CBlai�'Gma|Aninla| Clinic PC
David E.Johnson OVM
1734Front Street
Blair, Nebraska, 68008
Client ID:' 8887
Client Name: GendvCmbo|o 'D&�88 A��0y(|/
h
Address: 1G18Sunrise Drive
Blair, NEG8UU8
Phone: (402)301-2770
Tag Number:
7277
Vaccine:
|nnnab Rabies Vaccine
Producer
W1oUa|
Brand:
|rnnab3TF
Type:
Killed Virus
ennarof
Subcutaneously
Staff Name: David EJohnson DVM
License Number: 1893
Doctor Signature:
Patient |O:
Patient Name:
Species:
Breed:
Sex:
Markings:
Microchip ID:
13109
Rico
Canine
Yorkshire Terrier
K8o|a
KU
\&°.V"
\V0
OB/ O/2O21
7.00pounds on11/8/2O22
985141003348158
Vaccination Date: 11/9/2022
Expiration Date: 11/9/2025
Lot Number: 18542
Drug Expiration Date: 3V10/2024
Blair Smali Animal Clinic PC
David E. Johnson DVM
1734 Front Street
Blair, Nebraska, 68008
(402) 533-2722
Rabies Certificate
Client ID:
8887 1
jq
P ti nt ID:
Patient
14046
Client Name:
Sandy Cabello A'W(U
Patient Name:
Mia
Address:
1618 Sunrise Drive
Species:
Canine
Breed:
German Shepherd
Blair, NE 68008
Sex:
Female
Color:
Grey/Black
Phone:
(402)301-2770
Markings:
Birthday:
08/01/2022
Weight:
41.00 pounds on 1/6/2023
Microchip ID:
Tag Number:
7342
Vaccination Date:
1/6/2023
Vaccine:
Imrab Rabies Vaccine
Expiration Date:
11612024
Producer:
Merial
Lot Number:
18535
Brand:
Imrab 3 TF
Drug Expiration Date:
11/17/2023
Type:
Killed Virus
annerof
Subcutaneously
I Administration:
Staff Name: David E. Johnson DVM
License Number: 1893
Doctor Signature:
CITY OF BLAIR - 2023 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 a 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, 2023
Owner Name:
Owner Address: I`
city/state/zip: Blair, NE 68008
Phone #
LICENSE FEES: Dog or Cat: $16.00
Altered no or Cat: $11 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 3/15/2023. 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 to
be submitted with your license application.
g
Replacement Fae for Lost 'Tag; $5.vv
Included is a State Fee of $1.25 being collected to fund the Nebraska Dog & Cat Operator Inspection Program
PET # 1 Dog ❑ Cat CI Spayed/Neutered - License Fee $ i 1
Pet Name Birthdate Sex I
CBreed** I-, , I � �'di Replacement $ **
Declared Dangerous or Potentially Dangerous Dog: ❑ Y U N
MICROCHIP # '1 '` _ ' (If applicable) SUBTOTAL: $ (`
RABIES VACCINATION DATE:' : - (3 yr) (1 yr) City Tag #
PET #2 ❑ Dog ❑ Cat ❑ Spayed/Neutered
Pet Name Birthdate Sex
Color Breed**
Declared Dangerous or Potentially Dangerous Dog: ❑ Y
MICROCHIP # (If applicable)
RABIES VACCINATION DATE: (3 yr) _
(1 yr)
License Fee $
Replacement $
SUBTOTAL: $
City Tag # *
PET #3 . ❑ Dog ❑ Cat ❑ Spayed/Neutered License Fee $
Pet Name Birthdate 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.)
Do Not Send Cash by Mail TOTAL ENCLOSED $
If you have questions, please contact Blair Police Department at (402) 426-4747
++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
NEW PET/NEW RESIDENT LICENSING REQUIREMENTS (Marcie 15/ate fee date notapplicablefornewpety1newresidenly)
Newly Acquired Pets: New Residents to Blair:
■ Must be lioensed within 10 days of ownership ■ Must register pets within 10 days of
■ <OR> at 6 months of age if puppy/Idtben residency.
Countryside Small Animal
1306 Stevenson
PO Box 119
Fort Calhoun, NE 68023
402-468-4060
Printed: 01-09-23 at 2:50p
CLIENT INFORMATION
Name Mrs. Cathy Campbell (232)
Address 1166 Nebraska St.
Blair, NE 68008
Phone 402 426-5567
PATIENT INFORMATION
Name
Ellie (9419)
Species
Canine
Sex
Female, Spayed
Breed
Welsh Corgi
Birthday
11-25-21
Age
13m
ID
985141004675896
Rabies
22-0256
Color
Tan and White
Weight
17.60 lbs
Reminded
(none)
Codes
Reminders for: Ellie
Last done
03-30-23 Canine Rabies, 3 y
03-30-23 Canine DA2PP-L 03-30-22
Ellie's weight history (in Ibs)
06-02-22 17.60
03-30-22 13.50
02-24-22 9.00
MEDICAL HISTORY - Reminder View
Patient Chart
Date By Code Description City (Variance) Photo
03-30-22 KNP RV1 Canine Rabies Vaccn, 1 Yr, #22-0256
DA2PL Canine DA2PP-L Vaccination
02-24-22 KNP BORD DECLINED: Canine Bordetella Oral Vaccina
DA2PL Canine DA2PP-L Vaccination
(Additional history not shown)
a I t -1 12-3
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 9 218 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, 2023
Owner Name: —
Owner Address:
City/State/Zip: Blair, NE 68008
Phone #
LICENSE FEES: Dog or Cat: $16.00
Altered Dog or Cat: $11.00
***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 3/15/2023. 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 to
be submitted with your license application.
Replacement Tree for Lost Tag: $5.00
Included is a State Fee of $1.25 being collected to fund the Nebraska Dog & Cat Operator Inspection Program
PET #1 A Dog ❑ Cat A Spayed/Neutered
License Fee
Pet Nam rr Birthdate 2LJ -) to
2,ro
**
Color Breed** eir
Replacement$
Declared Dangerous or Potentially Dangerous Dog: ❑ Y 4 N
MICROCHIP # 9 W)000012-9�U! (P (If applicable)
SUBTOTAL: $
RABIES VACCINATION DATE: ---2--'" 1 (3 yr) (1 yr)
City Tag #
PET #2 ❑ Dog ❑ Cat ❑ Spayed/Neutered
License Fee $
Pet Name Birthdate Sex
Color Breed**
Replacement $ **
Declared Dangerous or Potentially Dangerous Dog: ❑ Y ❑ N
MICROCHIP # (If applicable)
SUBTOTAL: $
RABIES VACCINATION DATE: (3 yr) (1 yr)
City Tag #
PET #3 , ❑ Dog ❑ Cat ❑ Spayed/Neutered
Pet Name Birthdate Sex
Color Breed**
Declared Dangerous or Potentially Dangerous Dog: ❑ Y
MICROCHIP # (If applicable)
RABIES VACCINATION DATE: (3 yr) _
El
License Fee $
Replacement $
SUBTOTAL: $
(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.)
Do Not Send Cash by Mail TOTAL ENCLOSED $ I.
If you have questions, please contact Blair Police Department at (402) 426-4747
++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
NEW PET/NEW RESIDENT LICENSING REQUIREMENTS (March 15/ate fee date notapplicable fornewpeis/new residents)
Newer 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.
02/23/2023 18:10 40242GO101 HOLSTEIN VET CLINIC PAGE 02/02
2023 PET LICENSE
VERIFICATION/APPLICATION FOR CITY OF BLAIR
IF YOU LIVE IN BLAIR CITY LIMITS AND OWN A DOGS) AND /OR CAT(S).
COMPLETE THIS FORM AND RETURN WITH A CHECK PAYABLE TO:
CITY OF BLAIR - 218 8. '16T" ST - BLAIR, NE 6$008
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, THE CITY OF BLAIR REQUIRES PROOF OF RABIES VACCINATION.
Failure to do so is a violation of City Ordinances 6.105 and carries a penalty of a fine up to $150.00 per pet.
PET LICENSE RENEWALS ARE DUE BY 3/15/2023.
