IV7101l WeD 113LUIUV auot{1 d69:Z0 61, 91• Uef FROM :BSAC FAX NO. :402-533-2722 Feb. 19 2019 04:54PM P1 CITY OF BLAIR - 2019 PET LICENSE APPLICATION If you live in Blair City limits and own a dogs) and/or cat(s), complete this fbrrn 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 Mats, but no more than three (3) adult dogs or three (3) adult cats per residential of dwelling unit. LICENSE RENEWAL'S ARE DUE: Ma>;ch la. 20191 Owner Name! RjecTamna C)Wner Address: pity/statelzipt Blailrt NE 68008 Phone # qoA-!�33 i% Drivers License # or pate of Birth LICENSE FEES: Dog or Cat: $16.00 Altered Dog or Cat: $11.00 keplaceinent Foe for Lost 1`ag: $5.00 ynP4#,Aaa k o. Q atw Fop n* !ti _2r, heron coilkwW to Hind th ***PLEASE RM CAREFULLY"* Yqu ARE REQU,IaEti BY LAW TO LICENSE YOUR PETS. Failure to do Bo iS a violatlon of City ordinancds 6,05 and carries a ponnity of a fine up to $i50.0o par pbk. PET LICENSES RENEWALS ARE DUE BY 31i5/2018. Thp city shall reccignize a microchip identification number as the IicuiO number. It shall be unlawful for MY 049 or cat to w;er any license or other city Identification other than that 1"Ved by the City of filair for such don 6r cat. The City of Rhdr re4ulres prriof of nahle4 vaccintrtion. PET #1 Dog ❑ Cat ',Spayed/Neutered License Fee $ 11,0 Pet Name lik Ace Se Dolor Breed * Y Replacement $� Declared Dangerous or P t nti=Dae Dog: ❑ Y NMICROCHIP # f applicabl SUBTOTAU $ RABIES VACCINATION DATE: (3 yr) (I yr) . . City Tag # . PET #2 Do ❑ Cat Spayed/Neutered License Fee Pet Name Ae (p r/ Sex P�Re lacement ** Color Breed e* p — Declared Dang a s or Potential! Dangerous Dog, ❑ Y N MICROCHIP # I k (If applicable SUBTOTAL: RABIES VACCINATION DATE: / (3 yr) (i yr) City Tag # PET #3 ❑ Dog ❑ Cat ❑ Spayed/Neutered License Fee Pet Name AVe .._. Sex Color Breed * — Replacement ** Declared Dangerous or Potentially Dangerous Dog: ❑ Y ❑ N MICROCHIP #..__(If applicable) SU1370TAL: $ RABIES VACCINATION DATE: (3 yr) (i yr) — City Tag # �* *PLEASE INCLUDE THE CM TAG NUMBER IF THIS IS A RENEWAL ** (This fee iS due along with License Fee if requesting at the time of license renewal.) *Donation **SBS BACK �LI78T CK OF FORM FOR BREED SPECIFIC, LICENSE REQUIREMENTS � � VISA / MC # Signature Do Not Send Cash by !Nail TOTAL ENCLOSED Expires: Security Code: It you have questions, please contact City Hall at (462) 426,4191 or by Fax-, (402) 426-4196 NEW PET/NEW RESIDENT LICENSING REQUIREMENTS (March 151818fee ddtL-AataPPiiWfyl0&neWpmls/ Owrsidents) NeWy Anoufred Pehi; ■ Mu register peg within 10 days of ■ Mint bektgfsed within 1l0 days of owrl�r�hip rt <OR> at 6 months of age if puppy/kitten residency, 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: JAWORSKI, NICHOLAS & ELLIE Spayed/Neutered Dog or Cat: $11.00 MCINTOSH Replacement Fee for Lost Tag: $5.00 Fee includes $1.25 for the Nebraska Dog and Cat Owner Address: 1920 SOREN DR Operator Inspection Program City/State/ZIP: BLAIR, NE, 68008--0000 Phone #: (402) 426-0106 Drivers License #: or Date of Birth: 7/13/1978 Name: Mayzie Color: Brindle Spayed/Neutered: True Mirochip # Vaccination Date: 7/29/2016 Subtotal licensed pets from below: Replacement Tags from below: DOB: Not on File Sex: Female Breed: Bullmastiff Duration: 3 year vaccine Vaccine Exp: 7/29/2019 License Fee $ Replacement: ❑Y ❑N City Tag # 64 Total: 03/16/2019 09:24 4024260101 HOLSTEIN VET CLINIC PAGE 02/02 201-9 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 LEGALLY OWN A COMBINATION OF FOUR (4) ADULT PETS, BUT No MORE THAN THREE (3) ADULT DOGS OR TMREE (3) ADULT CATS PER RESIDENTIAL OR DWELLING UNIT. 'PLEASE READ CAREFULLY*** YOU ARE REQUIRED 8Y I,AW TO LICI=NS�YpUft PETS. Failure to do so is a violation of City Ordinances 6.103 and carries a penalty of a fine upto $150.00 per pet. PET LICENSE RENEWALS ARE DUE jyjLj5LZQj% The city shall recognize a microchip 11) 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 Blair for such dog or cat. NEW PET LICENSINQ.