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K04/03/2019 10:15 4024260101 HOLSTEIN VET CLINIC PAGE 01/01 2014 PET LICENSE VERIFICATION•/APPLICATION 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. 16'tH ST — BLAIR, NE 68008 YOU MAY LEGALLY OWN A COMBINATION OF FOUR (4) At)ULT PETS, BUT NO MORE THAN THREE (3) ADULT DOGS OR THREE (3) ADULT CATS PER RGXIENTIAL OR DWELLING UNIT. ***PLEASE READ CAREFULLY*** YOU ARE REQUIRED BY L N 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 LICENSE RENEWALS ARE DUE BY 3/•1512019, 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 bythe City of Blair for such dog or cat, NEW PET LICENSING Must be licensed within 10 days of ownership (aft) at 6 months of age if puppy or kitten NEW RESIDENTS TO BLAIR Must register pets within 10 days of residency Owner Name Pete Kaiser Spouse Nancy Owner Address 2406 Meadow Dr. City/State/Zip Blair, NE 68008 Phone # 402-426-I5948 DL '# or DOB Pet Name: Sophie Age: 10M sex: Spayed Fern ale color; White greed; Westie Declared Dangerous/ pntentilaIlly Dangerous Dog NO YEB Microchip # 985112010834340 City Tag # � '�I u f Il( 'll`I:I PIiIIJ:I�I G"'I!' .}' 'III`. 1: •Y19'" 1H; 7h',rgMtlbltGLYI' .i�1;�.li!.k11:, ;:I ;. 1'it:ll.;:f; ,��•,;:.I!„�rt,, r;nlan�.61V;;@ •.�upm:, .i I:t t�;••;ayl !: i{''i+`,` %o,I�tju�uYyitin.d•s"I{. tl� Rabies Tag # 1636� iJi".:I I•I�''�: _J..I1•Ililli .:.li;�sr•I::.lr.� 1 l ,;k!�. •I.Q. Ii�' :i�!ll'll Jl 14'. nV+1 ITT 11.1':: , i', �iE�J'ril•�Clit.t .It • ,.I,,,�i::lt n,r (�.I::� I I:Vi�G� 'r IIP <ini�., �4,r•i:ii �: r��l ,11JI r�ii). Ir,{JN;� I •'i!: 1 � _ ;alp :1> �"' I1: i b„ „iSi• Rabies Description: YEAR, 3 YEAR Holstein Veterinary Clinic Dr, ,Lisa Scbrttrn PVM & Dr. Krista Holstein .AVM '8 South 19th Street glair, NE 68008 402-426-7887 402-426-0101 Fax holsteindlniclfgmail,com LICENSE FEES Intact Dog or Cat: $16.00 Altered,— or cat: $11.00 Total $ FAXrD 04-03-19 9:19a RY TOTAL PAGES T 03/04/2019 14:33 4024260101 HOLSTEIN VET CLINIC PAGE 01/01 2019. PET LICENSE VERIFICATION/APPLICATION 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 THREE (3) ADULT CATS PER RESIDENTIAL OR DWELLING UNIT. ***PLEASE READ CAREFULLY*** YOU ARE REQUIRED BY LAW !a LlC N$F 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 LICENSE RENEWALS ARE DUE BY 3/15/2019. The city shall recognize a microchip ID number as the license number. it shall I)e 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 Pete Kaiser spouse Nancy Owner Address 2406 Meadow Dr. city/state/zip Blair, NE 68008 Phone 402-426-5948 DL * or DOE P'T # Pet Name: Lucy Age, SY I sex: Spayed Breed., Cairn Terrier Declared Dangerous/ Potentially Dangerous Dog NO YES Microchip # 981020005470398 City Tag # it L R0111 V-6&ffitit., dstlp �h, Rabies Tag V 15761 Rabies Description. 3 YEAR Holstein Veterinary Clinic Dr. Lisa Schrum DVM & Dr. Kri.5taHo1stein1)VM 718 South 19,1h Street Blair, NE 68008 402-426-7387 402-426-0101 Fax holsteinclinic@gmail.com LICENSE FEES Intact Dog or Cat: $16.00 W fieplacement Tag $5,00 Total $ '\, FAXED 03-04-19 2:26p BY TOTALPAGES 1�-� 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 payl 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: MarchJJ15, 2019 : Owner Name: �, 56 A ocJeC Lr / /? Owner Address: 33 y � )9 c�g 4,lt S S City/State/Zip: Blair, NE 68008 Phone # 4i © -5 3.3 C 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 Included is a State Fee of $1.25 being collected to fund PET #1 ❑ Dog 13 1 Cat ❑ Spay -/Neutered Pet Name (�,c)yvv e o Aye Color _;i �-o _ Breed * Declared Dangerous or Potentially Dangerous Dog: ❑ Y MICROCHIP # -c 1110 -1 33LI (If applicable) RABIES VACCINATION DATE: (3 yr) _ 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) PET #3 ❑ Dog ❑ Cat ❑ Spayed/Neutered Pet Name Me Sex Color Breed** Declared Dangerous or Potentially Dangerous Dog: ❑ Y MICROCHIP # (If applicable) RABIES VACCINATION DATE: (3 yr) _ ***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 3/1512019. 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. W ii Doo & Cat Operator inspection Program License Fee $ Replacement $ SUBTOTAL: $ " ��_ (1 yr) City Tag # ,, * (1 yr) (1 yr) License Fee $ Replacement $ ** SUBTOTAL: $ City Tag # 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 15 late fee date not applicable for newpets1new 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/ldtten residency. Blair Small Animal Clinic PC David E. Johnson DVM 1734 Front Street Blair, Nebraska, 68008 (402) 533-2722 Rabies Certificate Patient ID: 11185 Client ID: 268 Patient Name: Romeo Client Name: Lisa & Peter Kelly Species: Feline Address: 3348 Adams St Breed: Domestic Shorthair Blair, NE 68008 Sex: Male Color: Tan Phone: (402)533-2124 Markings: Birthday: 02/09/2019 Weight: Microchip ID: Tag Number: 000 Lot Number: 18416 Imrab Rabies Vaccine Producer: Merial K / MLV / R: Killed Virus Vaccination Date Expiration Date Staff Name: David E. Johnson DVM License Number: 1893 §., 9/14/2019 9/14/2020 0 Blair Small Animal Clinic PC David E. Johnson DVM 1734 Front Street Blair, Nebraska, 68008 (402) 533-2722 Lisa & Peter Kelly 3348 Adams St Blair, NE 68008 Page 1 / 1 Client ID: 268 Invoice #: 153747 Date: 9/14/2019 Patient ID: 11185 Weight: Patient Name: Romeo Birthday: 02/09/2019 Species: Feline Sex: Male Breed: Domestic Shorthair Description 9/14/2019 Examination General Microchip Implant & Enrollment Rhino-Calici-Flu-PanLeu-Annual Rabies Vaccination -Feline 1st Fecal: Idexx: O P Antigen Test Staff Name Quantity Total David E. Johnson DVM 1.00 $24.45 1.00 $47.15 T 1.00 $28.87 1.00 $27.59 1.00 $25.25 Patient Subtotal: $153.31 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. K cinder 09/14/2020 Rabies Vaccination - Feline Rhino-Calici-Flu-PanLeu-Annual Invoice Total: default Tax Rate Total: Balance Due: Previous Balance: Balance Due: Check Check # 1251: 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. $153.31 $3.30 $156.61 $156.61 $0.00 $156.61 ($156.61) ($156.61) $0.00 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: KELLY, PETER O & LISA W Spayed/Neutered Dog or Cat: $11.00 Owner Address: 3348 ADAMS 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) 533-2124 Drivers License #. or Date of Birth: 1/26/1963 Subtotal licensed pets from below: Replacement Tags from below: Name: Precious DOB: 3/12/2004 Sex: Female License Fee $ Color: Grey Breed: Domestic Shorthair Replacement: Spayed/Neutered: True ❑Y ❑N Mirochip # City Tag # 1851 Vaccination Date: 4/5/2017 Duration: 3 year vaccine Vaccine Exp: 4/5/2019 Total: CERTIFICATE OF, vA"CC.INAT I ON Date of Rabies Vaccination: 11-06-18 Next Rabies Vaccination On: 11-06-19 VETERINARY CLINIC Holstein Vet Clinic 718 South 19th Street Blair, NE 68008 402-426-7387 This is to certify... Certificate No: 0 Previous Rabies Vaccination: OWNER OF ANIMAL Connie Kephart -PO_Boxr663 . 5- Blair, NE 68008 q0 2- -- County: THAT I HAVE VACCINATED AGAINST RABIES THE ANIMAL DESCRIBED BELOW. Patient information... PATIENT: Bella allTAG NO: 16441 SPECIES: Canine ,`, WEIGHT: 12.50 SEX: F AGE: 16 weeks Color and markings... Tri Color Signed Lisa Schrum, DVM Due Date / Vaccinations 08-11-19 Bronchi Shield - Oral Bordetel 10-16-19 Vangard Plus 5 11-06-19 Defensor 1 (1 Year Rabies) Rabies Vaccine Information... License: 2310 MFG BY: ZOETI SER.NO: 282271 LOT EXP: 07-30-19 ADM: SQ pa" if -o S u CERTIFICATE OF VACCINATION Date of Rabies Vaccination: 03-06-19 Next Rabies Vaccination On: 03-05-22 VETERINARY CLINIC Thone Animal Care of Blair 902 S Hwy 30 Blair, NE 68008 402-426-3630 This is to certify... Certificate No: 0 Previous Rabies Vaccination: OWNER OF ANIMAL Jim Kephart 1006 State St Blair, NE 68008 County: THAT I HAVE VACCINATED AGAINST RABIES THE ANIMAL DESCRIBED BELOW. Patient information... PATIENT: Rosey SPECIES: Feline (0�)l SEX: S Color and markings... Torti Signed Dr. Joe DiMari TAG NO: 004632 WEIGHT: 12.19 AGE: 4 years License: Vaccinations done... 03-06-19 JRD Rabies Vaccination (3 Year), #004632 03-05-22 03-06-19 JRD Check up, FE-4way 03-05-20 Rabies Vaccine Information... MFG BY: ZOETI SER.NO: 293134 LOT EXP: 11 /29/19 ADM: SQ C, CERTIFICATE OF VACCINATION Date of Rabies Vaccination: 09-25-18 Next Rabies Vaccination On: 09-25-19 VETERINARY CLINIC Thone Animal Care of Blair 902 S Hwy 30 Blair, NE 68008 402-426-3630 This is to certify... Certificate No: 1620 Previous Rabies Vaccination: OWNER OF ANIMAL Jim Kephart 1006 State St Blair, NE 68008 County: THAT I HAVE VACCINATED AGAINST RABIES THE ANIMAL DESCRIBED BELOW. Patient information... PATIENT: Flash SPECIES: Canine SEX: N Color and markings... Chocolate I Signed Dr. Leon Leishman Vaccinations done... TAG NO: 004367 WEIGHT: 105.00 AGE: 2 years License: 1971 09-25-18 LL Rabies Vaccination (I Year), #004367 09-25-18 LL Check up, DA2PPV+L 09-25-19 Rabies Vaccine Information... MFG BY: ZOETI SER.NO-. 2�9133 LOT EXP: 11/29/19 ADM: SQ FROM :9SAC FAX 1,10. :402-533-2722 FEb. 26 2019 02:02PPM P1 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 I lath St, * Blair, NE 68008 You may legally own a colnoination 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: Larch 15, 2019 LICENSE FEES: peg or Cat: $16.00 Owner Name: KESLING, WILLIAM PAUL & CHRISTY• KAY Spayed/Neutered Dog or Cat: $11.00 Owner Address: 'i3Q6 ADAIVIS ST Replacement fee for Lost Tag! $5.00 Fee includes $1.25 for the Nebraska Clog and Cat City/Mate/,ZIP: BLAIR, NE, 68008--0000 Operator InspeCticn program Phone #: <NO PRIMARY PHONP> Drivers License #: 6�.90/0-7 2� _ or Gate of Birth: 41gjjy' y Subtotal licensed pets from below: Name. Pete Color: Black Spayed/Neutered. False Mirochip ## C , Vaccination Date.�/j7/2(5f6 gat' Replacelment Tags from below; - DOB, Not on File Sex; Male Breed: Labrador Retriever License Fee $ Replacement; OY ON City Tag # 86 Duration: 3 year vaccine Vaccine I=xp� 9 220-1& I 03/19/2019 14:13 4024260101 HOLSTEIN VET CLINIC PAGE 01/01 2019 FEET LICENSE VERIFICATION/APPLICATION FOP, CITY OF BLA,IR IF YOU LIVE IN BLAIR CITY LIMITS AND OWN A DOG(S) AND /OR CAT(5), COMPLETE THIS FORM AND RFTURN WITH A CHECK PAYABLE TO; CITY OF BLAIR W 218 S. 18TH 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*** YOU ARE RE UI M 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 op to $150,00 par pet. PET LICENSC RENEWALS ARE DUE BY 15 2U19. -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 la other than that issued by the City of Blair for such dog or cat. NEW PET LICENSING Must be licensed within 10 days c)f 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 # DL # or DOB Pet Name: R,oxi Age: 23M Breed: Heeler sex: Spayed Female Molli Kies 1160 Highland Drive Blain NE 68008 402- color: Red Declared Dangerous/Potentially Dangerous log I ( NO) I 'YES Microchip # 985112007971453 Rabies Description: I YEAR Holstein Veterinary Clinic Dr. Msa Schrum DVM & Dr. ,Kr•ista Holstein DVM A8 South 101h Street Blair, NE 68008 402-426-7387 402-426-0101 Fax holsteinciinicfgmail,com city Tag # Rabies Tag 9 16274 3 YEAR FAXED I1XI TOTAL PAGES LICENSE FEES Intact Clog or Cat: $16,00 Dog or cat: $11.00 $5.00 Total $ I 03-19-19 2:07p 02/21/2019 17:12 4024260101 HOLSTEIN VET CLINIC PAGE 01/02 2019 PET ' LICEN-S►E VERIFICATION/,APPLICA►,TION'. 