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 PET LlC1=NSING Must be licensed within 10 days of ownership (ON) at 6 months of age if poppy or kitten
NEW RESIDENTS TO BLAI9 Must register pets within 10 days of residency
Owner Name
Mayca Castillo��Y�
Spouse
Cindy Rodriguez
Owner Address
1016 N 18th Ave
CiitylState/zip
Blair, NE 68008
Phone #
���•��•} 972-809-91349
Pet,Narne: Bingo
Tag #®1Q
Age: 23M
DUB: 03-07-21
$ex; Male
Color: Black and Tan
Breed: German Shepherd
Microchip #
Rabies Tag #.20776
PLEASE INCLUDE CITY TAG NUMBER IF THIS
IS A RENEWAL (IF AVAILABLE): #
RABIES VACCINATION DONE ON
1144-22 �
Rabies Description: 1 YEAR
3 YEAR
Holstein Veterinary Clinic
Dr. Lisa 5017rurn VVM : Dr. Krista Holstein DVM
718 South 19th Street Blair, NE 68008
402-426-7387 402-426-0101 Fax
holsteinclinic@gmail.com
LICENSE FEE.$
t-
Dog
D6.OQ
or cat. $11.00
Replacement Tay
$6.00
Total $ � 0
PETS THATARE ON THE ACTIVE POTENTIALLY DANGEROUS APR
DANGEROUS DOG LIST NEED TO REGISTER DIRECTLYAT CITY BALL,
FAXED 02-23-21
BY
CITY OF BLAIR ® 2023 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 9 218 S 16th St 9 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, 2023
Owner Name: -7
a
Owner Address:
City/State/Zip: Blair, NE 68008
Phone #
LICENSE FEES: Dog or Cat: $16.00
Altered Dog or Cat: $11.00
***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 3/15/2023. 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 to
be submitted with your license application.
Replacement Fee for Lost Tag: $5.00
Included is a State Fee of $1.25 being collected to fund the Nebraska Dog & Cat Operator Inspection Program
PET #1 Dog ❑ Cat ;D Spayed/Neutered License Fee
Pet Name rt Birthdate 3 y Sex
Color ' : , Breed** :' Rep/acement $ **
Declared Dangerous or Potentially Dangerous Dog: ❑ Y ❑ N
MICROCHIP # (If applicable) SUBTOTAL: $
RABIES VACCINATION DATE: 1 (3 yr) � (1 yr) City Tag # d
PET # 2 . Dog ❑ Cat ,U tSpayecl/Neutered License Fee $
Pet Name: ; Birthdate Sex
Color l'� : Breed**Replacement $ **
Declared Dangerous or Potentially Dangerous Dog: ❑ Y ❑ N
MICROCHIP # (If applicable) SUBTOTAL: $
RABIES VACCINATION DATE: ` ' i A (3 yr) (1 yr) City Tag # f�
PET #3 ;[❑ Dog ❑ Cat ":U Spayed/Neutered License Fee $ J )
4'j
Pet Name € BAhdate t , Sex ``i
Color � . r t� Breed** i Replacement $ **
Declared Dangerous or Potentially Dangerous Dog: ❑ Y ❑ N
MICROCHIP # (If applicable) SUBTOTAL: $
:
RABIES VACCINATION DATE�J-(3 yr) (1 yr) City Tag # rt
*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.)
Do Not Send Cash by Mail TOTAL ENCLOSED $
If you have questions, please contact Blair Police Department at (402) 426-4747
++++++++++++++++++..........++++++++++++.....+++++++++++++++++++++++.++¢+++++
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 N Must register pets within 10 days of
• <OR> at 6 months of age if puppy/kitten residency.
Mai- 09 23 04:26p
P.1
CITY OF BLAIR - 2023 PET LICENSE APPLICATION
If you live in Blair Oty limits and own a dog(s) andjor cat(s), complete this form and return with check made payable to:
City of Blair a 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, 2023
Owner Name: 0�G��1[— J ���t-4 a ✓l
Owner Address: ) - t_iUU�hl�`�`YQ�
City/State/zip: Blair, NE 688008
Phone # 'qt G l +
LICENSE FEES: Dog or Cat: $16.00
Altered Dog or Cat: $11.00
***PLEASE READ CAREFULLY***
YOU ARE REQUIRED BYLAW 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 all,5/20M The City shall
recogn ze a microchip identification number as the license number. It
shall be unlaviful for any dog or cat to wear any license or other city
identification other than that Issued by the City or Blair for such dog or
cat. The City of Blair requires proof of rabies vaccination to
be submitted with your license aoDligatron,
Replacement Fee for Lost Tag: $5.00
?ncluded is a State Fee of $1.25 being collected to fund the Netlraska Dog & Cat C)perat or Inspection Program
PET #1 l DD(og Cat �5payed/Neutered r� License Fee $
Pet Na eT- Birthdate Sex
Color N &C� Breed** Replacement $ **
Declared Dangerous or Potentially Dangeroustog., ❑ YIN
MICROCHIP # (If applicable) SUBTOTAL.: $ 1
RABIES VACCINATION DATE: D ' ,�- (3 yr) __)C (1 yr) City Tag # 3017
PET # 2 - D o g ❑ Cat X; Spayed/Neutered License Fee $ l
Pet Na Birthdate - Sex it
Color Breed** _ Replacement $ **
Declared Danger us or Potentially Dangerous Dog: ❑ Y�
MICROCHIP # (If applicable) SUBTOTAL: $
RABIES VACCINATION DATE: " - 01-- .9- (3 yr) _,K___ (I yr) City Tag # 4057
PET ##3 ❑ Dog C1 Cat ❑ Spayed/Neutered License Fee $
Pet Name Birthdate 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.)
Do Not Send Cash by Mai! TOTAL ENCLOSED $
If you have questions, please contact Blair Police Department at (402) 426-4747
......+.*.++++t...*+..++.+++.++.++......++f+..++.++.........+++++.*+..f.... r++
NEW PET/NEW RESIDENT LICENSING REQUIREMENTS (A010 151ate fee datenotaOicaUefdrneWM&1newtesrdents)
Newly Acquired Peas:_ New -Residents to Blair:
■ Must be licensed uviUtin 10 days of amvship ■ Must register pets within 10 days of
■ <OR> at 6 months of age if puppy/Icitiben residency.
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CITY OF BLAIR ®2023 PET LICENSE APPLICATION
, 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 f Blair e 218 S 16th St e Blair, NE 6008
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, 2023
Owner Name: 41 / (V c l5 % lP&41/ Iee
Owner Address: 7-3 2- 612II/i4/ ,S / .
City/State/Zip: Blair, NE 68008
Phone #
LICENSE FEES: Dog or Cat: $16.00
Altered Dog or Cat: $11.00
***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 3115/2023. 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 to
be submitted with your license application.
Replacement Fee for Lost Tag: $5.00
Included is a State Fee of $1.25 being collected to fund the Nebraska Dog & Cat Operator Inspection Program
PET #1 21 Dog ❑ Cat 0 Spayed Ne tered License Fee $
Pet Name ('�74L Birthdate ILIz V Sex
Color K Breed** !,-/I J Rep/acement $ **
Declared Dangerous or Potentially Dangerous Dog: ❑ Y ® N
MICROCHIP (If applicable) SUBTOTAL: $
RABIES VACCINATION DATE: 7 - i--2-0 (3 yr) (1 yr) City Tag #
PET # 2 ❑ Dog ❑ Cat ❑ Spayed/Neutered
Pet Name Birthdate Sex
Color Breed**
Declared Dangerous or Potentially Dangerous Dog: ❑ Y
MICROCHIP # (If applicable)
RABIES VACCINATION DATE: (3 yr) _
W
License Fee $
Replacement $
SUBTOTAL: $
(1 yr) City Tag #
E . ❑ Dog ❑ Cat ❑ Spayed/Neutered License Fee $
Pet Name Birthdate 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.)
Do Not Send Cash by Mail TOTAL ENCLOSED
If you have questions, please contact Blair Police Department at (402) 426-4747
++++++++++++++++.++++++++++++++++++++++++++++++++++++++++¢++++++++.....+++++++
NEW PET/NEW RESIDENT LICENSING REQUIREMENTS (March 15late fee date not applicable fornewpets/newresidenis)
Newly AMuired Pets: New Residents to Blair:
• Must be lioensed within 10 days of ownership ■ Must register pets within 10 days of
• <OR> at 6 months of age if puppy/kitten residency.