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 `WET # Pet Name: Cody Age- 4Y _ � Sex: S Six: Breed,- German Wirehair Color: Declared Dangerous/ Potentially Dangerous Dog Microchip # Rabies Description: 1 YEAR Holstein Veterinary Clinic Dr. Lists Schrum DVM & Dr. Kristo Holstein DVM 718 South 19th Street Blair, NE 68008 402-426-7387 402-426-0101 Fax hoIsteincIinic@gmai1.com NO I YES City Tag # Rabies Tag # 16803 LICENSE FEES Intact Dog or Cat- $16.00 or cat: $11, Replacement Tag $5,00 Total � k lM FAXED 03-16-19 8:50a BY TQTAL PAGES 2fi - 03/16/2019 09:24 4024260101 HOLSTEIN VET CLINIC PAGE 01/02 2019 PET LICENSE VERIFICATION/APiPLICATION FOR CITY OF BLAIR IF YOU LIVE IN GLAIR 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 LEGALLY OWN A COMBINATION OF FOUR (4) ADULT PETS, BUT NO MORE THAN THREE (3) ADULT DOGS -OR THRizE (3) ADULT CATS PER RESIDENTIAL OR DWELLING UNIT, ***PLEASE READ CAREFULLY*** YOU ARE REQUIRLD BY LAW TO LICENSE YOUR PETS, Failure to do so is a violation of City Ordinances 6,103 and carries a penalty of a firyp up to $150.00 per pet. PET LICENSE RENEWALS ARE DUE BY 3/15(20��, The city shall. recognize a microchip ID number as the license number. It shall be unlawful for any dog or rat to wear any license or other city ID other than that issued by the City of Blair for such dog or cat. NEW PE7 LICENSING Must be licensed within 10 days of QWhership (OR) at 6 months of age if puppy or kitten NEW RESIDENTS M BLAIR Must register pets within 10 days of residency r%cT # Pet Name: Kasey Age: 15Y I sex: Sex: Breed: Jack )Russell Terrier Color: Declared Dangerous/Potentially Dangerous Dog Microchip # Rabies Description; 1 YEAR Holstein Veterinary Clinic Dr. Lisa Schrum PVM & Dr: Krfsta Holstein .DVM 718 South 19th Street Blair, NE 68008 102-426-7387 402-426-0101 Fax hoisteinrlinic@gmaii.com �=® City "fag # Rabies Tag # 16804 A,R, LICENSE FEES Intact Dog or Cat: $16.00 Altered Kgor 00 Replacement Tag $5.00 Total $. FAXED 03-16-19 8:60a BY TOTAL PAGES 1 C) t � p 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: L e e 1,e,,e r) K i hS Owner Address: 21. j S . City/State/Zip: Blair, NE' 68008 Phone # Ll p off ' 4010` W q Drivers License # or Date of Birth q -10 _1 J�" 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 Operator Inspection Program PET #1 �6 Dog ❑ Cat ❑ Spayed Neutered License Fee $ D Pet Nam Pt Vey' Aye Sex _ Color rtlwn Breed eymm6h W',r(1,Av0Ejih4trReplacement$ Declared Dangerous or Potentially Dangerous Dog: ❑ Y �$ N MICROCHIP # 0 A 9 54 > __(If applicable) SUBTOTAL: $ /L oo RABIES VACCINATION DATE: Wn W (3 yr) (1 yr) City Tag # A Cel PET # 2 ❑ Dog ❑ Cat ❑ Spayed/Neutered Pet Name Acie Sex Color Breed** Declared Dangerous or Potentially Dangerous Dog: ❑ Y MICROCHIP # (If applicable) RABIES VACCINATION DATE: (3 yr) _ ❑N (1 yr) License Fee $ Replacement $ ** SUBTOTAL: $ City Tag # * PET #3 ❑ Dog ❑ Cat ❑ Spayed/Neutered License Fee $ Pet Name Acie 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 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 newpetFlnewresidents) Newly Acauired Pets: New Residents to Blair: ■ Must be lioensed within 10 days of ownership ■ Must register pets within 10 days of 0 <OR> at 6 months of age if puppy/k tben residency. Patient History Report Client: Petska, Leslie and Trent (3831412) Patient: Piper (28770) Phone: (308) 383-1412 Species: Canine Breed: Pointer, German Wirehaired Address: 204 Scout St Age: 3 Yrs. 1 Mos. Sex: Female Gibbon, NE 68840 Color: Liver Date Type Staff History 4/1/2019 B 09 1.00 Bordetella Vaccination (BOVA) by 01 4/1/2019 B 09 1.00 DisHepPara Vacc. (DHLPVA) by 01 4/1/2019 B 09 1.00 Corona Virus Vaccination (COVIVA) by 01 4/1/2019 B 09 1.00 Parvo Virus Vaccination (PAVIVA) by 01 4/1/2019 B 09 1.00 Deworming (DWCMDT) by 01 7/3/2018 P 07 20.00 tablet of Alprazolam 2mg Tablets (ALPRA2) Rx #: 96478 Exp, 07/03/21 0 Of 0 Refills GIVE 1-2 TABLETS ORALLY 1-2 TIMES A DAY AS NEEDED FOR RELAXATION. 7/3/2018 P 07 20.00 tablet of Alprazolam 2mg Tablets (ALPRA2) Rx #: 96477 Exp. 07/03/21 0 Of 0 Refills GIVE 2 TABLETS ORALLY 2-3 TIMES A DAY AS NEEDED FOR RELAXATION. 7/3/2018 B 07 20.00 tablet of Alprazolam 2mg Tablets (ALPRA2) by 01 9/14/2017 CK BJS Reason for Visit: Update information Date Patient Checked Out: 09/14/17 Practice 1 7/14/2017 CK LEB Reason for Visit: Boarding Date Patient Checked Out: 07/14/17 Practice 1 6/29/2017 V RMC Jun 29, 2017 04:38 PM Staff: RMC ------------------------- 7---- Weight : 43.00 pounds 6/29/2017 B 02 10.00 Lodging/Meals/3 Walks a Day (BOCAM) by 01 6/29/2017 B 18 1.00 Bordetella Vaccination (BOVA) by 01 6/29/2017 B 18 `' 1.00 Rabies Vaccination (RAVAC3) by 01 6/29/2017 B 18 1.00 Deworming (DWCMDT) by 01 4/17/2017 B 01 1.00 can of KMR Powder 6oz (KMRP6) by 01 4/15/2017 B 02 8.00 Lodging/Meals/3 Walks a Day (BOCAM) by 01 3/10/2017 CK BJS Reason for Visit: Dr. Check Date Patient Checked Out: 03/10/17 Practice 1 2/6/2017 B 18 5.00 Lodging/Meals/3 Walks a Day (BOCAM) by 01 2/5/2017 P 18 14.00 tablet of Metronidazole 500 mg Tablets (FLAG500) Rx #: 84860 Exp. 12/01/17 0 Of 0 Refills GIVE 1 TABLET ORALLY TWICE A DAY, BEGIN 2/5/17 P.M. 2/5/2017 P 18 28.00 tablet of Pectalin Anti Diarrhea Tablets (PECTT) Rx #: 84859 Exp. 05/01/18 0 Of 0 Refills GIVE 2 TABLETS ORALLY TWICE A DAY, BEGIN 2/6/17 A.M. 2/5/2017 P 18 45,00 cc of Panacur Suspension (PANACUR) Rx #: 84858 Exp. 09/01/18 0 Of 0 Refills GIVE 11 CC ORALLY ONCE A DAY FOR 4 DAYS. BEGIN 2/5/17 P.M. 2/5/2017 V EAD Feb 5, 2017 04:36 PM Staff: EAD ------------------------------ Weight : 45.50 pounds 2%4/2017 CK LEB losing weight, loose stool, still acting eating.and drinking normal Reason for Visit: Dr. Check R-Billing, C:Med note, CB:Call back, CK:Check-in, CM: Communications, D:Diagnosis, DH:Declined to history, E:Examination, ES:Estimales, ,parting instr, L:Lab result, Klmage cases, P:Prescription, PA:PVLAccepted, PB:problems, PP:PVL Performed, PR:PVL Recommended, orrespondence, T:Images, TC:Tentative medl note, V:Vital signs Hilltop Pet Clinic Page 1 of 3 Date: 4/9/2019 12:30 PM . 2019 PET LICENSE VERIFICATION/AP'PLICATION 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 PAYA5I-E TO: CITY• OF BLAIR — 218 8. i fiTH BT BLAIR, NE 68008 YOU MAY LEGALLY OWN A COMBINATION oP FOUR (4) ADULT PETS, BUT NO MORE THAN THREE (3) ADULT DUGS OR THREE (3) ADULT CATS PER RESIDENTIAL OR DWELLING UNIT, ***PLEASE READ CAREFULLY"* YOU ARE REQUIRED BY LAW TQ LICENSE YOUR PETS. Failure to do so is a vi+aiatlon of City Ordinances 6,103 and carries a Penalty of a fine up to $150,00 per pet, PET LICENSE RENEWALS ARE DUE BY 3 15 2Q19. The city shall recognize a'microchip ID number as the license number. It shall be unlawful for any dog or cat to wear any license or other city ID other than that issued by the City of Blair for such clog or cat. NEW PET LICENSING, Must be licensed within 10 days of ownership (OR) at 6 rnQnths of age if puppy or kitten NEW 0SIDENT TTQ BLAIR Must register pets within 10 days of residency owner Narne Lissy Jennings Spouse Carey owner Address 1327 Park Street City/State/Zip Blair., NE 6800$ Phone # 785-220-1663 DL #gar DOB PET # Pet Name: Nolla Aye: 15Msex: Spayed Female Color: �triridie Breed: Shih/Poo Declared Dangerous/Pater-tlally Dangerous Dog I NO I YES Microchip # 9IM Rabies Description: FINUM3 Holstein Veterinary Clinic D7 ,. Lisa Schrum DVM & Dr. Ci ,jsta Holstein DVM 718 South 19th Street Blair, NE 68008 402-426-7387 402-426-01.01. Fax holsCeindinic@gmail.cem city Tag #` Rabies 'fag # 18738 LICENSE FEES Intact Dog or Cat; $16.00 ed Do Replacement Tag $S.00 Total $ \� 'n FAXED 20a BY ,X--- TOTAL PAGES y TO/To 39vd DINI-10 i3A NI3IS-10H T)TOK10ZFb Tb:0T 6TU71/EZ/710 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: Patrick & Brenda Jenny Spayed/Neutered Dog or Cat: $11.00 Replacement Fee for Lost Tag: $5.00 Owner Address: 556 S 16th St Fee includes $1.25 for the Nebraska Dog and Cat City/State/ZIP: Blair, NE 68008--0000 Operator Inspection Program Phone #: (402) 505-0431 Drivers License #: or Date of Birth: I Name: Lexi Kay Color: Yellow Spayed/Neutered: False Mirochip # 986112010030308 Vaccination Date: 07/12/2018 Subtotal licensed pets from below: Replacement Tags from below: DOB: 03/14/2018 Sex: Female Breed: Labrador Retriever Duration: 1 year vaccine Vaccine Exp: 07/12/2019 License Fee $ Replacement: ❑Y ❑N City Tag # 2427 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: JENSEN,- E°C & JANE M Spayed/Neutered Dog or Cat: $11.00 Owner Address: 755 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) 426-4973 Drivers License #:H12423471 or Date of Birth: 1/30/1947 ..... ...... Name: Bill Color: White Spayed/Neutered: True Mirochip # 0007113306A Vaccination Date: 3/3/2017 Subtotal licensed pets from below: Replacement Tags from below: DOB: Not on File Sex: Male Breed: Mix Breed Duration: 3 year vaccine Vaccine Exp: 3/3/2020 License Fee $ Replacement: ❑Y ON City Tag # 11,86- r Total: FROM :BSAC FAX NO. :402-533-2722 Apr. 29 2019 05:17PM P1 CITY OF BLAIR - 2019 PET LICENSE APPLICATION If you live In Blair City limits and own a dog(s) and/or rat(s), complete this form and return with check made payable to: Clty of Blair a 218 S. 16th Sit. • Blair, NE 68008 You may legally own a combination of four (4) adult pets, but no more than three (2) adult dotes or three (3) adult cats per rosidentlal or dwelling unit. LICENSE RENEWALS TE DUE: k4 rch 15. QiS Owner Name; Owner Addram; Irnea .._ L r City/state/Zip: Blair, NE 68000 Phone # a _ ar Drivers LiCOnsA # or Date of Birth I � LICENSE FEES: Dog or Cat: $16.00 Altered 009 or Cat: $11.00 Replacement Fee for Lost Tag, $5.00 ***PLeM READ CAREFULLY*** YOU ARE REQUIRED BY LAW TO LICENSE YOUR PETS, Failure to do 8010 a violotion of City ordinances 6.103 and carries a penalty of a fine up to $150.OD par pat. PET LICENSES RENIIWALS ARE DUk BY V=21tla. The r-ay shell recognize a microchip identification rhirtlber a5 the Iirkinsth ilutllUpr. K. shall be unlowfoi frar any dog or cat to wear any license or other city identiflcotlgn other than that issued by the City of Blair for such deg or cat. Tho city of alnir aeauiM proof of rables vgGdne111on. PET # 1 on ❑ Cat U payed/Neutered License Fee Pet Name r Age 1..