OCITY 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: Aimee O'Brien Spayed/Neutered Dog or Cat: $11.00
Replacement Fee for Lost Tag: $5.00
Owner Address: 1.262 Deertield BFvd Ap# 204 Fee includes $1.25 for the Nebraska Dog and Cat
City/State/ZIP: Blair, NE 68009 Operator Inspection Program
Phone #: (641) 569-3678
Drivers License #: or Date of Birth: 5/21/1982
Name: Zelda
Color: Brown/Black
Spayed/Neutered: True
Mirochip # 4B0100506B
Vaccination Date: 5/3/2017
Subtotal licensed pets from below: —
Replacement Tags from below:
DOB: 4/3/2010 Sex: Female
Breed: Mix Breed
Duration: 3 year vaccine
Vaccine Exp: 5/3/2020
License Fee $
Replacement:
❑Y C?N
City Tag # 2419
E
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: Emmalee O'Donnell Spayed/Neutered Dog or Cat: $11.00
Owner Address: 1339 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 Operator Inspection Program
Phone #: (402) 237.0283�
'
Drivers License #: - • or Date of Birth: 5/17/1968
Subtotal licensed pets from below: li -,'-
Replacement Tags from below:
Name: Tux DOB: 3/1/2016 Sex: Male License Fee $,
Color: Tri-Color Breed: Domestic Shorthair Replacement:
Spayed/Neutered True
0Y�,
Mirochip # ' ._.s ,: x �; , City Tag # 2002
Vaccination Date: WV2017 i ,
Duration: 1 year vaccine
Vaccine Exp: 10/9/2�178,
_�
Total:,
f}
i
" t 6L VR �1
ru-
CA, if 34B a-.2 / /S
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: David & Karin Oldberg Spayed/Neutered Dog or Cat: $11.00
Replacement Fee for Lost Tag: $5.00
Owner Address: 1069 James Dr Fee includes $1.25 for the Nebraska Dog and Cat
City/State/ZIP: Blair, NE 68008--0000 Operator Inspection Program
Phone #: (402) 426-4439
Drivers License #: or Date of Birth: 9/23/1954
Subtotal licensed pets from below: I
Replacement Tags from below:
Name: Moninga DOB: Not on File Sex: Female License Fee $
Color: Apricot Breed: Poodle -Toy Replacement:
Spayed/Neutered: True ❑Y EIN
Mirochip #
City Tag # 0057
Vaccination Date: 2/28/2017 Duration: 3 year vaccine
Vaccine Exp: 2/28/2020
Total: I i, 0'-_
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 RENEW4L A DUE: March 15, 2019
Owner Name:
Owner Address: �C
City/State/Zip: Blair, NE 68008
Phone # 40Q-� — �—
Drivers License # or Date of Birth 2--
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.
incivaea is a Stare tee or !�a..z5 Demg couectea to tuna me NeurasKa vog & Lat uperator inspection rrogran
—1- It
PET # 1 ❑ Dog .4 Cat ['Spayed/Neuter License Fee $__
Pet Named%2, Aye C v Sex
Color Breed * f t� Replacement $
Declared Dang rous or Potentially Dangerous Dog: ❑ Y INN
MICROCHIP # (If applicable) SUBTOTAL: $
RABIES VACCINATION DATE: -7 (3 yr) (1 yr) City Tag # �*
PET #2 ❑ Dog ❑ Cat ❑ Spayed/Neutered
Pet Name Agge Sex
Color Breed**
Declared Dangerous or Potentially Dangerous Dog: ❑ Y
MICROCHIP # (If applicable)
RABIES VACCINATION DATE: (3 yr) _
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) _
(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 15late fee date not applicablefornewpets/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.
08/08/2019 11:14 4024260101 HOLSTEIN VET CLINIC PAGE 01/01
Holstein Vet Clinic
718 South I 9th Street
Blair, NE 68008
402-426-7$$7'
Printed: 08-08-10 at 10,47a
CLIENT NEDRMATION
Name Rod Olsen (71101)
Address 2445 College Dr,
Blair, NE 68008
Phone 402 !333-9920
P4_TIENT INFORT—IQN
Name CAT #2
B OB Feline
MO
Sex Female, Spayed
ed Domestic Shorthair
Birthday 04-01-11 Ai(
I
e Ay
ID I;
ies
Color Gray Tiger VY
ight 0.00 lbs
Reminded 08-27-12
1 des
Reminder-s for: CAT #2 1
Last done
07-01-21 DenfensQr 3 (3 Year Rabies)
�
07-02-18
00-12-20 Felocell 4
11 06-13-19
MEDICAL HISTORY
-Va InationView
Date
By
Code
oescription
07-02-18
LS
4RA133
Defensor 3
420002
�elocell 4
06-18-19
KKH
420002
Felocell 4
CA+�
Year Rabies)
Patient Chart
Qty (Vadance) Photo
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: OLSON, DALE M & DEBBIE J, CO- Spayed/Neutered Dog or Cat: $11.00
TRUSTEES Replacement Fee for Lost Tag: $5.00
Fee includes $1.25 for the Nebraska Dog and Cat
Owner Address: 2150 PARK ST Operator Inspection Program
City/State/ZIP: BLAIR, NE, 68008--0000
Phone #: <NO PRIMARY PHONE>
Drivers License #: or Date of Birth:
Name: Harley
Color: Yellow
Spayed/Neutered: True
Mirochip # 985112008180876
Vaccination Date: 3/2/2018
Subtotal licensed pets from below:
Replacement Tags from below:
DOB: Not on File Sex:
Breed: Labrador Retriever
Duration: 3 year vaccine
Vaccine Exp: 3/2/2021
License Fee $
Replacement:
❑Y ON
City Tag # 2310
Total:
CERTIFICATE QF VACCINAT
Date of Rabies Vaccination: 09-12-19
Next Rabies Vaccination On: 09-11-20
VETERINARY CLINIC
Holstein Vet Clinic
718 South 19th Street
Blair, NE 68008
402-426-7387
Certificate No: 0
Previous Rabies Vaccination:
OWNER OF ANIMAL
Scott Olson
1133 Jackson Street
Blair, NE 68008
County:
This is to certify...
