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PCITY OF BLAIR - 2019 PET LICENSE APPLICATION i — .a 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 t 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: Mar h 15 2019 Owner Name: o a � — � ' 7 Owner Address: l�f��a a. , 2 -/ City/State/Zip: Blair, NE 68008 j Phone # %iDr� Drivers License # or Date of Birth LICENSE FEES: Dog or Cat: $16.00 Altered Dog or Cat: $11.00 Replacement Fee for Lost Tag: $5.00 ***PLEASE READ CAREFULLY*** YOU ARE REQUIRED BY LAW TO LICENSE YOUR PETS. Failure to do so is a violation of City ordinances 6.103 and carries a penalty of a fine up to $150.00 per pet. PET LICENSES RENEWALS ARE DUE BY 3/15/2019. The City shall recognize a microchip identification number as the license number. It shall be unlawful for any dog or cat to wear any license or other city identification other than that issued by the City of Blair for such dog or cat. The City of Blair requires proof of rabies vaccination. Induded is a State Fee of $1.25 being collected to fund the Nebraska Doq & Cat PET #1 clog JS Cat Spayed Neutered d License Fee $ Pet Name % V� Aye_ Sex Color Breed * ' r—Rep/acement$ ** Declared Dangerous or Potentially Dangerous Dog: ❑ Y MICROCHIP # (If applicable) SUBTOTAL: $ . RABIES VACCINATION DATE: 1-=`2 9 (3 yr) (1 yr) _City Tag #�* TT" PET #2 ❑ Dog ❑ Cat ❑ Spayed/Neutered License Fee $ Pet Name Agge Sex Color Breed** Replacement $ ** Declared Dangerous or Potentially Dangerous Dog: ❑ Y ❑ N MICROCHIP # (If applicable) SUBTOTAL: $ RABIES VACCINATION DATE: (3 yr) (1 yr) City Tag # PET #3 ❑ Dog ❑ Cat ❑ Spayed/Neutered License Fee $ Pet Name An 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 Do Not Send Cash by Mail TOTAL ENCLOSED $ VISA / MC # Signature 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 applicablefor newpe&lnewresidents) 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. ku 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: Joseph & Julie Ann Peare Spayed/Neutered Dog or Cat: $11.00 Owner Address: 960 N 24th Ave Replacement Fee for Lost Tag: $5.00 Fee includes $1.25 for the Nebraska Dog and Cat City/State/ZIP: Blair, NE 68008--1021 Operator Inspection Program Phone #: (402) 426-5515 Drivers License #:G29008287 or Date of Birth: 10/9/1959 Subtotal licensed pets from below: Replacement Tags from below: Name: Rascol DOB: 1/1/2014 Sex: Male License Fee $ J /' Color: White Breed: Mix Breed Replacement: Spayed/Neutered: True 0Y'PN Mirochip # City Tag # 1035 Vaccination Date: 3/30/2016 Duration: 3 year vaccine Vaccine Exp: 3/30/2019 Total: %/ A 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: Raymond Pedrick Spayed/Neutered Dog or Cat: $11.00 Replacement Fee for Lost Tag: $5.00 Owner Address: 1 Longview Dr Fee includes $1.25 for the Nebraska Dog and Cat City/State/ZIP: Blair, NE 68008 Operator Inspection Program Phone #: (402) 739-7197 Drivers License #: or Date of Birth: 4/3/1970 Subtotal licensed pets from below: Replacement Tags from below: Name: Oreo DOB: - Sex: Male License Fee $ Color: White/Brown Breed: Mix Breed Replacement: Spayed/Neutered: False ❑Y ❑N Mirochip # City Tag # 2039 Vaccination Date: 9/1,9/2015 Duration: 3 year vaccine Vaccine Expo "19/2018 Total: Blair Small Animal Clinic PC David E. Johnson DVM 1734 Front Street Blair, Nebraska, 68008 (402) 533-2722 Rabies Certificate Patient ID: . 