�?.....__ Sex Color - Breed"'* Replacement $ ** Declared Dangerous or Potentially Dangerous Dog: ❑ Y MICROCHIP # %(If applicable) SUBTOTAL: $ l% RABIES VACONA11ON DATE: .. (3 yr) IL-' (I yr) .- --- City Ta$ # ` j * PET #2 La Dog ❑ Cat ❑ Spayed/Neutered License ree $.. . Pet Name - -..... _ . Age Sex ------._._- ... Color Breed• * . Replacernent$ ** Declared Dangerous or Potsnrlaily Dangerous Dog: ❑ Y U N MICROCHIP # (Ir applicable) SUBTOTAL: $ ...........__. . RABIES VACCINATION DATE: (3 yr) — (I yr) — City Tag # PET #3 ❑ Dog G Cat U Spayed/Neutered License Fee $� Pet Name An Sex Color T�. — Breed * Replacement $ ** Declared Dangerous or Potentially Dangerous Dog: L7 Y U N MICROCHIP # (If applicable) SUBTOTAL: $ ......... RABIES VACC INA`nON IXTE: (3 yr) (1 yr) City Tag # * *PLEASE INCLUDE THE CITYTAQ NUMBER IF THIS IS A RMPWAL ** (This fria is due Along with License Fee If requesting at the time of license renewal.) Donation to care for anlmal$: ,_ $1 _ $3 _., $5 _ $10 Other, ***'SEE BACK OF PoRm rok BFtSED SPECIFIC LICENSE REQUIREMENTS '00 Not sand Cash by May TOTAL ENCLOSED $ VISA / MC 1i .^ �-Expires, Security Code: „ , .,-n Signature _.... ---- if you hove questions, please contact City Wahl at (402) 426-4191 or by Fax: (402) 426-4195 ++*.++++++++++ttt+tt+*++*.+*++++.+++++++++++*+-+++++.+-+.+........++++++++++t+++ NEW PIFT/NEW "SIDENrLIiCENSING REQUIREMENT$ (M�7lCI1 X5/St�lF�dr�f�l7At9ppl(47rbl�fiJl nPwp2i�neW1�51�enL3� .Now[V.Aoduined Pets: New Racidento to Clair., ■ Wist be kalsed Ywithln 10 clays ofovA-m hlp ■ Musk ragtstor p within 10 days of ■ <OR> at 6 months of age if lippy/mm rensidency, N., ,. 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: JENSEN, THEODORE ARNDT JR & SHERI Spayed/Neutered Dog or Cat: $11.00 LYNNE Replacement Fee for Lost Tag: $5.00 Fee includes $1.25 for the Nebraska Dog and Cat Owner Address: 1026 STATE ST Operator Inspection Program City/State/ZIP: BLAIR, NE, 68008--0000 Phone #: <NO PRIMARY PHONE> Drivers License #: Name: Browning Color: Black Spayed/Neutered: True Mirochip #9' )l -25 02I Vaccination Date,: 3/9/2618 or Date of Birth: 5/14/1971 Subtotal licensed pets from below: Replacement Tags from below: DOB: Not on Fi Sex: Male License Fee $ Breed: Labrador Retriever Duration: 1 year vaccine Vaccine Exp:.3/9/2619 R placement: Y ❑N City Tag # 5 Nei 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: Paul E Jipp Spayed/Neutered Dog or Cat: $11.00 Replacement Fee for Lost Tag: $5.00 Owner Address: 2107 Lincoln St Fee includes $1.25 for the Nebraska Dog and Cat City/State/ZIP: Blair, NE 68008--0000 Operator Inspection Program Phone #: (402) 533-3364 Drivers License #: or Date of Birth: Name: Mandarin Too Color: Orange Spayed/Neutered: True Mirochip # - I. Vaccination Date,-8/22/2017 Subtotal licensed pets from below: Replacement Tags from below: DOB: Not on File Sex: Male Breed: Domestic Shorthair Duration Jyear vaccine Vaccine Exp:.8/2212D19- License Fee $ l l 00 Replacement: ❑Y ON City Tag # 2027 Total: I tf 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: Paul E Jipp Spayed/Neutered Dog or Cat: $11.00 Replacement Fee for Lost Tag: $5.00 Owner Address: 2107 Lincoln St Fee includes $1.25 for the Nebraska Dog and Cat City/State/ZIP: Blair, NE 68008--0000 Operator Inspection Program Phone #: (402) 533-3364 Drivers License #: or Date of Birth: 1/8/1959 Name: Shiloh Color: Tan/Black Spayed/Neutered: True Mirochip # Vaccination Date: 5/23/2016 Subtotal licensed pets from below:°° Replacement Tags from below: o° DOB: Not on File Sex: Female Breed: Mix Breed Duration: 3 year vaccine Vaccine Exp: 6/23/2019 License Fee $ Replacement: ❑Y ON City Tag # 1-99i Total: No" 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: Paul E Jipp Spayed/Neutered Dog or Cat: $11.00 Replacement Fee for Lost Tag: $5.00 Owner Address: 2107 Lincoln St Fee includes $1.25 for the Nebraska Dog and Cat City/State/ZIP: Blair, NE 68008--0000 Operator Inspection Program Phone #: (402) 533-3364 Drivers License #: or Date of Birth: Name: Cherry Color: Black Spayed/Neutered: True Mirochip # Vaccination Date: 9/16/2017 Subtotal licensed pets from below: 1/0 0 Replacement Tags from below: DOB: Not on File Sex: Female Breed: Domestic Shorthair Duration:9 year vaccine Vaccine Exp: '"/ .6/2.01.8 License Fee $ 11 '90 Replacement: WY ON City Tag # 2028 d`a Total: I l FROM :BSAC FAX NO. '402-533-2722 Apr. 10 2019 04:4BPM P1 Dec. 26. 2018 2:5N CITY OF BLAIR No, 8225 p,.