THAT I HAVE VACCINATED AGAINST RABIES THE ANIMAL DESCRIBED BELOW.
Patient information...
PATIENT: Molly
SPECIES: Canine
SEX: F
Color and markings... Chocolate
Signed
Lisa Schrum, DVM
TAG NO: 17243
WEIGHT:0.00 Cod is
AGE: 6 months
License: 2310
Due Date / Vaccinations
09-11-20 Defensor 1 (1 Year Rabies)
Rabies Vaccine Information...
MFG BY: ZOETI SER.NO: 328007
LOT EXP: 07-07-20 ADM: SQ
tt //
l6
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: Scott Olson Spayed/Neutered Dog or Cat: $11.00
Owner Address: 1133 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 #: (605) 591-2877
Drivers License #:H13731912 or Date of Birth: 7/20/1978
Subtotal licensed pets from below: � I
Replacement Tags from below:
L
Name: Betty
Color: Tri-Color
Spayed/Neutered: True
Mirochip #
Vaccination Date: 7/,17/2014
Z
DOB: Not on File Sex: Female
Breed: Beagle
Duration:rtj ear vaccine
Vaccine Exp: 7117/2017
License Fee $—P—
Replacement:
V§Y ON
City Tag #- -1479
02 Total:
CITY OF BLAIR - 2019 PET LICENSE ADDITIONS
If you live in Blair City limits and own a dog(s) and/or cat(s), complete/verify this form and return with check made payable to:
City of Blair * 218 S 16th St. * Blair, NE 68008
You may legally own a combination of four (4) adult pets, but no more than three (3) adult dogs
or three (3) adult cats per residential or dwelling unit.
LICENSE RENEWALS ARE DUE: March 15, 2019
Owner Name: Scott Olson
Owner Address: 1133 Jackson St
City/State/ZIP: Blair, NE 68008--0000
Phone #: (605) 591-2877
Drivers License #:H13731912 or Date of Birth: 7/20/1978
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
Subtotal licensed pets from below:
Replacement Tags from below:
Total:
14 Dog ❑ Cat ❑ Spayed/Neutered
License Fee $
1
Pet Name P U n+-e L Pet DOB •- t
Sex
U
Color 61 QC 1 VTR h Breed Coo h 14o (A od
Declared Dangerous or Potentially Dangerous Dog? ❑ Y K N
Microchip # Rabies Vaccination Date'( �� 3 yr
,1 yr
❑ Dog ❑ Cat ❑ Spayed/Neutered
License Fee $
Pet Name Age Sex
Color Breed
Declared Dangerous or Potentially Dangerous Dog? ❑ Y ❑ N
Microchip # Rabies Vaccination Date 03 yr
01 yr
❑ Dog ❑ Cat ❑ Spayed/Neutered
License Fee $
Pet Name Pet DOB
Sex
Color Breed
Declared Dangerous or Potentially Dangerous Dog? ❑ Y ❑ N
Microchip # Rabies Vaccination Date 03 yr
01 yr
02/27/2019 14:03 4024260101 HOLSTEIN VET CLINIC PAGE 01/01
019 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 THREE (3) ADULT CATS PER RESIDENTIAL OR DWELLING UNIT.
'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 LICENSE FtENEWALS 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 bat 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
Harold Ortmteier
Spouse
owner Address
1519 Bustler Street
City/State/Zip
Blair, NE 68008
Phone #
402-426-4482
DL # or DOS
r°
Pet Name: Dora
Age: 11Y
sex:
Spayed Flemale
Golor: Tri
Breed: Beagle
Declared (dangerous/Potentially Dangerous Dog
NO
YES
Microchip #
City Tag #
;-,
f�{ I,�r• ' nh:' j�0�la e�
f iy'�+t'p s'i
d a?< l'tl7 {ouk�i
Rabies Tag # 16413
• i F {r i
J' ili a t p t
Jk��, III P'1 .d ! �t •h f''1 "• 6 i�1
I t`., u. t r•; v f
cur•, ��qd �i.1 •�!` w{t�"{{'Gt ,llt h.�
Rabies Description.