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. j TH ST — BLAIR, NE 68008 YOU MAY LEGALLY OWN A COMBINATION OF FOUR (4) ADULT PETS, BUT NO MARE THAN THREE (3) ADULT DOGS OR THREE (3) ADULT CATS PER RESIDENTIAL OR DWELLING UNIT. ***PLEASE READ CAREFULLY*** YOU ARE RE UIRFO 9Y LAW TO LICEN E YOUR LETS. Failure! to do so Ira violation of City Ordinances 6.10S and carries a penalty of a fine Up to $150.00 per pet. PET LICENSE RENEWAIu ARE DUE DY 3 15 2019. The city shall recognize a microchip ID number as the license number. it shall be unlawful for any dreg or cat to wear any license or other city ID other t 6 months issuedhat by the f city of Blair fo or Icitten$uc h dog or cat, NEW PET LICENSING Must be licensed within 1Q days of ownership (OR) NEW RESIDENTS TO BLAIR Must register pets within 10 days of residency Owner Name Spouse owner Address City/State/Zip Phone # DL # or DOB Holstein Veterinary Clinic Dr. Lisa schruln DVM & Dr. Kriste' Holstein DYM 18 South 19th Street, Blair, NE 68008 402-426-7387 402-426-0101 Fax holsteincliniciDgmail.cOm Lance King 276 N. 23rd Street Blair, NE 68008 402-237-0420 LICENSE FEES Intact Dog or Cat: $16.00 r Altered ) Dog or cat: $11.00 Replacernent Tag $5.00 60 Total $ FAXFD 1 02-21-19 4:350 BYt, TOTAL PAGES 02/21/2019 17:12 4024260101 HOLSTEIN VET CLINIC PAGE 02/02 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 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 Na MORE THAN THREE (3) ADULT DOGS OR THREE (3) ADULT CATS PER RFSIDENTFAL OR DWELLING UNIT. ***PLEASE READ CAREFULLY' YOU ARE REClUIRED BY LAW TD LICENSE YOUR PETS, Failure to do so is a violation of city ordlnances 6,105 and carries a penalty of a fine up to $150,00 Per pet, PET LICENSE RENEWALS ARE DUE PY 3 15 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 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 BLAIf Must register pets,within 10 days of residency Owner Name Spouse Owner Address city/state/zip Phone #� DL #k or DOB Holstein Veterinary Clinic Dr. Lisa Schrum DVM & Dr. ,Krista Holstein DVM 18 South 19th Street Blair, NE 68008 402-426-7387 402-426-0101 Fax holsteindinic@gmaU.ccam Lane King 7-a6 N, 23rd Street Slain NE 68008 482-237-0420 LICENSE FEES Intact Dog or Cat: $16.00 Dog or cat: $11.00 Replacement $5.00 1 b� 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: KIRBY, ANN M Spayed/Neutered Dog or Cat: $11.00 Owner Address: 2046 COLFAX 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) 670-9232 Drivers License #:.,,�e �� ` .;� or Date of Birth: , Name: Bailey Color: Sable Spayed/Neutered: True Mirochip # Vaccination Date: 1/21/2017 Subtotal licensed pets from below: Replacement Tags from below: DOB: Not on File Sex: Female Breed: Pomeranian Duration: 3 year vaccine Vaccine Exp: 1/21/2020 License Fee $ X'- Replacement: ❑Y dN City Tag # 691 Total: 4t A 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: KIRBY, ANN M Owner Address: 2046 COLFAX ST City/State/ZIP: BLAIR, NE, 68008--0000 Phone #: (402) 670-9232 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 Drivers License #: or Date of Birth: Subtotal licensed pets from below: Replacement Tags from below: ; Total Dog ❑ Cat 0 Spayed/Neutered License Fee $ Pet Name H a_ Pet DOB/ Sex" Colon ,V r t E Breed Jt 1 Declared Dangerous or Potentially Dangerous Dog? 0 Y, p� N Microchip # Rabies Vaccination Date _f'°- C3 yr 01 yr ❑ Dog ❑ Cat ❑ Spayed/Neutered Pet Name Color Age Sex Breed Declared Dangerous or Potentially Dangerous Dog? ❑ Y ❑ N Microchip # ❑ Dog ❑ Cat ❑ Spayed/Neutered Rabies Vaccination Date Pet Name Pet DOB Sex Color --• Declared Dangerous or Potentially Dangerous Dog? ❑ Y ❑ N Microchip # Rabies Vaccination Date License Fee $ 03 yr 01 yr License Fee $ 03 yr 01 yr Client ID: 27680 Client Name; Jacob Kirby Address: 2046 Colfax Street Blair, NE 68008 Phone: (402)90r5-5696 'Tag Number: 002425 Lot Number: 18276 Rabies Vaccination Canine Producer: Medal K/Ml.V/R, Killed Virus Best Care Pet Hospitals 402 446-8738 4915 N 120th Street Suite 8 Omaha, NE 68164 (402) 445-8738 Rabies Ce v1i, fir-, ate Patient ID: 17210 Patient Name: Cooper Species: CANINE Breed: RETRIEVER, LABRADOR Sex: Male Color, white Markings: Birthday: 11126/2014 Weight: 65,00 pounds on 5125/2016 Vaccination Date: Expiration Dato: Staff Name: Dr. Heather Koolma, D.V. M. License Number. 