� CITY OF BLAIR - 2019 PET LICENSE APPLICATION 4 ZF you live in glair O limits and own a do s avid tar cet(s) corn leto this form and reLurn with cheek m�lde poYa►51�` v �v p�) / P City of Blair • US S.16"1" St. • Blaillrr N9 68008 You may tegnlly own a combination of four (4) adult petal but no more than three (3) adult dogs or three (3) adult cats per residential Apr Oweil►ng unit. LIC15NSE RENEWALS ARE D➢.il)E: M r h. Owner rt1amm, nmve t Owner Address: t a- 68 citylstate/zlp: Blair, NE 68008 Phone Drlimm i cam* 0 or Datoi of Blit A LICP-N$E FEES. boo or Cats $16,00 Altered Dog or Cat: +'11.00 Replacamierit Fge for moat Tag: $5.40 An additional Stalin Poo of ti.25 W %einu czllwk d tD fund the 03PLEASE REM CMjFULLy-41** YOU ARR REQUIRED BY LAW XP I LCENSE YOUR PETS. Fallur6 to do go 19 A Vlolhtioi) Of city 6rdinaMINE 6.103 and caerio6 a panailty of n fine tip to oldu.uu per per. XVT LICINSIS R.VNHWALS ARE DUE a'Yj/1.V=. 'rue city Ahe ri gwmnlw o m1utiOlp identlfitatiori number es the 11cense nu0hber, It ahO be UnIAWfal for any dog or cat en wear ®ny ilcense or other city IdentificAtion Qthat thAn t11ot (Hood by the city of Hiatt fpr.Slich dog or cat. The city of 9,a1r requires proof of'rabies va=1natlon. PET #1 1, Dog Q Cut daSpayecter@—) Pot NameS�` , .V .... AVe �. _ SPX Color 4' . _._ _... Breed * s r .oi Declared Dangerous or Potentially Dangerous Dog', 0 Y -N MICRCHIP (If applicble) RABIES VA TNA-11C7N DATE: : (3 yr) Lkenvo Fee 1 � 6�() cclnent ** SUBTOTAL; $ (I yr) -. city Iraq # a! l PEI' #2 vd Dog Q Cat OSpayed ute_r"1ec1- Liif�ense Fee Pet Nam,,,, �--�e—iL'y�sY1 Age ex r - rolor C12 OL0 Breed" Replacement Declared Dangerous or Potentially Dangerous Dog: 0 Y , N MICROCHIP #� �- gfapplicable) SUBTOTAL; RABIES VACCINA-TTO J DATE: pL { r P yr) applicable) yr) _ City dreg #2-, l � x PET 03 0 Doc) ❑ C,�L ❑ Spayed/Neutercd License Fee � Pet Name w A e . _ Sex Color Breed' _ Replacement$ Declared Dangerous or Potentially 0angProus %oge l-A Y a N MICROCHIP #_ (If" aRplicablf?,) SUBTOTAL: $ _ PASI ES VAC:CINAIION CRATE: -- (3 yr) . (I yr) ..... city Too # *PLE p ,VN CLLIDE THE CM TAP NUMBER IF THIS 15 A REN11WAL *10 (This fee iu dUe along with License Foe If regUe Atlrto at the time of 11+C+arlse renewal.) ***E to OFMaPSCL.00 " y OtherSEtACK F QRFO,13REED SPECIFIC IC15Si0,1111EENTs DO Not Fond cash by 1411 TOTAL, ENCLOSM VISA/ MC # Expirma: _. _. .. Sewrity 'odw SIgnature 1(you hava questions, Please Contact City Hall at (402) 426.4191 or by FAX., (402) 426-4195 F�� •1 (. f• N f �d .Fh F Fh .h+f �Mh f+ k hd �+.i+ 1.,i4i+ 'F'I yF.'F+}"F.i+'F..."F...'F-F'F'I"Fi"h'I'. f.....t"#''f"'l"I"i'#'3"'F"# ++ NtW WEr•/NL'W RP,$ID)ENT MENSINC FtEQUXiEMENTS (MV[Vh l5lite ie daL-notappllrabl&*lornepvpe jnaiviaWdentsj fl ' lei ems' New RgEderits to Bla fro Mint f lit 16 a;;, 6Ftw-n iij5 PR Must mikor pets within ]A days of N �ORt , at 6 months d age if {guppy/fin widAncy. f hi z , 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: Geral & Kathleen Johnson Spayed/Neutered Dog or Cat: $11.00 Replacement Fee for Lost Tag: $5.00 Owner Address: 2052 Park St Fee includes $1.25 for the Nebraska Dog and Cat City/State/ZIP: Blair, NE 68008--1540 Operator Inspection Program Phone #: (402) 599-0816 Drivers License #: or Date of Birth: 10/26/1959 Subtotal licensed pets from below: Replacement Tags from below: Name: Jubilee Amber DOB: 1/1/2014 Sex: Female License Fee $ Color: Tri-Color Breed: Papillon Replacement: Spayed/Neutered: True ❑Y ON Mirochip # 986112004269547 City Tag # 1593 Vaccination Date: 2/17/2018 Duration: 3 year vaccine Vaccine Exp: 2/17/2021 Total: b r , 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: 'f 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: Geral & Kathleen Johnson Spayed/Neutered Dog or Cat: $11.00 Owner Address: 2052 Park St Replacement Fee for Lost Tag: $5.00 Fee includes $1.25 for the Nebraska Dog and Cat City/State/ZIP: Blair, NE 68008--1540 Operator Inspection Program Phone #: (402) 599-0816 Drivers License #: or Date of Birth: 10/26/1959 Name: Rylee Color: Grey Spayed/Neutered: True Mirochip # Vaccination Date 2/17/2018 Subtotal licensed pets from below: Replacement Tags from below: DOB: 1/1/2008 Sex: Male Breed: Domestic Shorthair Duration:.1,year vaccine Vaccine Exp: ,2/17/2019 License Fee $ Replacement: ❑Y ON City Tag # 1594 Total: 2019 PET LICENSE VERIFICATION/APP'LICATIQN FOR CITY OF SLAIR IF YOU LIVF IN BLAIR CITY LIMITS AND OWN A DOG(S) AND /OR CAT(S), COMPLLTE THIS FORM AND RETURN WITH A CHECK PAYABLE To: CITY OF BLAIR - 218 S. 16TM ST BLAIR,, NE 6,9oog YOU MAY LEGALLY OWN A COMBINATION OF FOUR (4) ADULT PET$, BUT NO MORE THAN THREE (3) ADULT DOGS OR THREE (3) ADULT CATS PER RESIDENTIAL OP DWELLING UNIT. 