10835 Client ID: 8034 (- Patient Name: Oreo Client Name: Raymond Tedrick Species: Canine Address: 1 Longview Drive Breed: Boxer Mix Blair, NE 68008 Sex: Male Color: White/Chestnut Phone: (402)739-7197 Markings: Birthday: 09/15/2011 Weight: Microchip ID: Tag Number: 5098 Lot Number: 18398 Imrab Rabies Vaccine Producer: Merial K / MLV / R: Killed Virus Vaccination Date: Expiration Date: Staff Name: David E. Johnson DVM License Number: 1893 3/15/2019 3/16/2022 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 Pelan Spayed/Neutered Dog or Cat: $11.00 Replacement Fee for Lost Tag: $5.00 Owner Address: 1661 Wilbur St Fee includes $1.25 for the Nebraska Dog and Cat City/State/ZIP: Blair, NE 68008 Operator Inspection Program Phone #: (402) 660-l8270 Drivers License #: 1`rl.� )ti `&' /?. or Date of Birth: 05/03/1982 Subtotal licensed pets from below:T/ _® Replacement Tags from below: Name: Abby DOB: 02/01/2018 Sex: Female License Fee $�� Color: Black/Tan Breed: Cairn Terrier Replacement: Spayed/Neutered: True ❑Y PN Mirochip # City Tag # 2462 Vaccination Date: 09/28/2018 Duration: 1 year vaccine Vaccine Exp: 09/28/2019 Total: 02/25/2019 08:56 4024260101 HOLSTEIN JET CLINIC PACE 01/01 2019 PET LICENSE VERIFICATION/APPLICATION FOR CITY OF GLAIR IF YOU LIVE IN BLAIR CITY LIMITS ANp OWN A DOG(5) AND /OR CAT(S), COMPLETE THIS FORM AND RETURN WITH A CHECK PAYABLE TO; CITY OF BLAIR — 218 S. 16TI.1 ST - BLAIR, NE 68008 YOU MAY LEGALLY (AWN A COMBINATION OF FOUR (4) ADULT PETS, BUT NO MORE THAN THREE (3) ADUtT DOGS OR THREE (3) ADULT CATS PER RESIDENTIAL OR DWELLING UNIT. 'PLEASE READ CAREFULLY"* • YQU ARE RE IRE!] BY LAW T4 LICENSE YOUR PETS. Failure to do so is a violation of Qity Ordinapgm 6.103 and carries a penalty of a fine up to $150_00 Per pet. PET LICENSE RENEWALS ARE DUE AY 3 15 2D1$. 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 oat. 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 Mast register pets within 10 days of residency — -'T # Pet Name: Bailey Age: 10X f Sex: Spayed Female Color: White Breed: Havanese Declared Dangerous/Potelntially Dangerous Dog Microchlp # Rabies Description: 11 Y Holstein Veterinary Clinic Dn Lisa Schrum DVM & Dr. Kristcz Holstein DVM 718 South 19th Street 8 b" ir, NE 68008 02-426-7387 4027-4.26-0101 Fax holsteinclinic@gmail.com VIES City Tang # Rabies Tag # 16141 3 YEAR LICENSE FEES Intact Dog or Cat: $16.00 D Ior cat: $1 00 Replacement Tag $5.00 Total $ l o FAXED 02-25-19 8:45a BY TOTAL PAGES i FROM : BSAC FAX 1,10. :402-533-2722 Mar. 04 M9 05: 40PM P2 CITY OF ELA,IR - 2019 PET LICENSE VERIFICATION If you live In Blair City limits and own a dQg(s) and/or cat(s), complete/verify this form and return with check made payable to: City of Blair * 218 8 16th St * Blair, NE 8$008 You may legally own a combinatlQu of four (4) adult pets, but no more than three (3) adult dogs or throe (3) adult cats per roaldential or but, unit. LICENSE RENMALS ARE DUE: March 15, 2019 LICENSE FEES: Dog or Oat, $16-00 Owner Name: MArk & wall Persson Spayed/Neutered Dog or Cat: $11,00 Replacement Fee for lost Tag: $5.00 Owner Address. 213 N 23rd St Fen Includes $1.25 fattM Nabraska Dog and Cat City/State/ZIP: Blair, NE 6$008--0000 Operator Impectlon Program -. Phone #: ( - 314a" Drivers License. #,G29012640 or Date of Firth: 1/1 Oil065 „ . Subtotal Heenlsed pets from below'.