Thone Animal Hospital
902 S Hwy 30
Blair, NE 68008
402-426-3630
FOR: Gary Christopher
2321 Grant Street
Blair, NE 68008
(402) 427-5420
Date For
Qty Description
Printed:
12-23-22 at 1:31 p
Date:
12-23-22
Account:
8178
Invoice:
113978
Net Price
12-23-22 Coal 1 Methylprednisolone Acetate Inj 37.00
Items used... 1 Depo-Medrol 20mg/ml
12-23-22 Cash payment -40.00
12-23-22 #KRB Cash Refund 3.00
Old balance Charges Payments New balance
0.00 37.00 37.00 0.00
Reminders for: Coal (Weight: 69.0 Ibs - 7y) Last done
.Y 07-08-23
Rabies Vaccination (3 Year)
07-08-20
07-05-23
DA2PPV 1yr
07-05-22
07-05-23
Bordetella (Kennel Cough)
07-05-22
07-05-23
Heartworm-Tick Test
07-05-22
07-05-23
Lepto 1yr
07-05-22
You Can Order Your Pet Supplies On animalcareofblair.com. Like us on Facebook!I
01/21/2023 10:21 4024260101 HOLSTEIN VET CLINIC PAGE 02/02
2023 PET LICENSE
VERIFICATION/APPLICATION FOR CITY OF BLAIR
IF YOU LIVE IN BLAIR CITY LIMITS AND OWN A DOG(S) AND /OR CAT($),
COMPLETE THIS FORM AND RETURN WITH A CHECK PAYABLE TO:
CITY OF BLAIR -- 218 S. 16TH ST -- BLAIR, ICE 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.
*OOPLEASE READ CAREFULLY***
XQU RE REQUIRED BY LAW TO LICENSE pE T E CITY OF BLAIR REQUIRES PRdCF EIF RABIES VACCINATICIISL
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 RENE1(-II,QLI,_S ARE WE BY 3/15/2023
The city shall recognize a microchip ID number as the license number.
It shall be unlawful for any dog or cat io 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
Robert W. Choate
Spouse
Owner Address
2271 Lincoln Street
City/State/Zip
Blair, NE 68008
Phone #
402-237-5795
Pet Name: Fiona
Age: 17Y
DOB: 06-24-06
Sex: Spayed Female
Color:
Breed:
Microchip #
Rabies Tag #
PLEASE INCLUDE CITY TAG NUMBER IF THIS IS A RENEWAL (IF AVAILABLE): #
RABIES VACCINATION DONE ON
01-21-23
Rabies Description: YEAR
3 YEAR
Holstein Veterinary Clinic
Dr. tIsB Schrum DIAM : De Kr/rfs Holsteln QVM
718 South 1W, Street glair, NE-68008
402-426-7387 402-426-0101 Fax
hoistelnolinic@gmail.com
LICENSE FEES
Intact
Dog or Cat: $16,00
/ r
Dog r c0t: $11.00
Replacement rag
• �6_QQ
Total $
PETS THAT ARE ON ME ACTIVE POTENTIALLY DANGEROUS OR
'DANGEROUS DOG LlSfNEDTO REGISTER DIRECTLYAT cITYHALL,
FAXED 01-21-23
BY
.. `; '�` i�i iw�, i�..i gLd;��n•; .; r.,li .,: 'I'. v':!•i e'i'i ::?i,�a;i 1'+:<�
i•.�; .. d`, r ;.if.i. �n ��i, i:;,,,i � .i, �..•rr r,, ••'j �.�i. ,; Pid�l q•,.;� r:
01/21/2023 10:21 4024260101 HOLSTEIN VET CLINIC PAGE 01/02
2023 PET LICENSE
VERIFICATION/APPLICATION FOR CITY OF BLAIR
IF YOU LIVE IN BLAIR CITY LIMrTS AND OWN A DOG(S) AND /OR CAT(S),
COMPLETE THIS FORM AND RETURN WITH A CHECK PAYABLE TO!
CITY dF BLAIR - 218 S. 16. 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 DWL1,41NG UNIT.
*"PLEASE READ CAREFULLY"
YOU ARE REQUIRED BY LAW TO LlQ9NSE YOUR PETS, THE CITY OF BLAIR REQUIRES PROOF OF RABIEkYACMNAILOUNI,
Failure to do so is a violation of City Ordinances 6.103 and carries a penalty of a fine up to $160,00 per pet,
PET LICENSE RENEIIII'ALS ARE DUE BY 3/15/2023,
Th® city shall recognize a microchip 11) number as the license number.
It shall be unlawful'for any dog or cat to wear any license or other city ID other than that issued by the City of Blair for such dog or cat,
NEW PET LICENSINga_Must be licensed within 10 days of ownership (011) at 6 months of age if puppy or kitten
NEW RESIDENTS TO BLAIR Must register pets within 10 days of residency
Owner Name
Robert W, Choate
Spouse
�• --
Owlner Addrv§s.
2271 Lint colntltreet
City/State/Zip
Blur, Ni, 68008
Phone #
402-237-5755 .
Pet Name: Flrankie • '•
.. '
Tag
1- ar
Age: 16Y
DOEI-—0$-07W
Sax, Neutered Male
Color: Aipricpt/Wh
Breed:' Poodle, Miniature
Microchip #
Rabies•Tag # 19047
PLEASE INCLUDE CITY TAG NUM13ER IF THIS IS A RENEWAL (IF AVAILABLE): #
RABIIHS VACCINATION DONE ON 04-06-21
Rabies.Description: 1 YEAR
3 YEAR
;.,'1- olstein Veterinary Clinic
Dr. Lisa Schrum DVM : Dr. ICrista Ho(steln DVM
718 South 1.0111 Street Blair, NE 68008
402-426-7387 402-426-0101 Fax
holsteinclinic@,grnall.com'
LICENSE FEES
Intact
Dog or Cat: $16.00
A/terse
Do or cat: 0-00
Replacement Tag
$6.00
Total $
PETS THAT ARP ON THP ACTIVE POTENTIALLY OANGEROLIS OR
DANGEROUS DOG LIsTNEEO TO RE ! TER DIRECTLY AT CITY HALL.
FAXED 01-21-23
BY
:,,.:CITY,,;►;LL.W0,.,2=7`:'..'.
i,�;'"��"���"i ��i. a.;1'•(:i,:;,. "i,LP,,,i i.'� i,'' i r,,,, 'iii i•, :'iy'ai, i.� r'r ;:i
7..
Jan 10 23 03:18p
p,1
CITY OF BLAIR - 2023 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 a 218 S 16th St a Blair, NE 68008 -$ne Antm�i"-'"t
You may legally own a combination of four (4) adult pets, but no more than three (3 a J:r i630
or three (3) adult cats per residential or dwelling unit. 9G2 S Hvwy 30
nbnn5:L
LICENSE RENEWALS
, ARE DUE: March 15,1023
Owner Name-Cj-is
Owner Address: LbAp
y)�
� �QQ�LN,P.cj',�
City/state/Zip: Blair, NEE 68008
/n�ty
Phone # `'2 - `yo • N�
LICENSE FEES: Dog or Cat: $16.00
Altered Dog or Cat: $1.1.00
lVG V%.0 —
***PLEASE READ CAREFULLY***
YOU ARE REQUXRED BYLAW TO LXCENSE YOUR PETS.
Failure to do so is a violation of City ordinances 6.103 and carries
a penalty of a tine up to *150.00 per pet.
PET LICENSES RENEWALS ARE DUE BY 3115/2023. The City shall
recognize a microchlp Identificatlon number as the license number. It
shall be unlawfu: for any dog or cat to wear any license or other city
Icentiflcaticn other than tha: Issued by the City of Blair for such dog or
cat. The City of Blair renulres proof of rabies vaocination to
be submitted with vour iloeose application.