3437 5126/2016 612512019 f : 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: $16.00 Owner Name: Daniel F And Suzanne M Kirwan Spayed/Neutered Dog or Cat: $11.00 Owner Address: 1046 N 20th Ave Cir 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) 533-2795 Drivers License #: or Date of Birth: Name: Lulu Color: White Spayed/Neutered: True Mirochip # Vaccination Date: 5/31/2017 Subtotal licensed pets from below: Replacement Tags from below: DOB: 1/1/2013 Sex: Female Breed: Scottish Terrier Duration: 3 year vaccine Vaccine Exp: 5/31/2020 License Fee $ Replacement: Y ❑ N City aE6 �0J) �54LP i W�P Total: 2019 PET LICENSE 'V'ERIFICATION/APPLICATION FOR CITY OF BLAIR xr YOU LIVE IN BLAIR CITY LIMITS AND OWN A DOG(S) AND /OR CAT($), COMPLETE THIS FORM AND RETURN WITH A CHECK PAYABLE TO; CIYY OF BLAIR — 218 S, 16TM 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 READ CARErULLY'k** YOU AIt9 REQUIRED BY LAW TO LICENSE YOUR PETS Failure to do so is a violation of City OP[lihances 6.103 and carries a penalty of a fine up to $150,00 per pot;, PET LICENSE RENEWALS ARE R—VE BY 3/1S 2019. The city shall recognize a microchip 1D 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 G rrioriths of age if puppy or kitten NEW MIDENTS TO BLAIR Must register pets within 10 days of residency PET # Pet Name: Ulu Age: 6Y sex: Spayed Female Breed: Westie Color. White Declared Dangerous/Potentially Dangerous Dog Microchip # Rabies Description: I YEAR Holstein Veterinary Clinic Dr. Lisa .Schrum DVM & Dr. Kr i to Holstein V'i M 718 South 1qth Street Blair, NE 68008 402-426-7387 402-426-0101 Fax halsteinciinic@gmail.ccm NO I YES Cite„ ,..� L. Rabies Tag ,#` 15212 LICENSE FEES Intact Dog or Cat: $16.00 A Clog G t; $ -00 Replacement Tag $5.00 Total $ t `—oo FAXED. 01-30-19 4;43p BY TOTAL PAGES L__ Z0/Z0 39Vd DINI-10 13A N=S-DOH Z0Z09ZbZ0b ZE:LZ 6Z03/0E/Z0 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: Daniel F And Suzanne M Kirwan Spayed/Neutered Dog or Cat: $11.00 Owner Address: 1046 N 20th Ave Cir 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) 533-2795 Drivers License #: or Date of Birth: Subtotal licensed pets from below: Replacement Tags from below: Name: Cramer DOB: 1/1/2006 Sex: Male License Fee $ Color: Brown Spayed/Neutered: True Mirochip # Vaccination Date: 6/31/2017 Breed: Labrador Retriever Duration: 3 year vaccine Vaccine Exp: 5/31/2020 Replacement: P(Y [IN City Ta # 1438 Total: 2019 PET LICENSE VERIFICATION/AP'PLICATION 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 - SLAIRr NE 68008 YOU MAY LEGALLY OWN A COMBINATION or roUR (4) ADULT PETS, CUT NO MORE THAN THREE (3) ADULT DOGS OR THREE (3) ADULT CATS PER RESIDENTIAL OR DWELLING UNIT. 'PLEASE READ CAREFULLY*** YOU ARE REQUIRED BY L4 LM 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 LICENSE RENEWALS ARE DUE BY 3/1512019. 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 Owner Name Dan Kirwan Spouse Suzanne Owner Address 1046 N. 20th Ave Circle City/State/zip Blair, NE 68008 Phone # 402-533-2795 Dl_#,>E'orDOB PET # Pet Name: Crawler —T—Age: 13Y sex: Neutered MaI� Color. Choc Breed: Lab Declared aangeraus/Potewitialiy Dangerous Doug NG1 YES Microchip # City Tag # Rabies Vaccination Dated 1 �. -� Rabies Tag # 15213 (Rabies Description,- 1 YEAR YEA Holstein Veterinary Clinic Dr. .Lisa Schrum DVM & Dr. Kr ista Holstein DVM 718 South) 19th Street Blair, NE 68008 402-426-7387 402-426-0101 Fax holsteinclinic@gmail.com LICENSE FEES Intact Dog or Cat: $16,00 re D or rat: $11.00 Replacement Tag $5.00 'rota I 1 FAXED 01-30-19 4:42p BY TOTALPAGES i3O/TO 39Vd DINI-10 13A N=S-101-1 TOT093b3Ob ZE:LT 6T03/0E/TO 03/12/2019 14:47 4024260101 HOLSTEIN VET CLINIC PAGE 01/01 2019 PET LICENSE VERIFICATION/APPLICATION FOR. CITY OF GLAIR 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. 1ST" ST — BLAIR, NC 68008 YOU MAY LL(�ALLY OWN A COMBINATION OF FOUR (4) ADULT PETS, BUT NO MORE THAN THREE (3) ADULT DOGS OR THREE (3) ADULT CATS PER RESIDENTIAL OR OWELLENG UNIT. ***PLEASE READ CAREFULLY*** YOU ARE REQUIRED BYLAW TO LICENSE YOUR PETS. Failmre to do so i5 a violation of City Ordinances 6,103 and carries a penalty of a fine up to $iso,00 per pet. PET LICENSE RENEWALS ARE DUE BY 3/15/2019. 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 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 GLAIR Must register pets within 10 days of residency Owner Name Spouse Owner Address City/State/Zip Phone # DL # or DOB Pet Namlec Nellie Julie Klinger * 1002 South St Blair, NE 68008 402-,426-2805 Age sex: Spayed Female Color: Tarn/Slack Breed: Chihuahua Declared Dangerous/Potentially Dangerous Dog NO vlEs Mlcrocbilp # 985112008167155 City g # R i�ie gX/ i i a,; Rabies Tag # 14493 Rabies Description: 1 YEAR Holstein Veterinary Clinic I]r. Lisa Schrum DVM & Dr, ,Krista Holstein DVM 718 South 19th Street Blair, NE 68008 402-426-7387 402-426--0101 Fax holsteinclinic@a gmail.cQm 3 YEAR LICENSE FEES Intact Dog or Oat: $16.00 Clog or cat: $11.00 Replacement Tag $5.00 ,l Total $ ` 00�0 FAKED 03-12-19 2:37p BY TOTALPAGES 2019 PET LICENSE VERIFICATION/APP'LICATION FOR CITY OF RLAIR IE 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. 