- Replacement Tags from below: Name: Luke Color: White/Liver Spayed/Neutered: True Mirochip # Vaccination Date.,,2A W2811 6, 3-9-0 DRIB, Not on File Sex: Male Breed: Pointer Duration: 3 year vaccine Vaccine Exp: License Fee $ __ Replacement: ❑YP City Tag # 461 Total: FROM : BSAC FAX 1,10, : 402-533-2722 Mar,. 04 2019 05: 40PM P1 CITY OF BLAIR � 2019 PET I„ CENSE VERIFICATION If you live in Blair City limits and own a dog(s) andlor oat(s), complete/verify this form and return with shook 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 mar® than three (3) adult dogs or three (3) adult cats per residential or dwolling unit. LICENSE RENEWALS ARE DUE; March 16, 2019 LICENSE FEES: Dog or cat: $1.6.00 Owner Name: Mark & Call Persson Spayed/Neutered Dog or Cat: $11.00 Replacement Fee for Wst Tag: $5.00 Owner ,address: 213 N 28rd St Fee includes $1,25 for the Ne4raska Dog and cat City/State/ZIP: Blair, NE 68008--0000 Operator inspection Program TY1A` Rhone #: (4M#-2 z4'`5 _3-- 47(6 Drivers License #:G29012640 or Date of Birth: 044"6M Subtotal'licensed pets from below: it 00 Replacement Tags from below: Name: Sophie Color: White Spayed/Neutered: True Mirochip # 686112007867667 Vaccination Date: 06/16/2017 DQB: 12/0712016 Sex: Female Breed, Mix Breed Duration: 8 year vaccine Vaccine Exp: 06/16f2020 License Fee $ Replacement„ 0Y�N City Tag # 2171 Total-, FROM : DGAC FAX NO. :402-533-2722 Mar. 06 2019 03:16PM P1 CITY OF BLAIR - 2019 PET LICENSE VERIFICATION If you live in glair Clty 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, out no more than three (3) adult dogs or throe (3) adult cats per residential or dwelling unit. LICENSE RENEWALS ARE DUE., March 15, 2019 LICENSE FEES: Dog or Cot: $16.00 Owner Name: PETERSIEN, DONOVAN L & KLLLY R SROgAMP-ute.r-ed.-t og-er.,,Cat;-$Ia..00 Owner Address: 1286 SKYLINE DR Replacement Fee for Lost Tag: $5.00 Fee *Imdes $1.25 for the Nebraska Dog and Cat City/State/ZIP: BLAIR, NE, 68008--0000 Operator Inspection Program Phone #k; (402) 633-8066 Drivers License ##: or Date of Birth: Subtotal licensed pets from below: Replacement Tags from below: Name: Chloe Color: Brown Spayed/Neutered: Prue Mirochip # DOD: Not on File Sex: Female Breed: Labrador Retriever Vaccination [date: 6/12/2011 . Duration: 3 year vaccine Vaccine Exp. 6/1212020 License Fee $ Replacement. QY MN City Tag 0 0077 Tota I :"_L �f all_ 6Ptol 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: Matthew Petersen & Sarah Marymee Spayed/Neutered Dog or Cat: $11.00 Owner Address: 2239 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--1111 Operator Inspection Program Phone #: (402) 239-8075 Drivers License #: or Date of Birth: 3/7/1976 Subtotal licensed pets from below: Replacement Tags from below: Name: Ellis DOB: 1/1/2012 Sex: Male License Fee $ A v o Color: White/Grey Breed: Domestic Shorthair Replacement: Spayed/Neutered: True ❑Y ON Mirochip # 985112007203477 City Tag # 1109 Vaccination Date: 6125/2U'I'S Duration:14 year vaccine Vaccine Exp:-6/2512018 Total 8/ o0 2019 PET LICENSE VERIFICATION/APPLICATION FOR CITY OF UJUR 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 r NE 68008 YOU MAY LEGALLY OWN A COMBINATION OF TOUR (4) ADULT PETS, BUT NO MORE THAN THREE (3) ADULT DOGS OR THREE (3) ADULT CATS PER RESIDENTIAL OR DWELLING UNIT, ***PLEASE READ CAREPULLY*** YOU ARE RE UIREn Y LAW TO LICENSE YOUR BETS. Failure to do so is a violation of CltY Oedinances 6.103 and carries a penalty of a fine up to $15o.00 per pet, PET 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 far such dog or cat. NEW PEA LICENSING 'Must be licensed 'within 10 days of ownership (OR) at 6 months of age if puppy or kitten NEW RESIDENTS TO BLAIR Must register pets within 10 days of residency PET # Pet Name: Penny Age; 22M Sex., Spayed Female Collor: [Zed and White P- Breed. Aussie X Declared Dangerous/Potentially Dangerous YES Microchip # Rabies Descriptlom I Holstein Veterinary Clinic Dr. Lisa Schrum DVM & Dr. Kristaffolstein DVM 718 South 191h Street Blair, NE 68008 402426-0101 Fax holsteinchnic@gmail,corn City Tag # )3 Rabies Tag # 1617os 3 YEAR ,LICENSE FEES intact Dog or Cat., $16.00 Do 47* 0 Replacement Tag $5.0o Total $ 1 \ �O, FAXED 02-11-19 4:20P BY TOTAL PAGES TO/TO 39Vd DINI-10 13A NI3iS-1OH TOT09ZVZ0P 06:9T 6TOZ/TT/30 2019 PET,L ICENSE VERIFICATION/APPLICATION FOR CITY OF BLAIR. IF YbU LIvF IN BLAIR CITY LIMITS AND OWN A DOG(S) AND /OR CAT(S), COMPLETE THis r6RM 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 OP THREE (3) ADULT CATS PER RESIDENTIAL OR DWELLING UNIT. ***PLEASE READ CAREFULLY' YOU ARE REM I RED BY LAW To I. EYOUR PETS. Failure to do so is a violation of City Ordinances 6,103 and carries a penalty of a fine up to $1-90.00 per pet. PET LICENSE RENEWALS ARE DUE BY 3/115/207.0,, The city shall recognize a microchip IP'number as the license number. It shall be unlawful for any dog or oat 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 he licensed within 10 days of ownership (OR) at E months of age if puppy or kitten NEW RESIDENTS TO BLAIR Must register pets within 10 days of residency Owner Nance Rex Pfeil Spouse Kris Owner Address 1022 N 20th Ave lair City/State/Zip Blair, NE 68008 Phone # 402-533-2044 DL#korDOD, PET # Pet Name: Cooper Age: 9Y sex: Neutered Male Color: Tri Breed: Beagle Declared Dangerous/Prtentilally Dangerous Dag ND Ylws Microchip # City Tag # fl.I ;f �n�l �� 011""�e�!fj }� r T , i { dry t 11 r1 �i �•iaf it j I.w I !r J � Alum �i�7�llf!���I R, k nlu iu 181 7i-•Air 7111'1� 1'IFt t , i �pi �7 u �sPjjj IiY L...Fp1F_Y.. e. il; d' 7�. lq� Isla vy;r ;o i.nu� x. iIs �1 Rabies Ta # 14706 9 Rabies Description: i YEAR 3 YEA Holstein Veterinary' Clinic Dr, Lisa Schrum DVM & Dr. K'rista Holstein ,AVM 718 South 19th ,Street glair, NE 68008 402*-426-7387 402-426-0101 Fax holsteinclinic@gmall.com LICENSE FEES Intact Dog or Cat: $16.00 .e"Altered Oaf or cat: $11.011 Hep a emrl ent Tack $5.00 Total FAXED 62,20-15 3:06p BY j' TOTAL PAGES TO/TO 39Vd OINI-10 13A NI3iS-10H TOTO9ZbZOb 03:91 6TOZ/97,/30 4 I- €M -_- 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: Hannah Pickell Spayed/Neutered Dog or Cat: $11.00 Owner Address: 1928 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 Operator Inspection Program Phone #: (402) 881-2392 Ext: Daniel Drivers License #: or Date of Birth: Name: Roxy Color: Spayed/Neutered: False Mirochip # Vaccination Date: 12/10/2016 Subtotal licensed pets from below: Replacement Tags from below: DOB: Not on File Sex: Female Breed: Unknown/Mutt Duration: 3 year vaccine Vaccine