1 YEARC3-YEA—
Holstein Veterinary Clinic
Dr. Lisa Schrum DVM & Dr. Ifristca Holstein DVM
13 South 19th Street Blair, NE 68008
402-426-7387 402-426-0101 Fax
hoisteinclinic@gmail.com
LICENSE FEES
Intact
Dog or Cat: $16.00
A e
g cat: $11. 0
Replacement Tag
$5.00
Total $ f (. 1)
0.
FAXED 02-27-19 1:27p
BY
TOTAL PAGES j / f
FROM :BSAC
FAX NO. :402-533-2722 Apr. 02 2019 05:19PM P1
Dec, 26. 2018 2:53PM CITY OF BLAIR Nn. 02H P. 1
CITY OF BLAIR. - 2019 PET LICENSE APPLICATION
ATION
If you live In Blair City limiN and own a dog(s) end/or cat s), complete this form and return with check made payable to:
City of Blair & 218 S. Wh St. * Slairr NE 68008
You moy legally own a combination of four (4) adult patta, but no mom than Wpm (3) adult drips
or three (3) adult cats per residential oil ttwoAlriy uric;
L'TMWE RENEWALS ARE DUE:. htal^-n
mb . 2019
.k y
Owner Name: : �-
yl b L
Owner Address,.
Clty/state/zlp: Blair, NE 68008
Phone # qn— �(D - 3 Q 11
Drivors LIcenge #8Y we of Blrth
LICENSE FEES., dcrp or Cot,, $M,00
Altered Dog or Cat: $34.0
Replacement Fee f+r Lost Tq9; $5.00
An addidmial States Fee of S1.25 liv beinu collected ba flu ed
***PLEARE RUD CAfiPPOLLY"*
YOU ARE REQUIRED BY LAW TO LICENSE YOIrR, FAT&1.
Palllire tb do 90 Is a violation of Paty ordinances 6.109 artd cnrcles
a penalty of a fline up to 0190.00 per pat.
PAT LIICEIVAES RENEWALS ARC DOE 9Y;jL;Uj..ZQ1a. Tha CRty .sllvall
recopnixe a microchip idenMretinn number as the li4ense mirnber, It
thAll Bra VAIAWFO ror any dog or cat Ep wear any licopdp or ether city
1(160I1`160 n dthet tW that fsstMd by tha MV or Blair for such day or
cat. 'Ibe Qfty of Vinfe regl11re9 pyodf of rables vaccination,
��rc= m
PET f p ❑ C t spe eel/NeLlter�c) Licenn Fee $ I/_ ,��
Pet Na
Color ' Replacement $
f?eclred pngrousr PQtnCialiy Dl7��ro�! Y'N
MIMOCH10 (If applicably SUBTOTALt $ . .
l�ABZf; VAC NATIt�N CAA" 1=: � 1 P Yr) iI Y►) _. City Tag a .
PET #2 � og � cat Q Spy d/Neutered - Licensee Fee $ l
Pet Naar o, A?e Sex,
altar, freed Re/�lac�ment ^�
Declared Dangerous or Potentially Dangerous Dob; ❑ Y IA N
MICROCHIP # (If applicabl�—.
SUBTOTAL; $ _
RABr�s VACCINATION DATE: (3 yr) (I yr) — city Tag #
PET *3 G Dog Q Cat ❑ Spayed/Neutered License Fee $....--
ftt Name . _ — Ar Sex — -
Color -.... Ref
Declared Dangerous or Potendolly Dangerous ))ng: 0 Y ❑ N
MICROCHIP # � _ (If applicable) SUBTOTAL: $ _
RABIES VACCINA-110N DATE (a yr) — (I yr) -- Ckv "tag # �
WusE iNcLuDE iL1E t.>tYjr' TA Q, >yUMBER IMMIS IS A RENEWAL
** (This fee is due along with License Fne If requestIq at tthos timo of 1lWh*0 reridwal.)
Donation to care for idkilti'tarm; _ $i ..,...... $3 $6 00 oth.e r "......
***SEE BACK of F011114 POR OREED SPrECIFIC LICENSS REQUIREIH NTS
Do Mot Sonel Ca$h by Afoll TOTAL ENCLOSW
1I1m i MC # >Txplres: Sawrlty Code: .
$19nature
If YOU FtRVe questions, please contact City Mali at (402) 426-4191 or by FaX: (402) 416-410s
i+F^h'htt��........#.....
NEW PEA'/NEW R VDENT LICENSmIG iREQUIREMENIrS (Abr h l$,ktefoo of tenotappllc4bloforneWp 7ewrz s(ent )
NuLk—■1a+ iii lnollk
ovm�r*,t mat p1 o Btairg
>! stb et t5 , ' O of age >ay u p 1R Must f mier rids With n 10 divs of
p ppy/wtLen nmidency.