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VFROM : BSAC FAX NO. :402-533-2722 Mar. 10 2019 12:49PM P1 CITY OF BLAIR - 2019 PET LICENSE APPLICATION If you five 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. 161h St. * Blair, NE 68008 you may legally own a combination of four (4) adult pets, but no more than three (3) adult flogs or three (3) adult cats per rejidential or dwelling unit. LICENSE If MWAL$ ARE QUE: _MarCjk, 5, ,2QJ9 Owner Name: / ? 11"+"`avv � Own er Address: ( _ _,f� %� ..:�, city/state/zip. Blair, NE 68008 Phone # ���� � -7� Drivers License # or bato of Birth LICENSE FEES: Dog or Cat: $16.00 ,Altered bog or Cat. $11.00 Replacement Flee for Lost Tag: $5.00 ***PLEME 1tE1 D CARER LLY*** YOU ARE REQuilzEa BY LAW TO LXCENSF YOUR PFTS. Failure to do so is a violation of City ordinances 6.103 and terries a penalty of a fift up to $160.00 per Pet, PET LICENSES RENEWALS ARE IDUE BY 3/18/2011 The City shall recognlzP A microchip identification nI mbvr as the license number. it xhall be unlawful for any dog or eat to wear any license or other eny Identification other than that 15sued py thn city of Blair for such dog or uht. Tho City of Blair requirew proof of rables vaccination. L" PET # 1 o a 0 Cat 0 Spayed/Neutered License Flee $�� Pet Name "� ,e'/ Ale Sex /Y-) Color z �� Bread * �� e -- Replacement$ ** Declared Da gerous or Potentially Danger4 s Dog: 0 Y ❑ N MICROCHIP # (if alpplicalbl ) SUBTOTAL: $ RABIES VACCINATION DATE: 1 (3 yr) %- (1 yr) — — City Tog # PET #2 Q Cat ❑ Spayed/Neutered�� License Fee $-,,�- pet Name��. �1111�19e- A e ,/ S .x Color l,, d ram` 'Breed* -Replacement $a. ,_ _.....,.._... Declared Dangerous or Potentially Dangerous�0;g-�]Y ❑ N MICROCHIP ## (If applicable) SUBTOTAL: $ RABIES VACCINATION DAl"E: ill. �.�-..._.. ( yr) (1 yr) City Tag # I v P, PET #3 ❑ Dog © Cat El Spayed/Neutered License Flee $ Pet Name Acie Sex Color Breed"* Replacement $ ** Declared Dangerous or Potentially Dangerous Dog: U Y Q N MICROCHIP # (If applicable) SUBTOTAL: $ RABIES VACCINATION DATE: (3 yr) _ (1 yr) City Tag #* *PLEASE INCLUDE VE CM TAG NUMBER I1=THIS IS RENEWAL ** (ThiA fee is due along with License Fee if requesting at the time of licermse renowal.) Donation to care for animoIPn _ $1 $3 „„ $5 $14 Other, ***SEE BACK OF FORM FOR BREED SPECIFIC LICENSE REQUIREMENTS VISA / MC # Signature ,00 Not sens/ C05h by Wit TOTAL ENCLOSED $ Expires: m. Security Code: If you have questions, please oontalct City Hall at (402) 420.4191 or by Fax: (402) 426-41915 +++++++.++++++++++*++*++......***.4M.*****+tttttt+++..*........................ NFWPET/NW RESIDENT LICENSING REOU10-MWS (March.islaYekedalenotappllcabletarnewpely/newresidenis) I!1cMly. At>ojAMg..Ppb. , ... _..,,. New Residents to Blair: ■ Must be fi within 10 days of ownership ■ Must register pets within 10 days of 6 <=, at 6 months of ago if puppy/Idtken residency. 