Exp: 12/10/2019 License Fee $ Replacement: ❑Y ON City Tag # 2021 Total: FROM :BSAC FAX NO. :402-533-2722 Jan. 25 2019 1150AM P1 Die, 26, 2018 2:53PM CITY OF BLAIR No, 0225 P, 1 CITY OF BLAIR - 2019 PET LICE NSEAP'PLI ANION If you live in Blair city limits and own a dog(s) and/or cat(s), complete this Form and return with eheulc mulde payahie to: City of Blair # 218 Sr 161'h St. a, Blair, NE 68008 You may legally own a combination of four (4) a4ult prey but no snore than three (a) adult dogs or three (3) adult cats+ per residential or dw'alling Unit. LI>CEI SE RENETLIS ARE E: M r � .�, owner Name! � " Owner Addrwal A - Clty/;state/zlp. Blair, Ne 68008 Phone # --46a'- R- (0 i:lrivQlm lleengA • t or C; ate of Birth LIMNSE FEES: Dog or CaU, $�6,00 Altered Dog or Cat: $I;..00 Roplacemetlt Fee for Lora Tag-. $5.00 An addiflani al *lotto$ Fee of $1.25 Is fiiMna calfected W fund the ***PMSE READ F iLI.Y"I YOU ARE REQUIRED 9Y LAW TO LICENSE YOUR PFTSr. FbIRIM tb do So is a violation bF City 6Mi0ar►4aa 6.103 and cairries a penalty of a flne tip to �Idux0 per pet. ptT LICENSES RENSWAT,MWi DUE BY 2[/. lanln. T114! City ahall recognize a microdllp ldentinradpn nVmbor as theilcenfe number. it shall be Unlawrul for any doo or cat t4 wepl' any IlCerlBe or othet City lderinfleation oth¢l- than tllot fRAuad by 0l9 city of 81AIr for such dog or Cat, The City Orelalr "films proof of rablac vacrinotloll, PET #1 M Duo 0 Cat A Spayed/Neuteted License Fee $ pet Na �,. r �. A PX Color ' - W. _ Breerl Replar;emel7t $ * Dedared Dangerous or Potentially anglerous bog: U Y 'A-N MICROCHIP � �� ! � (If �Ipplieml'Iie) . SUDTOTALx $ Y RABIES VACCINATION DATE: (3 Yr.) (I yr) --.. city roo PET License Fee Pet Ne—�� .. .� Color Breed* ,M' �`Replacement$ DeclaN MxCSUOTOTAAL; $ , RABIES VACCINATION DATE.,. �r�i / -9'.C7 (3 yr} � (i yr) — City Tali #` PET #3 oc0 © Cat � Spayed/Neutered � irr.VIM$ a Fee � Pete NV Ar I Sex . �L�,� lE Color - , Breed * Replacement $ De�l�r ' Danger us or Potentially Dangerous bog: o Y N MICROCHIP # .�....—, (If aRplirrdl�lr„) URTO ALi $ RAKES VACCINATION DATE. ��� (3 yr) yr) C,tb Tao # � *hLMSE INCJ�UDE TitF CMTAIR NUMBER IF THIS IS A RENEWAL ** ('rids fee In due aloing with I,laense Fee if requestYng Olit the timiti Of ilceAss rfteWal.) Donation ilo 0ara fdr anIRrll;§l!§: $1 $3 $S �p � �, Other ***SEP BACK OF FORM FOR F RRWFF � a$PtCIFIC LICENSE ROUIRP-Mg�NTS -M y �i -- CfbNot Sentar [ash by INai! 1 O p I1L E1�AC1.,OSED — VISA/MG Expire . � se�uri#y �:;cde; Sigrlatwte "�. If You h9V'D gul0siciun-s, please contact City hail at (402) 429-4191 or by'Fax., (402) 4:16-405 +�-++.....* . . . . . . . . . . . NrtW illEr/NEW PiSYDRNT UCEN.MNG FI1Q11Zl EMENTS (PIWO 151,Ttvfee dr* not applicable for MWPOLYlnewmsldenlT) MI�w� uYi n 10 a�('sy�yl-ler it —' g �Bn ' Blairc N eOR> at 6 months d' age w p IPPY/Idtten N � Mt�s;tl@n�i,�er pets WikI11n xQ days Qr 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: Erika Polzin Spayed/Neutered Dog or Cat: $11.00 Owner Address: 2045 South 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) 960-3240 Drivers License #: or Date of Birth: 2/4/1981 Subtotal licensed pets from below: Replacement Tags from below: Name: Reggie DOB: 3/16/2012 Sex: Male License Fee $ Color: White/Tan Breed: Beagle Replacement: Spayed/Neutered: True ❑Y ❑N Mirochip # City Tag # 392 Vaccination Date: 5/26/2017 Duration: 3 year vaccine i Vaccine Exp: 6/26/2020 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: Erika Polzin Spayed/Neutered Dog or Cat: $11.00 Replacement Fee for Lost Tag: $5.00 Owner Address: 2045 South St Fee includes $1.25 for the Nebraska Dog and Cat City/State/ZIP: Blair, NE 68008--0000 Operator Inspection Program Phone #: (402) 960-3240 Drivers License #: or Date of Birth: 2/4/1981 Subtotal licensed pets from below: Replacement Tags from below: Name: Lily DOB: 3/15/2017 Sex: Female License Fee $ Color: Tri-Color Breed: Mix Breed Replacement: Spayed/Neutered: True ❑Y ON Mirochip # City Tag # 391 Vaccination Date: 6/26/2017 Duration: 3 year vaccine Vaccine Exp: 5/26/2020 I Total: 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: Scott Polzin Spayed/Neutered Dog or Cat: $11.00 Owner Address: 1939 Grant 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) 709-8694 Drivers License #: or Date of Birth: Subtotal licensed pets from below: Replacement Tags from below: Name: Rocky DOB: 2/28/2010 Sex: Male License Fee $ Color: Breed: Dachshund Replacement: Spayed/Neutered: True ❑Y ON Mirochip # City Tag # 1197 Vaccination Date: 3/7/2018 Duration: 3 year vaccine Vaccine Exp: 3/7/2021 Total:-1 �— a-- q ' 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 Polzin Spayed/Neutered Dog or Cat: $11.00 Replacement Fee for Lost Tag: $5.00 Owner Address: 1939 Grant St Fee includes $1.25 for the Nebraska Dog and Cat City/State/ZIP: Blair, NE 68008 Operator Inspection Program Phone #: (402) 709-8694 Drivers License #: or Date of Birth: 6/5/1975 Subtotal licensed pets from below: Replacement Tags from below: Name: Jack DOB: 2/28/2011 Sex: Male License Fee $ Color: Black/Tan Breed: Dachshund Replacement: Spayed/Neutered: True ❑Y ON Mirochip # City Tag # 896 Vaccination Date: 3/3/2017 Duration: 3 year vaccine Vaccine Exp: 3/3/2020 Total: 2019 PET LICENSE VERIFICATION/APPLICATION FOR CITY OF BLAIR IF YOIJ LIVE IN RLAIR CITY LIMITS AND OWN A DOG(S) AND /OR CAT(S), COMPI-ETE THIS FORM AND RETURN WITH A CHECK PAYABLE TO: CITY OF BLAXR — 218 S. 16TH ST — BLAXR, NE 68008 YOU MAY LEGALLY OWN A COMBINATMN OF FOUR (4) ADULT PETS, BUT NO MORE THAN THREE (3) ADULT DOGS OR THREE (3) ADULT CATS PER RESIDENTIAL OR DWELI,MG UNIT. ***PLEASE READ CAREFULLY' YOU ARE REQUIRED BY LAW TO LICENSE YOURalL railUra 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 be unlawful for any dog or Gat 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 (DR) at 6 months of age if puppy or kitten NEW RESIDENTS TO B,LAIR Must register pets within 10 days of residency Owner Name Ardee 'Pounds Spouse 1 , Owner Address city/State/Zip Blair, NE 68008 Phone # 402-426-3414 OIL # or DOB PET # Pet Name: Thomas Age. 13Y sex: Neutered Male color: Y � Breed: Declared Dangerous/Potentially Dangerous Dog NO YES Microchip # City Tag # � # 4 L,Zl.til — ''aYl :vr Id';'J;I .�I 14U1'p"711 ""1'^d:yLu:c'L;tll.,�1'G l.i l;ri1'•''.IpS 'iL!'I S; S'�i i 'J: '.iI11.1 ri, ,ri.rr.r I •1'IlJ 1 • •'fi4t••:i I I• • I•'I 'III I V'I li!�' 'I'lii R I,If�tt ,(9{ ,(Irl•'�If �� y'1 •II••y: X•"X cr4" VllII HIX •ili��hl'. _{!:::.�, � k _ Ilifil"f'll. 