16TM ST BLAIR, NE 68008 YOU MAY LEGALLY OWN A COMBINATION OF FOUR (4) ADULT PETS, PUT NO MORE THAN THREF (3) ADULT DOGS OR THREE (3) ADULT CATS PER RESIDENTIAI- OR DWELLING UNIT. ***PLEASE READ CAREFULLY*** YOU ARE REQUIRED BY LAW TO LICENSE YQQR 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/15/201� The city shall recognize a microchip ID number as the license number. It shall he unlawful for any doe 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 GLAIR Must register pets within 10 days of re5idericy Owner #Varna Darn Kloster Spouse Deanna Owner Addre:9S 1930 Washington St city/6tate/zip Blair'r NE 68000 Phone # 402-427-3140 DL # or DOB PET V Pet Name: Charlie ,Age: OY Sex, Neutered Male enlor: Vlfhite Breed: Maltip oo Declared Dangerous/Potentially Dangerous Dog NO Microchip # Rabies Description: 1 YEAR Holstein Veterinary Clinic Dr, Lisa Schnon DVM & Dn Kristu Holste1n DVM 718 South 19th Street Blair, NE 68008 402-426-7387 402-426-0101 Fax holsteinclinicftmail.com 30/30 09vd DINI-10 i3A NI3iS�0H City Tag # � YES Rabies Tag # 15501 LICENSE PEES Intact [log or Oat: $16.00 tere�! as Gat: $11. Replacement Tag $5.00 Total $ � 1� FAXED 01-26-19 11:25a BY TOTAL PAGES TOT09Z030b LO:ZT 6TO3/93/10 2019 PET LICENSE VERIFICATIONJAPPLICATION FOR CITY OF BLAIR IF YOU LIVE IN BLAIR CITY LIMITS AND OWN A DOG(S) AND /OR CAT(S), COMPI-ETE 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 READ CAREFULLY*** YOU ARF. REQUIRED BY LAW TO LICEN E YOUR PETS. Failure to do sa is a violation of City Ordinances 6.103 and carries a penalty of a fine up to $150,00 per P7 t• PET LICENSE RENEWALS ARE DUE BY 3 Z5 2b19. The city shall recognize a microchip ID dumber as the license number. It shall be unlawful for any dog or cat to wear any license or other city ID Qther than that issued by the City of Blair for such dog or cat, NEW PET LICENSING Must be licensed within 10 days of ownership (OR) at 6 months of age if puppy or kitten NEW RESIDENTS TO BLAIR Must register pets within 10 days of residency owner Name Spouse owner Addres$ City/State/Zip Phone # RL # or OOB Dan Kloster Deanna 1930 Washington St Blair, NE 68008 402-427-3140 PET # Pet [Name: Mitzi Ape: 71l' :::[$�ex,::Spayed F+ male �coio`r-.Brown� lareed: Shih Tzu Declared Dangerous/Potentially dangerous DogT NO YES Microchip # Rabies Deescriptiori: 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@gMail.Com City Tag #>. Rabies Tag # 15562 LICENSE FEES Intact Dog or Cat; $16.00 t red Dog or cat: $11 0 Replacement Tag $5.00 Total $ 1 FAXED 01-215-19 11.25a BY TOTAL PAQES (' 30/T3 30dd DINI-10 i3A NI3IS-I01-1 T3T093b3Ub LO:ZT GT03/9Z/TQ 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: Lynette & Heath Kloster Spayed/Neutered Dog or Cat: $11.00 Owner Address: 2045 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) 278-0061 Drivers License #: k- 1 z3 5or Date of Birth: Subtotal licensed pets from below: Replacement Tags from below: Name: Jasper DOB: 1/1/2010 Sex: Male License Fee $ Color: Tri-Color Breed: Basset Hound Replacement: Spayed/Neutered: True ❑Y ❑N Mirochip # 0A11211E4B City Tag # 1321 Vaccination Date: 3/24/2017 Duration: 3 year vaccine Vaccine Exp: 3/24/2020 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: Lynette & Heath Kloster Spayed/Neutered Dog or Cat: $11.00 Owner Address: 2045 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) 278-0061 Drivers License #: i Co or Date of Birth: Subtotal licensed pets from below: Replacement Tags from below: Name: Tilly DOB: 8/4/2011 Sex: Female License Fee $ Color: Brown Breed: Labrador Retriever Replacement: Spayed/Neutered: True ❑Y ❑N Mirochip # City Tag # 1013 Vaccination Date: 4/ /201-6 Duration: 3 year vaccine Vaccine Exp: 4/512019 Tota I : CERTIFICATE OF VACCINATION Date of Rabies Vaccination: 03-26-19 Next Rabies Vaccination On: 03-25-22 VETERINARY CLINIC Holstein Vet Clinic 718 South 19th Street Blair, NE 68008 402-426-7387 This is to certify... Certificate No: 0 Previous Rabies Vaccination: 14274 OWNER OF ANIMAL Heath Kloster 2045 Jackson St Blair, NE 68008 County: THAT I HAVE VACCINATED AGAINST RABIES THE ANIMAL DESCRIBED BELOW. Patient information... PATIENT: Tilly TAG NO: 16834 SPECIES: Canine WEIGHT: 60.10 SEX: S AGE: 7 years Color and markings... Chocolate Signed Lisa Schrum, DVM Due Date / Vaccinations 03-25-16 Hwt Dog (Heartworm Test) 03-25-20 Vangard Plus 5 L4 03-25-22 Denfensor 3 (3 Year Rabies) Rabies Vaccine Information... License: 2310 MFG BY: ZOETI SER.NO: 293134 LOT EXP: 11-29-19 ADM: SQ 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 & Janice Kolb Spayed/Neutered Dog or Cat: $11.00 Owner Address: 823 N 26th AVe 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) 426-2904 Drivers License #: or Date of Birth: 7/24/1946 Name: Raiya Color: White/Red Spayed/Neutered: True Mirochip # 067260818 Vaccination Date: 3/2/2017 Subtotal licensed pets from below: Replacement Tags from below: DOB: 8/29/2012 Sex: Female Breed: Shiba Inu Duration: 3 year vaccine Vaccine Exp: 3/2/2020 License Fee $ %J Replacement: ❑Y ON City Tag # 1396 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: Wendell & Elaine Korth Spayed/Neutered Dog or Cat: $11.00 Owner Address: 833 Meadow 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) 533-2075 Drivers License #: or Date of Birth: Subtotal licensed pets from below: Replacement Tags from below: Name: Zoe DOB: Not on File Sex: Female License Fee $ Color: Apricot Breed: Pomeranian Replacement: Spayed/Neutered: True ❑Y ON Mirochip # 490529416C City Tag # 543 Vaccination Date: 12/28/2017 Duration: 3 year vaccine I Vaccine Exp: 12/28/2020 Total: CITY OF BLAIR 2019 PET LICENSE APPLICATION If you live in Blair City limits and own a dogs) 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: cif Owner Address-. I Q CG s' Pc:l r'< "4 City/ State/ Zip: Blair, NE 68008 Phone# Drivers License # or hate of Birth LICENSE FEES: Dog or Cat: $16.00 Altered Dog or Cat: $11.00 Replacement Fee for Lost Tag: $S.