'PLEASE READ CARIEFULLY*** YOU ARE R� UIRED BY LAW TO LICENSE YOUR PETS Failure to do so is a VIQiati0h of City Ordinanees 6.103 and carries a penalty of a fine up to $150.00 per pet. PET LICENSE RPNEUVAI S ARE DUE gY 3 1S 2p19. The city shell recognize a microchip ID number as the license number. It shall be unlawful for any dog or tat to wear any license or other city ID other than that issued by the City of Blair for such dog or cat. NWW PET LICENSING Must be licensed within 10 days of ownership (OR) at 6 months of age if puppy or kitten NEW RESIDENTS TO BLAIR Must register pets Within 10 days of residency Owner Name Spouse Owner Adidre$S City/State/zip R'hlane * DL * or DOB Holstein Veterinary Clinic Dr. Lisa Schrlarr DVl?' & Dr, r&ista Holstein DV'M .718 South 19th Street Blair, NE 68008 402-426-7387 402-426-0101 Fax holsteinclinic@gmail.com Hannah 3ohnsto n roan 451 S 16th APT 149 Blair,, NE 68008 402-889-8812 LICENSE FEES Intact Dog or Cat: $16.00 Altered or cat:8: Replacement Tag $5.00 T,otaf $H. -O TB/T9 SJdd DINI-10 i3A NISIS-IOH TUT093vZop ©T:9T 6T©Z/01/b9 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: Melissa G And Adam R Acker Johnson Spayed/Neutered Dog or Owner Address: 1391 Linden Dr Replacement Fee for Lost Tag5.00 Fee includes $1.25 for the Nebraska Dog and Cat City/State/ZIP: Blair, NE 68008-0000 Operator Inspection Program Phone #: <NO PRIMARY PHONE> /. 'ro Drivers License #: or Date of Birth: .5 -/ Name: Stryder Color: TA-Gotoi—<�,'j(j L (,onk Spayed/Neutered: True Mirochip # 985112007412670 Vaccination Date:,6l-a/2016� , - Subtotal licensed pets from below: f Replacement Tags from below: DOB: 2/14/2016 Sex: Male Breed: Collie Duration-j year vaccine Vaccine Exp: -6/,3/201'-r License Fee $ Replacement: ❑Y ❑N City Tag # 2092 Total: 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:44, Owner Address: .75 �' ! (e2 City/state/zip: Blair, NE 68008 Phone # 5 31- -7)-1 - )-)- Drivers License # or Date of Birth '�--)-9— (I- )- 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 operator inspection Program PET # 1 ❑ Dog 4 Cat d Spayed/Neutered � � License Fee $ Pet Name Aye a��✓ s� Sex Color i on f lit:sic Breed * - O S 4° Rep/acement $ ** Declared Dangerous or Potentially Dangerous Dog: ❑ Y ❑ N MICROCHIP # (If applicable) SUBTOTAL: $_) RABIES VACCINATION DATE: , — 14 m 11 (2lyr) X (1 yr) City Tag # �. 03 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 Pet Name Aye Sex Color Breed * Declared Dangerous or Potentially Dangerous Dog: ❑ Y MICROCHIP # (If applicable) RABIES VACCINATION DATE: (3 yr) _ W (1 yr) License Fee $ Replacement $ ** SUBTOTAL: $ 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. 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 — BLAIRy NE 68008 YOU MAY LEGALLY OWN A COMBINATION OF FOUR (4) ADULT PETS, RUT NO MORE THAN THREE (3) ADULT DOGS OR THREE (3) ADULT CATS PER RESXOENTIAL OR TOWELLING UNIT, ***PLEASE READ CAREFULLY' YOU ARE REQUIRED BY LAW TO LICENSE YOUR PETS. Vallure to do so is a violation Of City OrOlnances6.103 and carries a PeDaItY Of iR fine Upt0$150.00 per pet. PET LICENSE RENEWALSAREaL1E RY 3/15/2059., 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 (OR) at 6 months of age if puppy or kitten NEW RESIDENTS TO BLAIR Must register pets within 10 days of residency Owner Name Scott Johnson Spouse Jamie Owner Address 1441 Grant St. City/State/Zip Blair,, NE 68008 Phone # 402-533-2548 DL # or DOS PE'r # Pet Name,. Trax Age: 7Y DOB! 09-01-11 Sex: Spayed Female Color: Grey Breed: Domestic Shorthair Dangerous/ Potentially Dangerous Dog TDeclared NO ES Microchip # City Tog • "7es Tag #01 l"1N, 11-1 4 3 YEAR Holstein Veterinary Clinic Dr, Lisa Schrum DVM & Dr. Krista Holstein DVM 718 South 19th Street Blair, NE 68008 402-426-7387 402-426-0101 Fax holsteinclinic@gmaii.com FAX5D —04 09-19 BY 'TOTAL PAGES LICENSE FEES Intact Dog or Cat: $16.00 r cat." Replacement Tag $5-oo OPI) Total $ 1 �Y>— 30/TO 39Vd DINI-10 13A NI3-LS-1OH TOT093030t7 CT:LT 6TG3/60/170 2019 PET LICENSE VERIFICATION/APPLICA►TION FOR CITY OF BLAIR IF YOU LIVE IN GLAIR CITY LIMITS AND OWN A DOG(S) AND /OR CAT(S), COMPUTE THIS FORM ANO RETURN WITH A CHECK PAYABLE To, CITY OF BLAIR -- 218 S. 16 " ST — BLAIR, Nib 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 DWELLINGS UNIT. ***PLEASE READ CAREFULLY*** YYQU ARE RECIUIREp BY LAW iQ LICENSE YOUR PETS. Fallure to dQ 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 2Q19. 