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Rabies Description: YEA 3 YEAR Holstein Veterinary Clinic Dn Lisa Schrum DVNI & Dr. Kr•ista Holstein DVM 718 South 191h Street glair, NE 68008 402-426-7387 402-426-0101 Fax holsteinclinic@gmail.com TO/T0 SJdd DINI-10 13A N=S-101-11 LICENSE FEES Intact Dog or Cat: $16.00 e'red Dog r cat, $1 0 Replacement Tag $5.00 Total• FAXED 01-03-19 3!47p BY TOTALPAGES TOT09ZbZ0b Z0:9T L,T03/E0/T0 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: 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: Ardith Pounds Spayed/Neutered Dog or Cat: $11.00 Replacement Fee for Lost Tag: $5.00 Owner Address: 1085 S 13th Ave #404 Fee includes $1.25 for the Nebraska Dog and Cat City/State/ZIP: Blair, NE 68008 Operator Inspection Program Phone #: (402) 426-3414 Drivers License #: or Date of Birth: 4/18/1934 Name: Tomas Color: Grey Spayed/Neutered: True Mirochip # Vaccination Date: 1/3/2019 Subtotal licensed pets from below: Replacement Tags from below: DOB: 12/31/2005 Sex: Male Breed: Domestic Shorthair Duration: 1 year vaccine Vaccine Exp: 1/3/2020 License Fee $ / --- Replacement: ❑Y ❑N City Tag # 317 p0 Total: lI 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: Marjorie Pridie Spayed/Neutered Dog or Cat: $11.00 Replacement Fee for Lost Tag: $5.00 Owner Address: 731 N 14th Ave Fee includes $1.25 for the Nebraska Dog and Cat City/State/ZIP: Blair, NE 68008 Operator Inspection Program Phone #: (402) 426-0614 Drivers License #: G O ` f q lc a -2 r or Date of Birth: Name: Roxy Color: Black/White Subtotal licensed pets from below:_ Replacement Tags from below:Q DOB: Not on File Sex: Female Breed: Mix Breed Spayed/Neutered: True Mirochip # q F5 J /.1 a O 915 9 77?,a Vaccination Date: 4/16/2018 Duration: 1 year vaccine Vaccine Exp: 4/16/2019 CP�/31/ao/% 402.493.58 acom1 E�, INGW� WWW.centkAfyp E1-G----- T License Fee $.11,06 Replacement: ❑Y %N City Tag # 2374 Total:_ 01/31/2019 16:36 4024260101 HOLSTEIN VET CLINIC PAGE 01/01 2019 PET LICENSE VERIFICATION,/AP'P'LICATION FOR CITY' OF BLAIR IF YOU LJVE IN BLAIR CITY LIMITS AND OWN A DOG(S) AND /OR CAT(S), COMPLETE THIS FORM AND RETURN WITH A CHECK PAYABLE TO: CITY OF BLAIR - 218 S. 16TH ST - B'LAIR, Ni= 68008 YOU MAY LEGALLY OWN A COMBINATION OP FOUR (4) ADULT PETS, BUT ND MORE THAN THREE (5) ADULT DOGS OR THREE (3) ADULT CAT$ PER RESIDENTIAL OR DWELLING UNIT. ***PLEASE READ CAREFULLY' YOU ARE REQUIRED BY LAW TO LICENSE YgI PR ETs, Failure to do so it a violation of City Ordinances 6.103 and carries a ponalty of a fine up to $150.00 per pet. PET LICENSE RENEWALS ARE DU E 3 15 =9. The city shall recognize a microchip ID number as the IiCense 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 Mast register pets within 10 days of residency owner Name Marge Pridie Spouse Owner Address 731 N I4th Ave city/state/Zip Blair, NE 66008 Phone # 402-426-0614 DL # or DOB Pet Nair,rtie: Roxy ,Age: 7Y Tiex! Spayed Female Color: Black and White greed: Terrier X Declared Dangerous/Potentially Dangerous Dog O YES Microchip # City Tag # ,,:�• l�•. ;. �4„, { Rai�les Ta # I5943 9 t iar i iV,ol t i s; Rabies Description: YEA 3 YEAR. Holstein Veterinary Clinic Dr. Lisa Schrum DVM & Dr. Krista Ho1,5tein ,DVM '18 South 19th Street Blair, NE 68008 402-426-7387 402-426-0101 Fax hoisteinclinic@gmail.com LICENSE FEES Intact Dog or Cat; $16.00 Itre Da or cat: $11.00 Rep crcament Tag $5.00 Total $ t { FAXED 01-31-19 1:51p BY TOTALPAGES