Replacement Fee for Lost Tag: $5.00
included is a State Fee of $1.25 being collected to fund the Nebraska Dog & Cat Operator inspection Program
PET #1 Dog ❑ Cat Spayed Neutered License Fee $
Pet Name ' Birth a** Ar Sex FAY\e
Color Breed" Replacement $ **
Declared Dangerous or Potentially Dangerous Dog: ❑ Y N a
MICROCHIP # ---- (If applicable) SUBTOTAL: $
RABIES VACCINATION DATE: 2-• w10 (3 yr) (1 yr) City Tag #
PET #2 ❑ Dog ❑ Cat ❑ Spayed/Neutered
Pet Name Birthdate Sex _
Color Breed**
Declared Dangerous or Potentially Dangerous Dog: ❑ Y ❑ N
MICROCHIP # (If applicable)
RABIES VACCINATION DATE: ___ (3 yr)
License Fee $
Replacement $
SUBTOTAL; $
(1 yr) City Tag #*
PET #3 . ❑ Dog ❑ Cat ❑ Spayed/Neutered License Fee $
Pet Name Birthdate 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.)
Do Not Send Cash by Mail TOTAL ENCLOSED $
If you have questions, please contact Blair Police bepartment at (402) 426-4747
+++++++++++f....++++++..........+++++++++......*+++++.....++•r+++++++* **++....
NEW PET/NEW RESIDENT LICENSING REQUIREMENTS (Maros 151ate fee date not applicable fvrnewM41newresrdents)
Neylwljl Pets, New Residents to Blair•
■ Must be noensed within 10 days of amelship ■ Must register pets within 10 days of
■ <OR> at 6 months of age If puppy/Idtten residency.
02/14/2023 17:35 4024260101 HOLSTEIN VET CLINIC PAGE 01/01
2023 PET-LIMSE
VERIFICATION/APPLICATION FOR CITY OF FLAIR
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. 10T" 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 (2) ADULT CATS PER RESIDENTIAL OR DWELLING UNIT.
*"*PLEASE READ CAREFULLY°"A O
YOU ARE REQUIRED BY LAW TO LICENSE -YOUR PETS. THiF rL[Y Or BLAIR SIRES PROOF OF RABIES vAGONAMO
Failure to do so is a violation of City Ordinances 6.103 and carries a penalty of a fin® up to $150,00 per pat.
PET LICENSE RENEWALS ARK DUE $Y ��
The city shall recognize a microchip ID number as the liaehse numbor,
It shall be unlawful for any dQg 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 B months of age if puppy or kitten
NF1A1 Ppginrr iTg ro 9LAIP Muct rogibior pots within 10 daya of rcaidtnuy
Owner Name
- Matt Clements
Spouse
Joni
Owner Address
1420 Fieldcrest Drive
City/State/Zip
Blair, NE 68008
Phone #
402-659-0882
Pat Name: fiver Tag #4001
Age: ISM
DOB, 11-15-21
Sex: Spayed Female
Color: Gold
Breed; Golden Retriever
Micrvohip #
Rabies Tag # 23092
PLEASE INCLUDE CITY TACT NUMBER IF THIS IS A RENEWAL (IF AVAILABLE): #
RABIES VACCINATION IDDNF ON
02-14.23
Rabies Description: 1 YEAR 3 YEAR
Holstein Veterinary Clinic
Or, Lisa Sohmum DVM : Dr _ lkrista Ho/stein DV1W
718' South 19"' Street B I a i r, N E 6800E
402-426-7387 402-426-0101 Fax
hoisteine.linic@gmaii.com
LICENSE FEES
Intleet
Dog or Cat: $16.00
Altered
Dog or cat:.$11.00
$6.00
Total $--U=
PETS THAT ARE r]N T_HE ACtiVE POTENEALLY DANGEEQ7 S L
DANGEROUS b0G LIST NEED TO REGISTE'R DIRE(TLYArCITY HALL.
FAXED 02-14-23
BY
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Jan 09 23 01:24p
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CITY OF BLAIR - 2021 PET LICENSE APPLICATION
If you live in Blair City limits and own a dog(s) and/or cat(s)r complete this form and return with check made payable
to: City of Blair o 218 S 16th St a 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: Larch 15, 2021
Owner Name: i (2 ' , -L
owner Address: Tyi - `?
city/state/zip: Blair, NE 68008
Phone 1� tic
—r+ r
LICENSE FEES: Dog or Gat., $16.00
Altered Dog or Cat: $11.00
Replacement Fee for Lost Tag: $5.00
***PLEASE READCARERJLLY***
YOU ARE REQUIRED BY LAW TO LICENSE YOUR PETS.
Failure to do so is a violation of cityordlnances 6.103 and carries
a penalty of a fine up to $150.00 per pet
PET LICENSES RENEWALS ARE DUE BY 311.5/2021. The aty shall
recognize a microchip Identification number as the license number. It
shall he unla.vful rnr airy dog or cat to wear any license or other city
Identification other than that Issued by the aty of Blair for such dog or
cat. The Cry of Blair requires proof of rabies vaccination_
Included is a State Fee of $1.25 being collected to fund the Nebraska Dag & Cat Operator Inspedlon Program
PET #1��.l
Dog El :3 Spayed! utered License Fee $
Pet Name Birthdate EColor ' ri )Breed** '' Replacement$ **
Declare Dangerous or Potentially Dangerous Dog: ❑ Y N
MICROCHIP # (If applicable) SUBTOTAL: $ r
RABIES VACCINATION DATE: (3 yr) (1 yr) City Tag # #2948
PET #2; ❑ Dog ❑ Cat ❑ Spayed/Neutered License Fee $
Pet Name Birthdate 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 Birthdate Sex
Color Breed** Replacement$ **
Declared Dangerous or Potentially Dangerous Dog: ❑ Y ❑ N
MICROCHIP # Of applicable) SUBTOTAL: $
RABIES VACCINATION DATE; (3 yr) (1 yr) City Tag #
*PLEASE INCLUDE THE CITY TAG NUMBER IF THIS IS A RENEWAL
** (This feels due along with License Fee If requesting at the time of license renewal.)
Do Not Send Cash by Mail TOTAL. ENCLOSED $ .t
If you have questions, please contact Blair Police Department at (402) 426-4747
NEW PET/NEW RESIDENT LICENSING REQUIREMENTS(Marrhl51atefee d7tenot app4bailefcrnewpeis/newresid nts)
Newly A=mired lets: New Residents to Blair•
■ MLStbe kKe•6ed Wthi 10 days oPownery dp ■ Nust registar pets within 10 days of
■ <plty at 6 montts of age iF pjppy/Idtfen resid -
fllte4 icy l. 3 3
CITY OF BLAIR - 2023 PET LICENSE APPLICATION 3
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 e Blair, NE 68008
Yott irnay legally own a combination of four (4) ad"It pets, b"t no "10VC than three (3) adult dogs
or three (3) adult cats per residential or dwelling unit.
LICENSE RENEWALS ARE DUE. March 15 23 , ZQ--
Owner Name:
Darrin Collins
Owner Address-
-1047 N. 28th Ave
city/stateaip:
Blair, NE 68008
Phone #
(402) 670-3029
LICENSE FEES. Dog or Cat., $16.00
Altered Dou or Cat: !t11.00
*:'t*PLEASE READ CAREFULLY***
YOU ARE RrQUIRED BY LAW TO LICENSE YOUR PETS.
Failure to do so is violation of City ordinances 6.:103 and carries
a penalty of a fine tip to $150.00 per pet.
PFF LICENSES RENEWALS ARE DUE BY ALLSI2O21. The City shall
recognize a rniciochip 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 clog or
cat. The City of flair rerti ire proof of rabies vaccination to
he subri'lltLed witit ypyr ricgrLse at) ly;�Ltiqy. qi� --
Replacendient Fee for Lost'Yag. $5.00
linduded is aState Fee of $1A25 being colt ed to fund the Nebraska Dog & Cat Operator Inspection Program
PET #1 El Dog M Cat (A Spayed/Neutered License Fee $_11.00
Pei. Name mattle Birthdate June2021 Sex male,
Color Orange /White Breed** Domestic Sil/Mix — Replaceinent
Declared Dangerous or Potentially Dangerous Dog: El Y 11 N
MICROCHIP # '— (If applicable) SUBTOTAL"
RABIES VACCINATION DATE: 2021-10-06
— — (3 yr) — () yr) x City Tag #-AA4P"m'
PET #2 EJ Dog El Cat El Spayed/Neutered
Pet Name Birthdate Sex
Color Breed"
Declared Dangerous or Potentially Dangerous Dog: El Y
MICROCHIP # (If applicable)
RABIES VACCINATION DATE: (3 yr) _
License Fee $_
--Rep1c7r-en?ent$_
El N
SUBTOTAL: $
(I yr) _ City Tag
PET #3 El Dog El Cat 0 Spayed/Neutered License Fee
Pet Narne Birthdate Sex
Color Breed** --- Replacelnent
Declared Dangerous of, Potentially Dangerous Dog: El Y 0 N
MICROCHIP # --_.(If applicable) suB"rOTAL-.