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 Qr cat. NEW PET LICENSING Must be licensed within 10 days of ownership (OR) at 6 months of age if puppy or kitten NEW RESIDENTS TQ BLAIR Must register pets within 10 days of residency Owner Name Spouse. Owner -Address City/state/zip Phone # LPL # or DOS Scott Johnson Jarnie 1441 Grant St. Blair, NE 6soos 402-533-2548 LICENSE FEES Intact Dog or Cat: $10.00 =Altereedo.0 Replacement Tag $5.00 Total $ Holstein Veterinary Clinic 71BY a 04.09-19 Dr. Lisa Schrurn DVM & Dr. KPista Uolsteln DVM 718 South 19th .Street Blair, NE 68008 402-420-7387 402-426-0101 Fax TOTAL PAGES holsteindinic «tmail.cc)m 30/30 39dd DINI-10 i3A N=S701-1 13T09Zb30b ET:LT 6TOZ/60/09 FRDM :BSRC FAX NO. :402-533-2722 Feb. 15 2019 05:14PM P1 4c, 26. 2018 2:53PM CITY OF BLAIR No. 8225 P, 1 CITY OF BLAIR - 2019 PET LICENSE APPLICATION W YP, t i[vein 8Iair City limits and own a dog(s) and/or cat(s), complete this form and return with check made payable to; City of 81aiir a 218 S. wh Sid. + Blair, NE 68008 YOU may 100011y own a CoMbination of four (4) adult pets/ but no more than three (3) adult dog$ or three (3) adult cats per residential or dwellitlo Unit. LICENSE RENEW Ls ARIA DUE: MaMbjrU Owner NrkMe: J 16M. VM O.(� QwnerAddrl;,sro; to ��i-ft I-1\ BAS city/+state/71p! Blair, No 68008 Phogv # ' h Drivers Viceltae # or Date of Birth T LICENSE FEES: Dtig or Catty $16,00 Altered Dog or Cat: $11.00 Replacelr4arlt Fee'fqr Lo$t Tang: $5:00 An addiNgtihl StaM1*_46AM,25 Is bei pWf*s*d to fond b "*PLEASE READ CAit):MY'*** YOU ARt )tEQUIRED 8Y LAW 7d LICENSE YOUR pits. Fallurp to day so is a violation bf MY ordinaylMir 6,z.03 and carrigq A penalty of It fine up to 016g.QU pee pet. P15T LIceNNIN REN15WALS ARK 001513Y 3JASIZ04p, The city stroll rtimgntze a mlcroMp identiticatlon number n8 tho liGengc ltul bey. it shell bd unlawful Mr Any dog or cat to w99r any licenso or other city Idbatilicefan Other than that IMIRd by the City oP Ulair far AUch dog or 0t. The city of Wale requires proof of t bles vaeclUAtidn. PET 41 �A Dog ❑ Cat Spe4N'eluterLed �.. Licenso Fee $ Pat Naa Age x — Colar �� Sreed �--. Revlac'ement$Declared Dang r air Potentlaily DangerY Q N MICROCHIP # IPOppllca1—' SUBMTALy $ RABIES VACCINATION DATE; . i (3 yr) (1 yr) — City Tag PE #:Z ❑ 009 0 COt ❑ Spayed/Neutered License Fee $, Pat Name _ A ie _ Sex Corr, -_ Potentially C.� ngeraus --- �..�._ Declared Dangerous - R�plac�rri�n t ;� rous o ,.._ Dog; a Y Q N MICROCHIP #- (If applicable) SUBTOTAL; $ _ RABIES VACCINATION DATE-,,.._. (3 yr) — (I yr) City Tag � PET #3 ❑ Dop ❑ Cat 0 Spayed/Neutered License Fee $ ... -. Pet Name _ Sax _ Color. Breed, * " Replacement$ *� Declared Dangerous or Potentially Dangerous Dog: ❑ Y ❑ N P41C-ROCHIP # ff applicable) 9URTIOTAL."$ RAKES VACCINA-RON DATE: _-_- (3 yr) yr) City Talg /# *PLEME INCLUDE THE CM TAS NUMBER IV THIS IS A RENEWAL,.— ** (Thl,g fee is due along with License Nee if requ4estrhg at the timia of 11co nse reriatwal.) Donation to care for animals: $i ___ $3 _ _ $5 $10 _ CIth er ***SEE BACK OF FORM FOR OIRPED SPrlsCIPIC LICENSE P-EQUIREMLzNTS DO f4at Sonel Cash byAfall TOTAL. ENCLOSED $ VISA /MGN Signatum 1_xpirea' .� — Snourity Carlo, If You haVe auostions, Please contact City Hall at (402) 426-4191 or by Fax: (402) 426-4t95 t^M+++....++t......#+.++++.++. NEW OFT/NEW RP9ZpENT i tCENSINEi prQUIREMENTS (Ma�/i YS1at��e dad �pCappllr�6/�f�r�l�6vpet,/tc�ltiicsidsn�,) Must be IC.r�t 1od8orow-a ii Nie esi 5i1 �>lljC to <oP> at 6 rrwrMs cli'�pe II'y u U MuR relWo l7� within 10 days P ppy/�h tesidel7cy. �� i, ic4A� 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: Larry & Jean Ann Jones Spayed/Neutered Dog or Cat: $11.00 Owner Address: 1366 S 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 #: (402) 426-5109 Drivers License #: or Date of Birth: 1/8/1951 Name: Chia Color: Brown/Tan Spayed/Neutered: False Mirochip # Vaccination Date: 3/12/2018 Subtotal licensed pets from below: Replacement Tags from below: DOB: 1/1/2008 Sex: Female Breed: Chihuahua Duration: 3 year vaccine Vaccine Exp: 3/11/2021 License Fee $ Replacement: ❑Y MA City Tag # 266 f Total: 2019 PET LXCENSE VERIFICATION/APPLICATION FOR CITY OF BLAIR IF YOU LIVE IN BLAIR CITY LIMITS AN15 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 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, ***PLEASE READ.CAREFULLY*** YC7 ARE RE UIReo BY LAW TO 41GENSE YOUR PETS. , Failure to do so is a violation of City Ordinances 6,103 and r2rriOS a penalty of a fine up tQ $150.00 per pet, PET LICENSE RENEWALS ARE DUE BY �J1S/2d19 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 (OR) at 6 months of age if Puppy or kitten NEW RESIDENTS TO BLAIR Must register pets within 10 days of residency Owner Name Spouse Owner Address City/State/Zip Phone # Di. # or DOB Lennie Jones 2354 Park St Blair, NE 68008 ,PET # — I Pet Name: Stevie Nicks Age: 3 � Sex: Spayed Ferna—Ie Collor- White/Brn Breed: Lab Mix Declared Dangerous/Potentially Dangerous Dog : NO VIES C: Microchip City Tag # i 11 �—J Rables Tag # Im I Will. �410'1411"ii t i (P Rif Ralbies Description: I YEA 3 YEAR 601-3S'o -- LICENSE FEES intact Dog or Cat: $16.00 Dog or cat: $11,00 Replacement Tag "y $5.00 -- Total $ (.Poo \ 'IV, '�:3"��-heirIty ,�c cfthcr II-�jo �Ovl�'v �que ,dC9 11 ) Holstein Veterinary Clinic Dr. Liso Schrurn DVM & Dr, Krista Holstein DVM 718 South 19th Street Blair, NE 68008 402-426-7387 4 ' 02-426-0101 Pax holsteindinic'@ghnail,com FAXED 02-26-19 1:31p BY TOTALPAGES �0/To 39vd DIFII-10 13A NI S701-1 IOT09Zvzov t16:9T 6T7Z/93/30 2019 P IET LICENSE VIE RIFICATION/AP PLICATIO N FOR CITY OF BLAIR IF YOU LIVE IN BLAIR CITY LIMITS AND OWN A DOG(S) AND /OR CAT(5), COMPLETE THIS FORM AND RETURN WITH A CHECK 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. 'PLEASE REAL] CAREKIILLY*** YOU'ARE R�C1UlRED BY LAW TO LICENSE Yd�1R PETS. Failure tQ do so Is a violation of city Ordlnances 6.10� and carries a penalty of a fine up to $150.00 per pet. PETLICEN5ERENEWALSAREpRJLgy� 15 �(IZ9. The elty 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 (tea) at'6 months of age if puppy or kitten NEW RESIDENTS TO FLAIR Must register pets within 10 days of residency Owner Name Spouse Owner Address city/Slane/Zip Phone # aL # or ROB Holstein Veterinary Cline Dr. Lisa Schri n .DVm & Dr. KHsta Holstein 17VM 718 South 191h Street 0l,"ir, NE 68008 402-426-7887 402-426-0101 Fax holsteinclinic@gmail-.com Lennie Jones 2354 Park St Blair, NE 68008 402-426-8761 LICENSE FEES Intact Dog or Cat: $1.6.o0 or cat: $11.()0 $5.00 Total $i_ I ! FAXED 1 02-26-19 1:3-3p TOTAL PAGES M ZO/30 39dd OINI-10 13A NI3IS-10H TOT093IV30V 17E:91 6TOZ/9Z/ZO FROM :99AC FAX 1,10. :402-533-2722 Mar. 11 2019 09:47AM P1 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. 1,6d, St, e elairo NE 68008 You may legally own a combination of four (4) adult pets, but no more than three (3) odult dogs or three (3) adult cats per residential or dwelling unit, LICENSE' RENEWALS ARE DUE: Marth 15, 2019 Owner Name: '9+nyt 4- a,= Thneb Owner Address: city/state/zip.- Blair, NE 618008 Phone # 40 a,-5m -zq 15 Drivers License# or D!!�f firth a 37-63 LICENSE FEES. Dog or Cat: $16.00 Altered bog or Cat, $11.00 Replacement Fee for Lost Tag; $5,00 included is a State Fee of t1.25 beina collected to fund the ***PLEASE READ CAREFULLY*** YOU ARE REQUIRRO BY LAW TO LIChNSE YOUR PETS, Failure to do so Is a violation of City ordinances GA03 and carries a penalty of a f lite up to $130.00 per pat. PET LICENSE$ RVINIPWALSARli DUE BY 3115J2018 The 0tyshall recognlAe a microchip Identification nurnbtr ba tho licanso number. 1k ghaii be unlawful for any (log or cat to wear any (Icen.ge Qr other city Iclentificatlon other than that ]$Sued by the City or Blair for such dog or rat. The Clty,of Blair rd4ulrat proof of tables Vattination, a, C49 PET #1 C3 Dog Y Cat D Spayed/Neutered License Fee $ Pet Name -Sgjaa,ji&n Aye Sex M I I Color 0 MLf 1jA)hLjy-. Rrp. d * j . Replacement Declared D&g"erous or Potentially Dangerous Dog: LI Y \1 MICROCHIP # (if applicable) SUBTOTAL:$ RABIES VACCINATION DATE ,2 Z,'24- (3 yr) (1 yr) City Tag PET #2 El Dog E3 Cat L3 Spayed/Neutered License Fee $ Pet Name Age Sex Color Breed * ... . Replacement $_„_, ** Declared Dangerous or Potentially Dangerous Dog: 0 Y Ll N MICROCHIP # (If applicable) SUBTOTAL:$ RABIES VACCINATION DATE: (3 yr) _ (I yr) _ City Tag PET #3 Ll Dog El Cat D Spayed/Neutered License Pee Pet Name AVe Sex Color Breed * — I Replacement $ Declared Dangerous or Potentially Dangerous Dog: U Y LJ N MICROCHIP #__ (If apllcable) 9UB'FOTAL: RABIES VACCINATION DATE: (3 yr) (I yr) _ City Tag # *PLEASE INCLUDE THE cTTy TAG NUMBER IF P11IS IS A RENEWAL ** (This fee Is due along With License Fee If requesting at the time of license renewal.) DonaMon to care for animals: _$I _$3 _$5 _$10 Other ***SEE BACK OF FORM FOR BREED SPECIFIC LICENSE REQUIREMENTS Ov Not Send Cash by Mail TOTAL ENCLOSED $ VISA / MG # Expires; Security Code: Signature . ...... If you have questions, please contact City Hall at (402) 426-4101 or by Fax., (402) 426-4195 ....... t ... *4.++* .... * .... + ........ + ............................................ NEW PETINEWRIMSIOENT LICENSING REQUIREMENTS (Maid) 15 late &e datenatapdlcahle tornewpehoiew ragldants) New Residents to Blair, 0 Must be licr d within 10 days or ownership m Must register pets within 10 days of III -,,'OR> at 6 monft of age If puppy/kiln re-sidt4licy,