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 A11512018, The city shall recoplze a microchip identification number as the :icense number, It shall he 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. :e Fee of $1.25 being collected to fund the Nebraska Don & Cat Operator Inspection Pro PET #1 la, Dog ❑ Cat 'Q Spayed/Neutered License Fee $ f. CX Pet Name ri,��: Acie � _ Sex Color �5I K 4 > Breed** v l,, Replacement $ * * Declared Dangerous or Potentially Dangerous Dog: ❑ Y �U N MICROCHIP # (If applicable) SUBTOTAL: $ 0.00 RABIES VACCINATION DATE: (3 yr)(1 yr) City Tag # diy PET #2 ❑ Dog , T Cat Q25payed/Neutered License Fee $ 00 Pet Name,(Uo L— An S, Sex Pr Color �,'"'- Breed * i fi�il- Replacement$ ** Declared Dangerous or Potentially Dangerous Dog: ElY ElN MICROCHIP # (If applicable) SUBTOTAL: $ RABIES VACCINATION DATE: w4-r � (3 yr) (1 yr) City Tag # a V PET #3 ❑ Dog ❑ Cat ❑ Spayed/Neutered License Fee $ Pet Name An Sex Color Breed * Replacement $ ** Declared Dangerous or Potentially Dangerous Dag: ❑ Y O N MICROCHIP # (If applicable) SUBTOTAL: $ RABIES VACCINATION DATE: (3 yr) (1 yr) City Tag # *PLEASE INCLUDE THE CrrY 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 RACK 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 ++++.++++4•+.i.+.+.+++++++++++++++++4•++++++++++++++++++++.I +++++++++++++++.t.+++++++ NEW PET/NEW RESIDENT LICENSING REQUIREMENTS (March I5late faedatenot applicablefor newpets/newmsldents) Newly Acquired Pets; NeW Residents to Blair: • Must be licensed within 10 days of owns� ip registerp y e tOR> at 6 months of age if puppy/kitteh"C711B ATllnlal Care o a residency, etc within 10 days of (402) 426-3630 902 S. HWy 30 Blair, NE 68008 l-'d 90999zvzot? e.jeo lewluV euogj ego: 61, 66 0i,,idV `i93%)- 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 `� 6 o Owner Name: l c, 1 g 'c 0c o °-1 of Owner Address: 1, ") � -� i w' )t � City/State/Zip: Blair,. NE 68008 Phone # G G O - � 3 3 — J �_� / Drivers License # or Date of Birth i l b i G,_ LICENSE FEES: Dog or Cat: $16.00 5rl lrvut A'\iw d Altered Dog or Cat: $11.00 0 3 s ' I 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 DoA & Cat PET # 1 YD o q ❑ Cat ❑ Spayed/Neutered License Fee $ Pet Name Mh; s Acle 1 '12 Sex Color r. t / i Breed** P0080, Z, ' Replacement $ Declared D na Declared or us or Potentially Dangerous Dog: ❑ Y ❑ N MICROCHIP # (If applicable) SUBTOTAL: $ RABIES VACCINATION DATE: & (3 yr) (1 yr) City Tag # PET #2 ❑ Dog ❑ Cat ❑ Spayed/Neutered Pet Name Acle Sex Color Breed** Declared Dangerous or Potentially Dangerous Dog: ❑ Y ❑ N MICROCHIP # (If applicable) RABIES VACCINATION DATE: (3 yr) (1 yr) PET #3 ❑ Dog ❑ Cat ❑ Spayed/Neutered Pet Name Age 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 # 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 fornewpets/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. 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: y m c r Owner Address: 13 212 B(A � I f l- S T city/state/zip: Blair, NE 68008 l Phone # ` 02 Drivers License # or Date of Birth �� 19 53 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 3115/2019. 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. Lfj-�;IT j[E7 Wi r 1- =Y= �E-* "r1.17 �- i.a �.�. -Isis---[��ia'Tm I u1 lim—' "a PET # 1 10 Dog ❑ Cat Spayed/Neutered License Fee $ Pet Nam a u r Ave -T-I i SexMalys Color, c� r Breed * s K� /12a I-r� u� r Replacement $ Declared Dangerous or Potentially Dangerous Dog: ❑ Y IA N MICROCHIP # 9 310 ao d ) 5`7'7 ,� v'(a6R (If applicable) SUBTOTAL: $ 1/ . 0 0 RABIES VACCINATION DATE: ®(,c (3 yr) � (1 yr) City Tag # _ _ PET #2 4 Dog ❑ Cat Spayed/ -Neutered License Fee $ ., 00 Pet Name} .-M Gk+ Age +- Sex Color SIR; v 2�Breed rri v (21 r- ti Replacement $ Declared Dangerous or Potentially Dangerous Dog: ❑ Y ❑ N MICROCHIP # %Q.�On A 5'7,� ,2 7 (If applicable) SUBTOTAL: $ � ®� RABIES VACCINATION DATE: % (3 yr) (1 yr) City Tag #q A PET #3 ❑ Dog ❑ Cat ❑ Spayed/Neutered License Fee $ Pet Name Agee Sex Color Breed** Rep/acement $ Declared Dangerous or Potentially Dangerous Dog: ❑ Y ❑ N MICROCHIP # (If applicable) SUBTOTAL: $ RABIES VACCINATION DATE: 1,7 (3 yr) -4- (1 yr) City Tag # *PLEASE INCLUDE THE CITY TAG NUMBER IF THIS IS A RENEWAL ** (This fee is due along with License Fee if `r� questing at the time of license renewal.) Donation to care for animals: $1 „ L $3 $5 $10 Other ***SEE BACK OF FORM FOR BREED SPECIFIC LICENSE REQUIREMENTS VISA /MC# Signature Do Not Send Cash by Mail TOTAL ENCLOSED $ 5� 00 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 I5/ate fee date not applicable fornewpets/new residents) Newly Acquired Pets: New Residents to Blair: s Must be licensed within 10 days of ownership ■ Must register pets within 10 days of ■ <OR> at 6 months of age if puppy/Idtten residency. WILLOW PARK VETERINARY CLINIC 415 EAST ERIE ST. MISSOURI VALLEY, IA 51555 (712)642-3815 Sue/Barb Kramer/Boicourt 1326 Butler Blair, NE 68008 Page 1 / 1 Client ID: 920 Invoice #: 158581 Date: 2/9/2019 Patient ID: 9105 Species: CANINE Weight: 24,40 pounds Patient Name: P-nut Breed: MIX, CHIHUAHUA Birthday: 04/01/2010 Sex: Neutered Description Staff Name Quantity 2/9/2019 Examination& Prof. Consultation Jack D. Gochenour, D.V.M 1.00 Subaceous Cyst needs to come off 1.00 Primor 600mg 7.00 Patient Subtotal: Reminder 06/01/2019 Interceptor Plus 8.1-25lbs Grn ( 6 ) 08/25/2019 HEARTWORM EXAMINATION DHLPP & Bordetella Booster Annual Physical & Vaccinations 11/03/2020 RABIES CANINE 3 YEAR BOOSTER Invoice Total: State Sales Tax Total: Balance Due: Previous