RABIES VACCINATION DATE: (3 yr) -- (I yr) -- City Tag #
*PLEASE INCLUDE THE CnY TAG NUMBFR IF T"IS IS A RENEWAL
** (This fee is due along with License Fee if requesting at the time of license renewal.)
Do #Vot Send Cash by Mail TOTAL ENCLOSED $ Lloo
It you have questions, please contact Blair Police Department at (402) 426-4747
I'++1 ............................... I ..... t-1 ............ I .......... I ......
NEW PET/NEW RESXDENT LICENSING REQUIREMENTS (March 15 late fee date not applicable for newl)eIsInew residents)
Newly Acqtflired Pets:_ New Residents to Blair:
* 1v1tjstN--� license-d willin 10 (Jays of ownership Must register pets within 10 days of
* <OR> at 6 months of age if puppy/kitten residency,
j
CITY OF SLAIR - 2023 PET LICENSE APPLICATION / - C ,
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 9 218 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 2023
Owner Name:
Owner Address: / L a 1-'/ J-i n < No (VI v,C:1r'.,
City/State/zip: Blair, NE 68008
Phone # �'�0, h 1 r/'1� /
LICENSE FEES: Dog or Cat: $16.00
Altered Dog or Cat: $11 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 3/15/2023. 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 to
be submitted with your license anDlication.
Replacement Fee for Lost Tay: $5.00
Included is a State Fee of $1.25 being collected to fund the Nebraska Dog & Cat Operator Inspection Program
PET # 1 ,r� Dog ❑ Cat ❑ Spayed/Neutered License Fee $�'
Pet Name I � Birthdate Z-c S x
Color Breed** G�vor Ic; Rep/acement
Declared Dangerous or Potentially Dangerous Dog: ❑ Y '14 N %/
MICROCHIP # ; a _`>' (If applicable) SUBTOTAL: $'�
RABIES VACCINATION DATE: C)J- /1) 1 (3 yr) &— (1 yr) City Tag # (( qEZ
PET #2 ❑ Dog ❑ Cat ❑ Spayed/Neutered
Pet Name Birthdate 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 Birthdate Sex
Color Breed**
Declared Dangerous or Potentially Dangerous Dog: ❑ Y
MICROCHIP # (If applicable)
RABIES VACCINATION DATE: (3 yr) _
■W
WIV
(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.) �/
" L
Do Not Send Cash by Mail TOTAL ENCLOSED $ //
If you have questions, please contact Blair Police Department at (402) 426-4747
++++++++++++++++++++++++.....+++++++++++++++++++++++++++++++++++++++++++++++++
NEW PET/NEW RESIDENT LICENSING REQUIREMENTS (March 15/ate fee date not applicable for newpets/newresidenty)
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/Idtten residency.
I - I
f b'
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 a 218 S 16th St 9 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, 2023
Owner Name: r%tia e, Cep ° , - ee-
Owner Address: H� C f o' r
city/state/zip: Blair, NE 68008
Phone # - `"` '411
LICENSE FEES: Dog or Cat: $16.00
Altered Dog or Cat: $11 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 3/15/2023. 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 Citv_of Blair requires proof of rabies vaccination to
be submitted with your license application.
I :eplaceiient Fee for Lust Tag: $5.00
Included is a State Fee of $1.25 being collected to fund the Nebraska Dog & Cat Operator Inspectilion Program
PET #1 Poo ❑ Cat �Spaye Neutered License Fee v
Pet Nar�e 5a CAI Birthdate�J % Sex 1sal ( r
Color \� i Breed** Replacement $ --
Declared Dangerous or Potentially Dangerous Dog: ❑ Y N o U
MICROCHIP # 9 / / ?-o0 96133� (If applicable) SUBTOTAL: $ r
RABIES VACCINATION DATE: 6, -l2 -2 s;Zo (3 yr) X (1 yr) City Tag # 661SI3
PET #2 ❑ Dog ❑ Cat ❑ Spayed/Neutered
Pet Name Birthdate 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 Birthdate Sex
Color Breed**
Declared Dangerous or Potentially Dangerous Dog: ❑ Y
MICROCHIP # (If applicable)
RABIES VACCINATION DATE: (3 yr) _
W
(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.)
Do Not Send Cash by Mail TOTAL ENCLOSED $ - t
If you have questions, please contact Blair Police Department at (402) 426-4747
++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
NEW PET/NEW RESIDENT LICENSING REQUIREMENTS (Marcie 15/ate fee date notappiicabie fornewpets/newresidents)
Newly Acquired Pets: New Residents to Blair:
® Must be Iloensed within 10 days of ownership ■ Must register pets within 10 days of
® <OR> at 6 months of age if puppy/khen residency.
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01/30/2023 16:13 4024260101 HOLSTEIN VET CLINIC PACE 01/01
2023 PET LICENSE
VERIFICATION%APPLICATION FOR CITY OF ECLAIR
IF YOU LIVE 1N BLAIR CITY LIMITS AND OWN A DOG(S) AND /OR CATS),
COMPLETE THIS FORM AND RETURN WITH ACHECK PAYABLE'I'p;
CITY OF BLAIR -- 218 S. 16TH ST — BLAIR. NIE 68008
YOU MAY LRGALLY OWN A COMBINATION OF FOUR (4) ADULT PETS,
PUT NO MORE THAN THREE (3) ADULT DOGS OR THREE (3) ADULT CATS PER RESIDENTIAL OR DWELLING UNIT.
"'""PLEASE REAd CAt:#EFULLY***
YC�U ARE REQUIR? BY LAW Tie LICEIVE YOUR PETS. THE 01TY OF BLAiR REClU1FtES PROOF OF RABIES VACS ATION.
F�ilU►-o to cio so is � vinletlon'�if City Ordinances 6.103 find carries a penalty of a 'fine up i;p $1,Fi0,(l0 per pet.
• PET LICENSE E ALS ARE C1UE BY' 20�3.
The city shad recognizQ s microchip ID numbAr as the licehse number•,
It shall h� unl�wf�l far any dog or cat to wear any liconse ar other city ID other than that I$ued by the ity of Blair for such dealt or cat.
NEW PET LICENSING Must be licensed within 10 days of ownership (OR) at 6 months of age if puppy or kitten
NEW {ESIDEIdTS T( i3I AIR Must registor pets within 10 days of residency
Owner Name
Spouse
Owner Address
city/state/zip
Phone #f
Holstein Veterinary Clinic
Dr. Lisa Solirtim DVM Dl-, Kriste Pofstein DVM
718 South I91h Street Blair, NE 68008
402-426-7387 402-426-0101 Fax
holsteinclinicIAgmail.corn
Peggy (Cowley
Russ
957 N. 18th Ave
Blair, NE 68008
492-63-3'I43
LLCENSE FEES
Intact
Dog or Cat; $16.00
Do r cat: $11, Q
Replacament Tag
$5.00
Total $ �
FATS T NAT ARE ON THE ACTIVE PUTENTIAI„1,1' DANCERDLIS OR
DANGER(JU� DUG LIST NEED TO REGISTEf�,(�%17EGTCYAT C1T1' NACL'
FAXED 01-30-23
BY
Ty
03/22/2023 13:39 40242GO101 HOLSTEIN VET CLINIC PACE 01/01
2023 PET LICENSE
VER.IFICATIONIAPPLICATION 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 OP VOUR (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 REQURREI) 13Y LAW TO LICENSE YOUR PETS. THE CITY Or BLAIR REQUIRES PRO,QF Q HAH1E6 VACCINATION.
rallure to do so is a violation of City Ordinances 6.103 and carries a penalty of 8 fine Ill) to $150.00 per pet.