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: Aaron Hill & Paige Van Cleve Spayed/Neutered Dog or Cat: $11.00 Replacement Fee for Lost Tag: $5.00 Owner Address: 2078 Colfax St Fee includes $1.25 for the Nebraska Dog and Cat City/State/ZIP: Blair, NE 68008 Operator Inspection Program Phone #: (402) 237-0308 Drivers License #: or Date of Birth: Subtotal licensed pets from below: I I Replacement Tags from below: Name: Buttercup Color: Grey Spayed/Neutered: True Mirochip # Vaccination Date: 12/01f2017 DOB: 08/07/2017 Sex: Female Breed: Great Dane Duration3 year vaccine Vaccine Exp: 12101/20—f6— License Fee $ , . ` 1 Replacement: ❑Y qN City Tag # 2442 Total: f E 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: Aaron Hill & Paige Van Cleve Spayed/Neutered Dog or Cat: $11.00 Replacement Fee for Lost Tag: $5.00 Owner Address: 2078 Colfax St Fee includes $1.25 for the Nebraska Dog and Cat City/State/ZIP: Blair, NE 68008 Operator Inspection Program Phone #: (402) 237-0308 Drivers License #: or Date of Birth: Subtotal licensed pets from below: + 'L Replacement Tags from below: .• (61 Name: Scooch DOB: 09/0 12017 Sex: Male License Fee $ i Color: Blue Merle Spayed/Neutered: True Mirochip # Vaccination Date:-12722%2017 - ' 4 Breed: Great Dane Duration."i year vaccine Vaccine Exp: 1,2/�2 2049— Replacement: ❑YIDN City Tag # 2443 Total: u a 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: %J VP,Y i t Owner Address:l.s's�r�k city/state/zip: Blair, NE 68008 Phone # — k& "�N'2 Drivers License # or Date of Birth LICENSE FEES: Dog or Cat: $16.00 Altered Dog or Cat: $11.00 Replacement Fee for Lost Tag: $5.00 ***PLEASE READ CAREFULLY*** YOU ARE REQUIRED BY LAW TO LICENSE YOUR PETS. Failure to do so is a violation of City ordinances 6,103 and carries a penalty of a fine up to $150.00 per pet. PET LICENSES RENEWALS ARE DUE BY 3/15/2019. The City shall recognize a microchip identification number as the license number. It shall be unlawful for any dog or cat to wear any license or other city Identification other than that issued by the City of Blair for such dog or cat. The City of Blair requires proof of rabies vaccination. Included is a State Fee of $1.25 being collected to fund the Nebraska Dog & Cat PET # 1 Dog ❑ Cat ❑ Spayed/Neutered License Fee $ Pet Name rf i' Age — I -- Sex Al Color -W111A Breed** hr Replacement $ Declared Dangerous or Potentially Dangerous Dog: ❑ Y ❑ N MICROCHIP # (If applicable) SUBTOTAL: $ RABIES VACCINATION DATE: (3 yr) (1 yr) X, City Tag #* PET #2 ❑ Dog ❑ Cat ❑ Spayed/Neutered License Fee $ Pet Name Aye Sex Color Breed * Rep/acement$ ** Declared Dangerous or Potentially Dangerous Dog: ❑ Y ❑ N MICROCHIP # (If applicable) SUBTOTAL: $ RABIES VACCINATION DATE: (3 yr) (1 yr) City Tag # PET #3 ❑ Dog ❑ Cat ❑ Spayed/Neutered License Fee $ Pet Name Aye Sex Color Breed * Rep/acement$ ** Declared Dangerous or Potentially Dangerous Dog: ❑ Y ❑ N MICROCHIP # (If applicable) SUBTOTAL: $ RABIES VACCINATION DATE: (3 yr) (1 yr) City Tag # *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 applicablefor newpets/new residents) Newly Acquired Pets: New Residents to Blair: ■ Must be licensed within 10 days of ownership ■ Must register pets within 10 days of ■ <OR> at 6 months of age if puppy/ldtten residency. 