Balance: Balance Due: VISA Card Number: ... XXXX6327: Less Payment: Balance Due: FINANCE CHARGE applied to all accounts unpaid after 30 days. FINANCE CHARGE Is computed by a periodic rate of 1.75% per month, which is an annual percentage rate of 21.0%. MINIMUM CHARGE $2.00. Total $38.00 $0.00 $27.15 T $65.15 $65.15 $1.90 $67.05 $67.05 $0.00 $67.05 ($67.05) ($67.05) $0.00 WILLOW PARK VETERINARY CLINIC 415 EAST ERIE ST. MISSOURI VALLEY, IA 51555 (712) 642-3815 Sue/Barb Kramer/Boicourt 2973 - Fremont Ave. Missouri Valley, IA 51555-7012 Page 1 / 1 Client ID: 920 Invoice #: 156268 Date: 9/22/2018 Patient ID: 9796 Species: CANINE Weight: 75.20 pounds Patient Name: Bear Breed: MIX, HUSKY Birthday: 02/07/2011 Sex: Neutered Description 9/22/2018 Fluoxetine 20 mg./per capsule Reminder 12/20/2018 HEARTWORM EXAMINATION DHLPP & Bordetella Booster Annual Physical & Vaccinations Interceptor Plus 50.1-100 Blue (6) 06/30/2021 RABIES CANINE 3 YEAR BOOSTER Staff Name Quantity Jack D. Gochenour, D.V.M 90.00 Patient Subtotal: Total $42.60 T $42.60 Invoice Total: $42.60 State Sales Tax: $2.98 Total: $45.58 Balance Due: $45.58 Previous Balance: $0.00 Balance Due: $45.58 VISA Card Number: ... XXXX0696: ($45.58) Less Payment: ($45.58) Balance Due: $0.00 FINANCE CHARGE applied to all accounts unpaid after 30 days. FINANCE CHARGE is computed by a periodic rate of 1.75% per month, which is an annual percentage rate of 21.0%. MINIMUM CHARGE $2.00. 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: KUHL, DAVID H & ANN L Spayed/Neutered Dog or Cat: $11.00 Owner Address: 1009 S 16TH AVE 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) 426-2182 Drivers License* IGi 26) 00 1,06 or Date of Birth: 16'6 Z Yy v v Subtotal licensed pets from below: Replacement Tags from below: Name: Mini Color: Black/Grey Spayed/Neutered: True Mirochip # 986121007760445 Vaccination Date: 11/18/2017 DOB: Not on File Sex: Female Breed: Domestic Shorthair Duration: Vaccine Exp: 11/18/2019 License Fee $ l (' Replacement: ❑Y PIN City Tag # 1785 Total( I `-' duclL :0 `' `3'm 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: KUHL, DAVID H & ANN L Spayed/Neutered Dog or Cat: $11.00 Owner Address: 1009 S 16TH AVE 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) 426-2182 (P-^-) Drivers License #:G29001856 or Date of Birth: 1/11/1962 Name: Smudge Color: Black/Grey Spayed/Neutered: True Mirochip # 985121006484485 Vaccination Date: 11/18/2017 Subtotal licensed pets from below: Replacement Tags from below: DOB: 5/4/2008 Sex: Female Breed: Domestic Shorthair Duration: Vaccine Exp: 11/18/2019 License Fee $ (I'% Replacement: ❑Y I23N City Tag # 1786 Total: M I (vo 2019 PET LICENSE VERIFICATION/APPLICATION FoR CITE' 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 GLAIR — 218 S. 16TH ST — BLAIRF NE 6800E YOU MAY LEGALLY OWN A COMBINATION OF FOUR (4) ADULT PETS, BUT NO MORE THAN THREF (3) ADULT DOGS OP THREE (3) ADULT CATS PER RESIDENTIAL OR DWELLING UNIT. ***PLEASE READ CAREFULLY*** YOU ARE RE UIRED 8Y LAW ICENSE YOUR PETS, Failure to do so is a violation of City Ordinances 6.1u3 and carries a penalty of a fine up to $150,00 per pet. PET LICENSE RENEWALS ARE DUE BY 3 1S 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 other city ID other than that issued by the. City of glair for such dog or cat, NEW PlET LICENSING Must be licensed within 10 days of ownership (OR) at 6 rnonths of age if puppy or kitten NEW RE51DENTS TO BLAIR Must register pets within 10 days of residency P T Pet Narne: mlv.a Age; 9Y sex.. Spayed Female Color: Ilan Breed: MIX Declared Dangelrous/Potentially Dangerous Dog NCl YES Microchip # 61ty Tag 'r ::,' :IC' � I/qr:'.e:: :; • L. , ::, I ..;..III,,. ,.., .,' ;.;,,: „',,,;:. �•I `�es;V` �i(��rr��[aiax:,:;:,;.,„. ;Ily,r.i''.r4' .:Fria •41Y1,, L'!',''i%d .... •1:41 •.�' �/7�'y� � ���il�' � ���.. .It �.�. !� � �i�lT, I' .� i .. (r �'�: )I;il; l'II�:I' �r:^I.� � '11� '� "i��,: �•�� ,il�� �'Il�� it' 1� �� f �� � :�'�. 1! :1�"� '� � I:.'I'I��I �. �� I Ifl' �I �~f nl�� li �i: ' ..� '! �Itt:7�, I �''�}��I Ini ����l Rabies Tag #' 16704 Rabies Description: I YEAR . 3 Holstein Veterinary Clinic Dr-. Lisa Schrurn DVM & Dr. Krista Holstein DVM 718 South 19th Street Blair, NE 68008 402-426-7387 402-426-0101 Fax holsteinclinic@gmail.com LICENSE FEES Intact Dog or Cat: $16.00 Dog or cat: $11.00 Replacement Tag $5.00 Total $ FAXED 03-06-15 2:44p BY l ` TOTAL PAGES TO/T0 D9dd OIHI-10 i3A NIDIS-IOH T0T09Z17Z0P 99:PT GTaZ/90/c© FRDM :BSAC FAX NO. :402-533-2722 Apr. 13 2019 11:29AM P1 CITY OF BLAIR - 2019 FEET LICENSE AP'P"LiCATION_ � if you livo in Blair City limits and own a dogs) and/or cat(s), complete this farm and return withcheck made payable to: �,1 1 City of Blair 0 21S S.16th St, • Blair, NE 68008 "You May iegaiiY own a combination of fadult lthree or three (3) adult cats perresiden> al or dwelling p)L LICENSE NIENEW ILS ARE DOE: M , 9 Owner Noma: % i{ Ire I Lid YJ n i �i— �� - *4*PLEA E READ CAREFULLY*** 8)-%0 eeP�i�Owner Address, r YOU ARE REQUIRED BYLAW TO LICENSE YOUR POTS. ` S �h 8 � Failure to do 00 ig a violation of city ardinlnCsx B.x03 anq Carries City/.'+fate/gyp: Blair NE 68008 1 _ a penalty *1 a fine upto sis0.00 a9r Pet. Phone # r Drivers License # or Date of Birth — LICENS15 FEES: Dog Or Cat: $1600 Altered Dog or Cat: $1.1.00 Replacement Fee for Lost Tog., $5.00 Fws of !Lii _7r.. heina coliectied to fund 0 (3) adult dogs PET LICENSES RENtWALS ARE DDE BY 3/3':.