PET LICENSE RENEWALS ARE DUE BY 3115/2023.
The city shall recognize a microchip ID number as the license nurnber.
It shall be unlawful for any dog or cat to wear any l)cemo or otbor city ID ptherthan that issued by the City of Blair for such dog or cat.
NEW PET LICENSING Must be,licensed within 10 days of ownership (Off) at 6 months of age if puppy or kitten
NEW RESIDENTS TO BLAIR Must register pets within 10 days of residency
Owner Name
Lisa Cox
Spouse
Tom
Owner Address
2004 Cauble Creek Circle
City/State/zip
Blair, NE 68008
Phone #
402-
Pet Name, Piper
.
Tag #1738
Age: 8Y
DOB: 06.30.14
$ex: Spayed Female
Color: Tan
Breed: Chesapeake
Microchip #
w --
Rabies Tag # 20061
PLEASE INCLUDE CITY TAG NUMBER IF THIS IS A RENEWAL (IF AVAILABLE): #~
RABIES VACCINATION DONE ON
01-26-22
Rabies Description:
1 YEAR 3 YEAR
Holstein Veterinary Clinic
Dr. Lisa Schrum DVM : Dr. Krista HolWain DVM
718 South M" Street Blair, NIH 68008
402-426-7387 402-426-0101 Fax
holsteinclinicgmail.com
LICENIETI=
Intact
Grog or Cat: $16,00
Itc�. i).00
Dog o at:
Replacernent Tag
$5.00
Total $ 1 y
PETS THAT ARE Qiy THE ACT1Vf POTENTIALLY DANGEROUS OR
DANGEROUS DOG LIST NEED TO RPh1$ MA DIRECTLY AT CITY HALL.
FAXED 03-22-23
BY
"IT ALL;C ;: Il. - 1
03/14/ 2023 17: 55 4024260101 HOLSTEIN VET CLINIC PAGE 01/01
2023 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. 16T" ST - BLAIR, NE 68008
YOU MAY Lr-OALLY OWN A COMBINATION OF FOUR (4) ADULT PETS,
BUT No MORE THAN THREE. (2) ADULT DOGS OR THREE (3) ADULT CATS PER RESIDENTIAL OR DWELLING UNIT.
46**PLEASE READ CAFtErULLY"o
YOU A
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.
The city shall recognize a microchip ID nornber as the license nurnor.
It shall be un)avvfu) for any dog or rat to wear any license or other city ID Other than that issued by the City of Blair for such dog or rat,
NEW PaIlICENSIN-C4 Must be licansed within 10 days of ownership (OR) at 0 months of age if puppy or kitten
N)E V Rg,,�NTSTQILAIR Must register pets within 10 days of residency
Owner Name
Alexis Cozad
Spouse
I .
lb7w--n er Address
1226 N 1 Oth St Apt 203
citylstate/zip
Blair, NE 68008
Phone #
402-740-5520
Pet Name'. Opal TEa!g #3432
Age; 4Y
DOS: 07.23-18
Sex- Spayed Female
Color: White
Breed: Boxer X
Microchip # 985112011627596
Rabies -rag # 23153
PLEASE INCLUDE CITY TAG NUMBER IF THIS IS A gr!NEWAL (OF AVAILAIRLE). 4
RABIES VACCINATION DONE ON
03-14-2-3
Rabies Description, 1 YEAR
3 YEAR
L.
Holstein Veterinary Clinic
L7r. tjSB SCUM 0 VM - Dr. Krlst& Holstein D V44
716 $outh 1 qthStreet Blair, NE 68008
402-426-7387 402-426.0101 Fax
holsteind inic ftrritail.Gom
LIPENSE FEES
Intact
Dog or Cat, $16,00
Dog of t4: $1 7a
Replacement Toy
$5,00
Total $J\
L
FAxEb 03-14-23
BY
------------
26'44b
CITY OF BLAIR - 2023 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 e 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, 2023
Owner Name:
Owner Address:
city/state/zip: Blair, NE 68008
Phone # �ko D` 4 L(
LICENSE FEES: Dog or Cat: $16.00
Altered Dog or Cat: $11.00
***PLEASE READ FULLY***
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 3/16/2023. 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 renuires Proof of rabies vaccination to
be submitted with your license application.
Replacement Fee for Lost Tag: $5.00
Included is a State Fee of $1.25 being collected to fund the Nebraska Dog & Cat Operator Inspection Program
PET #1 Dog Cat l,Spayed/Neutered License Fee $ 06)
Pet Name t �, o c Birthdate / �- �; Sex k.-(r
Color _ "1 c:Cc Breed** mac, �& Replacement$ **
Declared Dangerous or Potentially Dangerous Dog. ❑ Y N
MICROCHIP # (If applicable SUBTOTAL:,
RABIES VACCINATION DATE:(3 yr) (1 yr) City Tag # d3l
PET #2 ❑ Dog ❑ Cat ❑ Spayed/Neutered
Pet Name Birthdate 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 Birthdate Sex
Color Breed**
Declared Dangerous or Potentially Dangerous Dog: ❑ Y
MICROCHIP # (If applicable)
RABIES VACCINATION DATE: (3 yr) _
W
W
(1 yr)
(1 yr)
License Fee $
Replacement
CUBTOTAL:
— City Tag
License Fee $
Replacement $
SUBTOTAL:$
*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.)
Do Not Send Cash by Mail TOTAL ENCLOSED $
If you have questions, please contact Blair Police Department at (402) 426-4747
++++++++++++++++++.....r++++++++++++++++++++++++++++++++++++++++.++.++++++++++
NEW PET/NEW RESIDENT LICENSING REQUIREMENTS (March 15late fee date notapplicable 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.
Client ID: 4678
Client Name: Chris & Shari Cozad
Address: 214 Jackson St
Blair, NE 68008
Phone: (402)676-8753
Tag Number:
6997
Vaccine:
Imrab Rabies Vaccine
Producer:
Merial
Brand:
Imrab 3 TF
Type:
Killed Virus
Anner of
Subcutaneously
Administration:
Staff Name: David E. Johnson DVM
License Number: 1893
Doctor Signature:
Blair Small Animal Clinic PC
David E. Johnson DVM
1734 Front Street
Blair, Nebraska, 68008
(402) 533-2722
Rabies Certificate
Patient ID:
Patient Name:
Species:
Breed:
Sex:
Color:
Markings:
Birthday:
Weight:
Microchip ID:
Vaccination Date:
Expiration Date:
Lot Number:
Drug Expiration Date
2797
Elwood
Canine
Dachshund
Neutered Male
Dapple
Long haired
09/26/2008
16.81 pounds on 6/16/2021
4/15/2022
4/1512025
18528
9/15/2023
/o/
CITY OF BLAIR ® 2023 PET LICENSE APPLICATION 3 -3-
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 e 218 S 16th St 9 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, 2023
Owner Name: Qaw-%�ek`L C.IAvv%
Owner Address: om to 'AA01 Ave,
City/State/Zip: Blair,, NE 68008
Phone # L4P2- S15- 4LAOIr
LICENSE FEES: Dog or Cat: $16.00
Altered Dog or Cat: $11 00
***PLEASE READ CARERJLLY***
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 3/15/2023. 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 to
be submitted with your license application.
Replacement Fee for Lost Tag: $5.00
Included is a State Fee of $1.25 being collected to fund the Nebraska Dog & Cat Operator Inspection Program
T #1 W Dog ❑ Cat W Spayed/Neutered License Fee $ kk • c-)O
Pet Name Birthdate M/2% Sex mw\4
Color W\,-4, 1, br►x,,)vN Breed** MA Replacement$ **
Declared Dangerous or Potentially Dangerous Dog: EJ Y tO N
MICROCHIP # 6li;VTk -k1 WIA5YO716 (If applicable) SUBTOTAL: $ 1\• (-b
RABIES VACCINATION DATE: kkA4, j R2 (3 yr) �_ (1 yr) City Tag # -QW3'10
PET #2 ❑ Dog ❑ Cat ❑ Spayed/Neutered
Pet Name Birthdate Sex
Color Breed**
Declared Dangerous or Potentially Dangerous Dog: ❑ Y
MICROCHIP # (If applicable)
RABIES VACCINATION DATE: (3 yr) _
T #3 ❑ Dog ❑ Cat ❑ Spayed/Neutered
Pet Name Birthdate Sex
Color Breed**
Declared Dangerous or Potentially Dangerous Dog: ❑ Y
MICROCHIP # (If applicable)
RABIES VACCINATION DATE: (3 yr) _
License Fee $
Replacement
❑N
SUBTOTAL: $
(1 yr) City Tag #
License Fee $
Replacement $
❑N
SUBTOTAL:
(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.)
Do Not Send Cash by Mail TOTAL ENCLOSED$ J1,00ENCLOSE
If you have questions, please contact Blair Police Department at (402) 426-4747
+++++++++++++++++++++++++++++++++++++++++++++++++++++++++.++++++++++++++++++++
NEW PET/NEW RESIDENT LICENSING REQUIREMENTS (March 15/ate fee date notappllcable fornewpeis/newresidents)
Newly Acquired Pets: New Residents to Blair:
• Must be licensed within 10 days of ownership a Must register pets within 10 days of
• <OR> at 6 months of age if puppy/Idtten residency.
Client ID:
Client Name
Phone:
Tag Number:
Vaccine:
Producer:
Brand:
loe:
.annerof
8904
DanneUeCnam
911 N.24thAve
Blair, NE 68008
(402)515-6408
7274
|mrabRabies Vaccine
Merial
|mnab3TF
Killed Virus
Subcutaneously
Staff Name: David E.Johnson DVM
License Number: 1893
Doctor Signature:
Blair Small Animal Clinic PC
David E.Johnson DVM
1734Front Street
Blair, Nebraska, 68008
Rabies Certificate
Patient |D:
Patient Name:
Species:
Breed:
Sex:
Color
Markings:
Birthday:
Weight
Microchip ID:
Vaccination Date:
Expiration Date:
Lot Number:
Drug Expiration Date
13139
River
Canine
Mixed Breed
Neutered Male
VVh|ta
Brown Ears
O1/2Q/2O21
G1.5Opounds on11/4/2O22
11/4/2U22
11/4/2825
18542
3/1O/2O24
Mar 14 23 07:43a
p.1
CITY OF BLAIR - 2023 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 la, 2023
Owner fume: lei (� / ?
Owner Address: Z D YO C#cw. le cue k C t r
city/state/Zip: Blair, NE 68008
Phone # �d " �y 6 �
LICENSE FEES: Dog or Cat: $16.00
Altered Dog or Cat: $Ii.00
***PLEASE READ CAREFULLY***
YOU ARE REQUIRED RY LAW TO LICENSE YOUR PETS.
Failure to do so is a violatlo►t of [Sty ordinances 6.X03 and carries
a penalty or a tine up to $150.OU perpet.
PET LICENSES RENEWALS ARE DUE BY ViSi 2023. The City shall
recognize a microchip identification number as the 1(cense number. it
shall be unlawful For any dog or cat to wear any license or other city
Idendfication other than that Issued by the City of Blair for such dog or
cat. The City of Blair reauir+es proof of rabies vaccination to
be submitted with 'your license apylication.
Replacements free far Lost Tag: $5.00
Included is a Skate free of $1.25 being collected to fund the Nebraska Dog & Cat Operator Inspection Program
PET #1 ❑ Dog X Cat Spayed/Neutered License Fee, $ dG
Pet Name ('l t I S Birthdate .,-Ol � Sex
Color �j/a . J U � � fe �— Breed** S ti et filr rr;� Replacement $ **
Declared Dangerous or Potentially Dangerous Dog: 0 Y ;4 N
MICROCHIP # (If applicable) SUBTOTAL: $
RABIES VACCINATION DATE: 3 3D Z (3 yr) (I yr) City Tag # Z%Z q_*
PET #2 ❑ Dog X Cat Spayed/Neutered License Bee $ h. 00
Pet Name SJQ0A4 Birt date 0 z Sex 1�
Color ,'a r Cwo Breed** Sher` Replacement $ **
Declared bangerobs or Potentially Dangerous Dog: Ll Y ❑ N
MICROCHIP -# �' S l S 009 7-pS y3Z (If applicable) SUBTOTAL: $
RABIES VACCINATION DATE: 7,:3 f Z (3 yr) (I yr) Ciit�i Tag #
PET #'3 ❑ Dog a Cat ❑ Spayed/Neutered License Fee $
Pet name Birthdate Sex
Color Breed** Replacement-$ **
Declared Dangerous or Potentially Dangerous Dog: a Y ❑ N
MICROCHIP # (If applicable) SUBTOTAL: $
RABIES VACCINATION DATE: (3 yr) (I yr) City Tag ar#
*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.)
Do Not Send Cash by Mail TOTAL ENCLOSED $
If you have questions, please contact Blair Police bepartment at (402) 426-47,47
NEW PET/ NEW RESIDENT LICENSING REQUIREMENTS (Mardi15/atek-edate not applkab/efornewpaWnewresidents)
Ney& Apquired Pets: New Residents to Blair:
A Must be lioersed vMln 10 days of miership ■ Must register pets within 10 days of
■ <QR> at 6 months of age iFpuppy/ldd:en residency.
Thone Animal H05113 tal
(402) 426-3630
002 S Hwy 30
Blair, NE 68008
03/11/2023 10:26 4024260101 HOLSTEIN VET CLINIC PAGE 01/02
2023 PET LICENSE
VERIFICATION/APPLICATION FOR CITY OF BLAIR
IF YOU LIVE IN BLAIR CITY LIMITS AND OWN A DOGIS) AND /OR CAT[$),
COMPLETE THIS FORM AND RETURN WITH A CHECK FAYARLE TO:
CITY OF BLAIR - 218 S. I STH ST - BLAIR, NE 68008
YOU MAY LEGALLY OWN A COMBINATION OF FOUR (4) ADULT PETS,
BUT NO MORE THAN THREE 13) ADULT DOGS OR THREE (3) ADULT CATS PER RESIDENTIAL OR DWELLINQ UNIT.
***PLEASE READ CAREFULLY***
YOU
Failure to do ,so is a violation of City Ordinances 8.103 and carries a penalty of a fine Lip to $160.00 per pet..
'PET LlgF-NSE REN5 JALS ARE DUE 9Y3 6/20
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 tiy the City of Blair for such dog or cat.
NEW PET -LtQEN5WC-Must be licensed within 10 days of ownership (OR) at 6 months of age if puppy or kitten
VIEW BEaLULNIS T BLAIR Must register pots within 10 days of residency
Owner Name William Curry
spouse Joy
Owner Address 624 N I 1th
city/state/zip Blair, NE 68008
Phone# 402-533-1184
Pet Name: Red
Tag #1365
Age: * 9Y
DOB: 05-26-13
$ex: Neutered Male
Color, Tri Color
Breed: Mix
Microchip # 985141001672165
Rabies Tag# 20076
PLEASE INCLUDE CITY TAG NUMBER IF THIS
IS A RENEWAL (IP AVAILAB # P AVA'LAB #
RABIES VACCINATION DONE ON
02-01-22
Rabies Description, 1 YEAR
Y YEAR
Holstein Veterinary Clinic
Dr. 1-1sa Schrum D VM ! Dr. KrIsta Holstein D VM
718 South 19111 Street Blair, NE 68008
402-426-7387 402-426-0101 Fax
holsteinclinic@ qmail,cam
ILIUM FEES
Intact
Dog or Cat- $16,00
Ooq�br cat: $1
Replacement rag
Total $�'
EPENTJ'rHMALTAARELPLnLEAC'TIVEPQTENTIALLYDANGERpUSOR
0ANC;ENLJS DOG LISTNEEDTo REGISTER 01,9-ECTLYAT -CITY HALL,
FAXED.- 03-11-23
BY
-7
03/11/2023 10:26 4024260101 HOLSTEIN VET CLINIC PAGE 02/02
2023 PET LICENSE
VERIFICATION/APPLICATION FOR CITY OF BLAIR
IF YOU LIV5, 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. 16"" ST - BLAIR, NE 68008
YOU MAY LEGALLY OWN A COMBINATION OF FOUR (4) ADULT PETS,
BUT NO MORE THAN THREE 0 ADULT DOGS OR THREE (3) ADULT CATS PER RESIDENTIAL OR DWELLING UNIT.
—PLEASE READ CAREFULLY***
YOU ARE 13EQUIRED BY E
Failure to do 80 is a violation of City Ordinances 6,103 and carries a penalty of a fine up to $150-00 PQr Pet.
PET LICENSE EEN—E—W—A—L—S-AgF---D—U—E—BY-3—/1-5—/2--O—a-
The city Shall recognize a microchip ID number a-, the license number.
It shall be unlawful for any dog or cat to wear any license or other city ID othor than that issued by the City of !;flair for such dog Or Cal,
NEW FLIlLCENSL -Must be licensed within 10 days of ownership (OR) at 6 manths of ago if puppy or kitten
N�G
NEW Bg-$DENTS T 11LAIR Must register pets within 10 days of residency
Owner Name
Spouse
Owner Address
City/State/Zip
Phone#
William Curry
Joy
624N11th
Blair, NE 68008
402-33-1184
1
Pet Name" rV109gie Tag #2499
Aget BY Sex: Spayed Female Color: Brindle
DOB: 10-05-16
Breed: Lab Mix
Microchip #
Rabies Tag # 18378
PLEASE INCLUDE CITY TAG NUMBER IF THIS IS A RENEWAL (IF AVAILABLE):
RABIES VACCINATION DONE ON
11-07-20
Rabies'Description'.' 1 YEAR �3YEAR
74
LIQ5N$j-EE-E—S
Intact
Dog or Cat: $16.00
� nar ed
."D r cat,
."Dog . $ 1-00
Replacement 709
Total $iL-
PETSTHAT ARE NT�HEACTIV�POTENT�IALIYDA�NGEROI)�S I
VA-N(3jR0U5D(X�LIST NEED T0jqf(31-5TCR _01RE1711 AT CITY HALL
I ,� --
Holstein Veterinary Clinic
Dr. Lisa Schrum 17VM : Dr, Krista Holstein DVM
718 South 1 9th Street Blair, NE 68008
402-426-7387 402-426-0101 Fax
h o Iste i n cl i n 1 c @ 9 rn a i 1,00 m
FAXED 03-11-23
BY
----------
1 r
rY 40. -4195
01/26/202.3 18:17 4024260101 HOLSTEIN VET CLINIC PAGE 02/03
2023 PET LICENSE
VERIFICATION/APPLICATIOM FOR CITY OF BLAIR
IF YOU LIVE IN GLAIR CITY LIMITS AND OWN A DOG(S) AND IOR CAT(S),
COMPLTE THIS FORM AND RETURN WITH A CHECK PAYABLE TO:
GITY OF 13LAIR - 218 S. 16TH ST - SLAIR, 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,
**wPLEASF. READ CAREFULLY"'*
Eaull BY L TO LIQ E Uri pr-rcz F OF RA VA NATIQrd
YOU ARE Failure to do so Is a violation of City Ordinances 6.103 and carries 8 penalty of a fine up to $150-00 per pet.
PEI LN59HENEWALS ARE DUE BY 3/15/2023.
The city shall recognize a microchip ID nLtml?or as the license number.
It shall 'po unlawful for any don or oat to w,-.qr env keri5n or other ci!y. ID other than that issued by the City Of 131air for such dog or cat.
NEW EErLICE N_$iNQ MList be licensed within 10 days of ownership (OR) at 6 months Qf age if puppy or kitten
NEW RESIDENTS TO BLNE Must register pets within 10 days of residency
Owner Name
Spouse
Owner Address
City/State/Zip
Phone #
Holstein Veterinary Clinic
Dr. Lis*.Sahrtim VVA4 : Dr, Krista Ho/stein DV
718 South 19tb Street Blair, NE 68008
402-426-7387 402-426.0101 Fax
holsteinclinic,(�Pgmail-cOm
Pam Cushman
Michael
762 S. 13th Street
Blair, NE 68008
402-426-3286
LICE 4SE-E—EES
h7tact
Df'e ;pv cati VC-00
DO 49i). 00
Replacement Tag
$5.00 ' I.
Total $—Ll* ---
PETS THATARESNTHE ACTIVE POTENTIALLY I?ANGERQqSOR
—DANGER
FAXED 01-26-23
BY
"AL
402.1
�r :- ,1 :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 9 218 S 16th St 9 Blair, NE 608
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 RENEW/GALS ARE UE: March 15 2023
Owner Name:
Owner Address: c�2'-t V� �r•
city/state/zip: /Blair,
7E(Q,168008
Phone # ��i'% / O' 7(1
LICENSE FEES: Dog or Cat: $16.00
Altered Dog or Cat- $11 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 3/15/2023. 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 to
be submitted with your license application.
Replacement Fee for Lost Tag: $5.00
Included is a State Fee of $1.25 being collected to fund the Nebraska Dog & Cat Operator Inspection Program
PEE T # Dog ❑ Cat Spayed/Neutered License Fee $ $ % . 00
Pet Name a6cl Birthdatebl~Zb ZD D Sex
Color hl Breed** i—nn Carle Lba Replacement$ **
Declared Dangerous or Potentially Dangerous Dog: ❑ Y ❑ N 4,
MICROCHIP # (If applicable) SUBTOTAL: $
1.
RABIES VACCINATION DATE: q -11 - f (3 yr) (1 yr) City Tag ,3*
PET #2 ❑ Dog ❑ Cat ❑ Spayed/Neutered
Pet Name Birthdate Sex
Color Breed**
Declared Dangerous or Potentially Dangerous Dog: ❑ Y
MICROCHIP # (If applicable)
RABIES VACCINATION DATE: (3 yr) _
License Fee $
Replacement $
❑N
PET #3 , ❑ Dog ❑ Cat ❑ Spayed/Neutered
Pet Name Birthdate Sex _
Color Breed**
Declared Dangerous or Potentially Dangerous Dog: ❑ Y ❑ N
MICROCHIP # (If applicable)
RABIES VACCINATION DATE: (3 yr)
SUBTOTAL: $ _
(1 yr) City Tag #,
Replacement $
SUBTOTAL: $
(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.) i
Do Not Send Cash by Mail TOTAL ENCLOSED
**
E3
If you have questions, please contact Blair Police Department at (402) 426-4747
+++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++•a
NEW PET/NEW RESIDENT LICENSING REQUIREMENTS (March 15/ate fee date not applicable fornewpets/newresidenty)
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/Idttxn residency.
Date of Rabies Vaccination: 09-11-21
Next Rabies Vaccination On: 09-10-24
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
Tracy Custer
1324 Voss Dr.
Blair, NE 68008
County:
THAT I HAVE VACCINATED AGAINST RABIES THE ANIMAL DESCRIBED BELOW.
Patient information...
PATIENT: Bella TAG NO: 19479
SPECIES: Canine WEIGHT: 55.60
_EX: F _ - _ __ _ _ _ AGE:-14 months
Color and markings... Black and Tan
Signed
Lisa Schrum, DVM
Rabies Vaccine Information...
License: 2310
MFG BY: ZOETI SER.NO: 500084
LOT EXP: 08/09/22 ADM: SQ
Client ID:
Client Name
Address:
■ao=M
8761
John Cychosz
1342 State St
Blair, NE 68008
(402)312-8603
Tag Number:
7364
Vaccine:
Imrab Rabies Vaccine
Producer:
Merial
Brand:
Imrab 3 TF
Type:
Killed Virus
-inner of
Subcutaneously
iministration:
Staff Name: David E. Johnson DVM
License Number: 1893
Doctor Signature:
Blair Small Animal Clinic PC
David E. Johnson DVM
1734 Front Street
Blair, Nebraska, 68008
(402) 533-2722
Rabies Certificate
Patient ID:
14050
Patient Name:
Roxxi
Species:
Canine
Breed:
Australian Shepherd Mix
Sex:
Female �'
Color:
Black/Brown/White
Markings:
Birthday:
09/30/2022
Weight:
33.00 pounds on 1/28/2023
Microchip ID:
Vaccination Date:
1/28/2023
Expiration Date:
1/28/2024
Lot Number:
18535
Drug Expiration Date: 11/17/2023