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: Nondas Vitols Spayed/Neutered Dog or Cat: $11.00 Replacement Fee for Lost Tag: $5.00 Owner Address: 620 Blaine St Fee includes $1.25 for the Nebraska Dog and Cat City/State/ZIP: Blair, NE 68008--0000 Operator Inspection Program Phone #: (402) 533-8422 Drivers License #: 6�-tqll57-�o 3 or Date of Birth: 9/1/1938 Name: Hunter Color: Brown/Grey Spayed/Neutered: True Mirochip # Vaccination Date: 4/24/2018 Subtotal licensed pets from below: Replacement Tags from below: DOB: Not on File Sex: Male Breed: Duration: 1 year vaccine Vaccine Exp: 4/24/2019 License Fee $ Replacement: ❑Y ON City Tag # 372 Total: 1. do 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: Nondas Vitols Spayed/Neutered Dog or Cat: $11.00 Replacement Fee for Lost Tag: $5.00 Owner Address: 620 Blaine St Fee includes $1.25 for the Nebraska Dog and Cat City/State/ZIP: Blair, NE 68008--0000 Operator Inspection Program Phone #: (402) 533-8422 Drivers License #: & ol) �5 7(-e3or Date of Birth: 9/1/1938 Subtotal licensed pets from below: Replacement Tags from below: Name: Jager Color: Brown Spayed/Neutered: True Mirochip # Vaccination Date: 4/20/2018 DOB: Not on File Sex: Male Breed: Siamese Duration: 1 year vaccine Vaccine Exp: 4/20/2019 License Fee $ . oo Replacement: ❑Y ON City Tag # 370 Total: Il • Do 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: VOGEL, NATHANIEL J & JULIA A Spayed/Neutered Dog or Cat: $11.00 Owner Address: 506 N 19TH 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) 239-5332 Drivers License #:H12974465 or Date of Birth: 12/9/1987 Name: Molly Color: Brown Spayed/Neutered: True Mirochip # Vaccination Date;.-V/ 1/2015 Subtotal licensed pets from below: I Replacement Tags from below:-6-- DOB: Not on File Sex: Female Breed: Labrador Retriever Duration: 3 year vaccine Vaccine Exp: 7L21/201-8- License Fee $I(r.60 Replacement: ❑Y qN City Tag # 1685 201-9 PET LICENSE VERIFICA°f'ION/APP'LICATION 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 POUR (4) ADULT PETS, BUT NO MORE THAN THREB (3) ADULT DOGS OR THREE (3) ADULT CATS PER RESIDENTIAL OR DWELLING UNIT. 'PLEASE READ CAREFULLY"* . YOU qRE R� UIRED BY !AW TO L1GEN5E YOUR PETS. Failure to do so is a violation of City ordinances 6,109 and carries a penalty of a fine up to $150.00 per pet. PET LI*vENSE RENEWALS ARE DUE 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. N5W 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 reglster pets within 10 days of residency PST #G 1 Pet Name: Max Age: Sy sex: Neutered Male i Color: Mack Breed: Lab/Golden Declared Dangerous/Potdentiailly Dangerous Dog NCf FYE! Microchip # City Tag # I'ai�.L..,. _,il ii�, •..,•I'f'::L,,.f•� i ,iaii: ��I I;i;;�11��1'vinyti� ��ii� .ilia i' j�L�,'�i,�ldn's+,': n�ff'P�t;it i� 6788 abies Tag # lir.^,;i{„,i�... ;i:tli�biS, „.0 ,. • , , � � , . ,,,�:1,i, �� ,�...,.��u... 1,:,,•.ii.l: .tl...�.. ,,�„1, �,3•.,L� �tt�Zl�g I�.,ifluwl{,>�' .; 9fr'. i( „ile�'��•i� lily �.� '3� ff L•",I�' Radfsies Desgriptleri: YEIti1 3 YEAR Holstein Veterinary Clinic Dr. Lisa Schrurn DVM & Dr. Krista Holstein DVM 718 South 10th Strut Blair, NE 68008 402-426-7337 402-426-0101 Fax holsteinciinic@gmail,com LICENSE FEES Intact Dog or Cat: $16.00 AlteredDog or cat: $11.00 Replacement Tag $5.00 Total' I.JV FAXED 03-12-19 11;19a BY TOTAL PAGES IO/T0 39dd 0I1,1I-10 13A NI31S-10H T0T09ZbZ0b SZ:TT GT03/ZT/E0