+= The City shall r+:Cogni- a microchip Identification number as the license number. It shall be unlawful for Lilly (log or cat to wear any license or other city identification other than that i88ua(1 by the City of plpir for such dcxj or (!eL. The City of Bivir required pr001f0f rabies-wrYAticn. PET #1. g ❑ Cat SpaQdNeute�red License F+ee $ 1pet Name Color i. Abet wed * Sex _Replacement$._,,,, ** Declared Dangerous or potentially Dangerous [log: ❑ Y A N MICROCHIP # If applirrabl SUBTOTAL: $ RABIES VACCINATION DATE: ' (3 yr),_ PET #2 k'o4 ❑ Cat Spay /Neutered License Fee $ � Pet Nam Ae Sex Qi Color Breed * Repla,~ement $... Declared [dangerous or Potentially Dangerous bog; ❑ Y MICROCHIP # (If a plicablej SUBTOTAL: $ RABIES VACCINATION DATE: (3 yr) (1 yr) _ .. City Tag PET #ag ❑Cat Spay d/Neute +~d License Fee $ Ll l!l,; NaCA Ac?e 1.1 ex Color reed *Rep/ac�mant $ ** Declared Dangerous or potentially Dangerous Dog_ ❑ YP— Pet MICROCHIP # If applicable) SUBTOTAL: $ RABIES VACCINATION DATE: (3 yr) (1 yr) ... _..— City Tag # *PLEASE INCLUDE THE CX YTAG NUMBER IF THIS IS A RENEWAL ** (Thl$ fee is due along with License Fee it requesting at the time of license renewal.) Donation to care for animals. _,„ $1 _ $$ _ $5 _ $10 Other, ***69E BACK OF FORM FOR BREED SPECIFIC LICENSE REQUIREMENTS Do Not Fend Cash by Mef/ VISA / MC # Signature TOTAL ENCLOSED $ Expires: Security Cade: It you have questions, please contact City Ball at (402) 426.4191 or by Fax: (402) 426-4195 +++++++++...f"...4... ++++++.+.++++++++++++++.++.+++++.+++++++++++++++++a..+++.r+++ NEW PETINEW RESIDENT LICENSING REQUIREMENTS (M*iM j5lao ite dote notappPcabL-Ibrn6,wpot$lnewlYlsldel t,9) Newly,A0Qm1 4 Pr _ Bl" penidents to Blair: ■ wist be Nae and Wthin 1.0 days of omazhip ■ Must register rx4s wiHiin 10 days of 0 �=, at 6 months of age If puppy/Iften residency. FRDM :BSAC FAX NO. :402-533-2722 Apr. 13 2019 11:29AM P2 CITY OF BLAIR - 2019 PET LICENSE APPLICATION Af you live; In Blair City limits and own a dog(s) and/or cat(s), complete this form and return with cheO made payable to: City of Blair • 218 S, 16to St. 0 Slair, NF 68008 Yeu 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 RENE S ARf: DllE: Marc Owner Name: Ti Owner Address: city/statetzip: etair NE 880081 _ Phone # l�.>.�.._.._.._._t_1� .­(U Drivers License #A qr Date of Birth LICENSE FEES: Dog or tat: $16.00 Altered Dog or Gat: $u,00 Replacement Fee far Lost Tag: $5.00 Included is a State Fee of $1.25 bein a collected to fund tiro PET LICENSES RENEWALS ARE DUE BY 3115/2018. ThO cty shall recognize a microchip Identification nuinbur as tho Ilcahse ntunbbr. It uhail be unlawful for any dog or cat to wear any license or other city ideAtificatim other than that. Issued by the City of Blair for such dog or cat. Tao city of Bitlir Yequtw�s proof of re6les vacctnatlon. PET #JL ❑Doc `i; Cat ,Spay d Neuter d License Fee $ / r, IL)!c� ColorPet s 'e Bre d* vx Replacement$., Declared Ding' ous or Potentially Dangerous Dog: ❑ Y MICROCHIP # If applicable) D C SUBTOTAL: $ RABIES VACCINATION DATE: V ) c,P yr) � City Tag # * PET # 2 ❑ bog ❑ Cat ❑ Spayed/Neutered Pet Name — __.. Ae __-_ ....._.. _ Sex Color - Breed * .__..._.-- -..... _�� Oeclared Dangerous or Potentially Dangerous [log: ❑ Y MICROCHIP # (lf applicable) RABIES VACCINATION DATE°:.._..__...--.-- - . (3 yr) — (1 yr) License Pee $_........._..__.__... . Replacement; $_ * * SUBTOTAL:$ — City Tag # PET #•3 ❑ Dog ❑ Cat ❑ Spayed/Neutered License Fee $� Pet Name An Sex .... _.__... Color — m� • ........ - --.-.- .... Breed * Replacement $ Declared dangerous or Potentially Pattgereus Dog. ❑ Y ❑ N MICROCHIP # (If applicable) SUBTOTAL: $ RABIES VACCINATION DATE: (3 yr) _ (1 yr) City Tog # *PLEASE INCLUDE THE CITY TAG NUMOM IFTHIS IS A RENEW41, ** (This fee Is due along with License FAR if requesting at the time of license renewal.) Donation to care for animals: _ $1 _ $3 _ $5 _ $10 Other ***SEE BACK OF FORMA FOR DREED SPECIFIC LICENSE REQUIREMENTS rt Pa riot Send Cash by Mail ` OTAL ENCLOSED VISA / MC # , f;xpires: ,-- Security Code: Signature If you have questions, please contact City Fall at (02) 426,4191 of by Fax., (402) 426.4195 +++++++++++t+... t ***a..++•i•+++++++++++++++++++++++++++++++++.++.+w+++++t++tt •r+•r. NEW PEt/NEWRESIDENT LICENSING REQUIREMENTS (Mara`i,rs14iaftw*tenotapptlo�k/efDrnewpoWnewresltlelll5) NeWIV.Atxluired pets: ielow Reuldants to Slain ■ Musk be Eoan9W v th i0 dayscf awnelshlp ■ Mu.4, regif for pots Within 10 days of m ■ •FOR? at 6 monft or age if puppy/kitten r4den )6 sV 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 RENEWALS ARE DUE: March 15, 2019 LICENSE FEES: Dog or Cat: $16.00 Owner Name: Dan & Vicki Kwallek Spayed/Neutered Dog or Cat: $11.00 Replacement Fee for Lost Tag: $5.00 Owner Address: 1043 N 28th Ave Fee includes $1.25 for the Nebraska Dog and Cat City/State/ZIP: Blair, NE 68008 Operator Inspection Program Phone #: (402) 426-1381 Drivers License #: or Date of Bi Ch:8/12/1955� Subtotal licensed pets from below: Replacement Tags from below: Name: Brody DOB: 1/1/2009 Sex: Male License Fee $ Color: Blonde Breed: Labrador Retriever Replacement: Spayed/Neutered: True ❑Y ON Mirochip # 985121008133901 City Tag # 1841 Vaccination Date: 3/11/2017 Duration: 3 year vaccine Vaccine Exp: 3/11/2020 ICI Total: