I03/17/2023 15:35 4024260101 HOLSTEIN L?ET 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 1011 CAT(S),
COMPLETE THIS FORM AND RETURN WITH A CHECK PAYABLE TO;
CITY OF BLAIR - 218 S-16TIl ST - BLAIR, NE 68008
YOU MAY LEGALLY OWN A COMBINATION OF FOUR (4) ADULT PET8,
131-IT NO MORF THAN THREE (3) ADULT DOGS OR THREE (3) ADULT CATS PER RESIDENTIAL OR DWELLING UNIT.
"'PLEASE READ CAREFULLY"*
YOU ARE REQUIRED BY 1 AW TO LICENSE 1� UR PETS, THE CITI� OF GLAIR I?Et�U1REy� PEti�OF O� IRA$IES ]rAl;C1NAT�CU
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 LlCgNSE_RENEWALS Af�E DUE BY 3/95/02,
The city shall recognize a microchip ID 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 issuad by the City of Blair for such dog Or Cat.
—NEW -RE1LICE NZING Must be licensed within 10 days of ownership (OR) at 6 months of ago if puppy or kitten
NEKt-RkaQENjS-jQ-ULMMast register pets within 10 days of residency
wner Name
Melissa Ingot
S P*Ouse
Justin
Ow'ner Address
1137 Grant Street
CityfState/Zlip
Blair, NE 68008
Phone #
402-995-9465
Pet Name- CaSSIUS
ag #1684
Age: 'SY
DOB: 10-16-14
Sex, Neutered Male
Color: Fawn/Bllk
Breed: Pug X Mix
Microchip# 985112001529340 Rabies Tag # 189 M
PLEASE INCLUDE CITY TAa NUMBER If THIS IS A RENEWAL or AVAILABLE): #
RABIES VACCINATION DONE ON
02-24-21
Rabies Description: 1 Y3 YEAR EAR—D
Holstein Veterinary Clinic
,Or, Lisa Schrum] D VM , Dr, Krisra Holstein D VM
718 South 191h Street Blair, W 68008
402-426-7387 402-426-0101 Fax
holste1ncIiriic@gmai1.com
LICENSE F�Ea
Intact
Dog or Cat: $16,00
A It-sted
og 8 :: or $11.()o
og or cat: $11.00
ep/ noemen eg
00me" reg
$5.00
total t
DANGEROUS DOG L)6r NEED TO RPP , jSTER DIRE
FAXED 03-11-23
BY
6
AL
CITY OF BLAIR - 2023 PET LICENSE APPLICATION
1
- - 3 03
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, 2023
Owner Name: r, as Isna5bo
Owner Address: 1126 - i\ llei V ,ut r) QVZ .
City/State/zip: Blair,. NE 68008
Phone # 4 b'Z , 4 5P • Q g
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 reauires Droof 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 id Dog LiCat kdSpaye /Ne tered License Fee $ % ®f
Pet Name b Birthdate a Sex
Color c Breed**V5o Replacement $ **
Declared Dangerous or Potentially Dangerous Dog: ❑ Y Ur N
MICROCHIP # _9,5G0o I2to, (If applicable) SUBTOTAL: $
RABIES VACCINATION DATE: 2 I t (3 yr) ✓ (1 yr) City Tag # 4_9
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 # (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 $ ®6
If you have questions, please contact Blair Police Department at (402) 426-4747
++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
NEW PET/NEW RESIDENT LICENSING REQUIREMENTS(Maroh15late fee date not applicablefor newpets/newre5idents)
Newly Acquired Pets: New Residents to Blair:
■ Must be lberised within 10 days of mnership ■ Must register pets within 10 days of
■ <OR> at 6 months of age if puppy/khen residency.
NVOICE
Thone Animal Hospital
902 S Hwy 30
Blair, NE 68008
402-426-3630
Printed:
07-21-21 at 9:22a
FOR: Curt Isaacson Date:
07-21-21
120 East River Drive Account:
9941
Blair, NE 68008 Invoice:
101518
(402) 650-0598
Date For Qty Description
Net Price
07-21-21 Aero 1 Vaccination Exam
31.00
07-21-21 1 DA2PPV
23.20
07-21-21 1 Rabies Vaccination (3 Year)
29.00
07-21-21 1 Simparica Teal 40mg 22.1-44# #23429
14.89
07-21-21 1 Iverhart Max 25.1-50# Each #23430
6.96
07-21-21 Visa payment
-105.05
Merchant ID: 4445046763017, Approval code: 620297, Transaction ID: 1993127339
Ref #: 19100, Act #: ************3949, Exp: XX/XX, Entry: Contacticc, Card: VISA
Your card balance is not available
I AGREE TO PAY ABOVE TOTAL AMOUNT ACCORDING TO CARD ISSUER AGREEMENT
X
Old balance Charges Payments
New balance
0.00 105.05 105.05
0.00
Reminders for: Aero (Weight: 25.0 Ibs - 13m) Last done
07-20-24 Rabies Vaccination (3 Year) 07-21-21
07-21-22 DA2PPV 07-21-21
01-28-22 Bordetella, P13 Intra-trac 3 01-28-21
05-28-21 Hwt Dog (Heartworm Test)
You Can Order Your Pet Supplies On animalcareofblair.com. Like us on Facebookl!