VCITY 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 f Blair e 218 S 16th St e Blairr 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: - fl ('I )e ,1 ��=r1 yo
Owner Address: -Y1 A) Z.5 A Ave-
city/state/zip: Blair, NE 6808
Phone # 66 -S 2C31 3 3 /-
LICE SE FEES: Dog or Cat: $16.00
Altered Do or Cat: $11 00
***PL E 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 3/1512023. 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.
g
ft-lacFee for Lost Tag: $5.00
Included is a State Fee of $1.25 being collected to fund the Nebraska Dog & Cat Operator Inspection Program
Dog ❑ Cat ,� Spayed/Neutered License Fee $
Pet Name Ui WS Birthdate & -/2.20 Sex i►lde-
Color c(01 en Breed** 4eo0e.ro 1Z04eQe-r Replacement$ **
Declared Dangerous or Potentially Dangerous Dog: ❑ Y A N
MICROCHIP # (If applicable) SU T TAL: $
RABIES VACCINATION DATE: H' 36 - ?-'1- (3 yr) (1 yr) City Tag # 9!�
E '. Dog ❑ Cat Spayed/Neutered License Fee $ 11,06
Pet Name is Birthdate I '-20'ez Se� fh
Color �1e Breed** &-me ck-x 1 e-- Replacement $ **
Declared Dangerous or Potentially Dangerous Dog: ❑ Y N
MICROCHIP # (If applicable) SU TOTAL: $i
RABIES VACCINATION DATE: 1130 -e (3 yr) (1 yr) City Tag # 60
❑ 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 $ VoOO
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 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.
MAE
Date of Rabies Vaccination: 11 -30-22
Next Rabies Vaccination On: 11 -30-23
VETERINARY CLINIC
Morgan Pet Clinic
16937 Audrey Street
Omaha, NE 68136
402-895-1001
Certificate No: 0
Previous Rabies Vaccination:
OWNER OF ANIMAL
John VanBeek
10840 S 204th AveCir #306
Gretna, NE 68028
This is to certify...'
THAT I HAVE VACCINATED AGAINST RABIES THE ANIMAL DESCRIBED BELOW:
Patient information...
PATIENT: Mud TAG NO: 44274
SPECIES: Canine WEIGHT: 0.00
SEX: Neutered Male AGE: 2Y
Color & markings: Tri Color BREED: Bernese Mountain Dog Mix
Microchip:
Kayla Renee Clark
Vaccinations done...
11-30-22 MRC
11-30-23
11-30-22
MRC
11-30-23
11-30-22
MRC
11-30-23
02-08-21
MRC
12-22-20
CL DA2PPC
Rabies Vaccine
Information...
MFG BY: MERIA
SER.NO:
LOT EXP:
ADM: SQ
I
Bordetella Intranasal
DAP+C41-
Rabies Canine 1 year, #44274
Leptospirosis vaccine
Date of Rabies Vaccination: 11 -30-22
Next Rabies Vaccination On: 11-30-23
VETERINARY CLINIC
Morgan Pet Clinic
16937 Audrey Street
Omaha, NE 68136
402-895-1001
This is to certify...
Certificate No: 0
Previous Rabies Vaccination:
OWNER OF ANIMAL
John VanBeek
10840 S 204th AveCir #306
Gretna, NE 68028
Patient information...
PATIENT: Caicos
TAG NO: 44275
SPECIES: Canine
WEIGHT: 0.00
SEX: Neutered Male
AGE: 2Y
Color & markings: Golden
BREED: Golden Retriever
Kayla Renee Clark
Vaccinations done...
11-30-22 MRC
11-30-23
11-30-22
MRC
11-30-23
11-30-22
MRC
11-30-23
12-22-20
CL Leptospirosis vaccine
11-17-20
MRC
Rabies Vaccine Information...
MFG BY: MERIA SER.NO:
LOT EXP: ADM: SQ
License: 3448
Bordetella Intranasal
DAP+C4L
Rabies Canine 1 year, #44275
�- 10 10061
s' I I - , < (,� t 3 -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 15, 2023
Owner Name: CC..l O/41p yo-1 Lu-
Owner Address: 1(o f (� ` /��, AL11; 54; A-&-. Imo%
City/State/Zip: Blair, NE 68008
Phone# UbZ. 96/ 07Z
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 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 ❑ Dog b Cat b Spayed/Neutered License Fee $ ,a
Pet NameJ,Ly Birthdate 712 2 Sex 49-ma e
Color W1,K- c.al ew Breed** � c�no hwir Replacement $ **
Declared Dangerous or Potentially Dangerous Dog: ❑ Y 23 N
MICROCHIP # (If applicable) SUBTOTAL: $°
RABIES VACCINATION DATE: 2A fzZ (3 yr) (1 yr) . City Tag # IS
PET # 2 ❑ Dog 'D Cat b Spayed/Neutered License Fee $ Y if
Pet Name few' 64W(p4� j�&j Birthdate 511712-Z Sex -re- 1mA,
Color bla,, l- c c,--n T Breed** _Lori L,; r Replacement $ **
Declared Dangerous or Potentially Dangerous og: ❑ Y U N
MICROCHIP # (If applicable) SUBTOTAL: $ �f
RABIES VACCINATION DATE: 9A/'ZZ (3 yr) (1 yr) 5( City Tag # vA n 1
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 (March 15late fee date not applicable 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.
Firefox
about:blank
Patient Chart for Kitty Kai Client: Cookie Gittleman
Date: 05-01-23, Time: 1:58p Page: 2
Date By Code Description Qty (Variance) Photo
08-13-22 BOA 6505 Boarding (feline)
6560 Medication Adm With Boarding
08-16-22 TEH DNOTES Dr. Notes
Called for post sx check up. O states doing well at home. JS: 08-16-22 at 2:22p:
09-08-22 AL VISIT Patient check -in
vax
APPT$ Appointment notes for 09-08-22
vex
1235 Fvrcp/Pn Third vac
1290 Rabies 1 Year Booster, #73278
Age: 16w
ID: 73278 Serial: E007336A Expires: 04/03/23 Type: KIL Mfg: ELANC Admin: SQ
01-12-23 SUR VI$IT Patient check -in
spay
spay
APPT$ Appointment notes for 01-12-23
01-12-23
WT
5119
10-Panel - No Electrolytes
IVLSO
Requisition 52604-2308615
Test
Result
Flag Normal Range
Measure
Low High
Catalyst_Dx 01-12-23 10:44a
GLU
93
74 159
mg/dL
CREA
1.0
0.8 2.4
mg/dL
BUN
26
16 36
mg/dL
BUN/CREA
26
TP
7.1
5.7 8.9
g/dL
ALB
3.6
2.2 4.0
g/dL
GLOB
3.5
2.8 5.1
g/dL
ALB/GLOB
1.0
ALT
43
12 130
U/L _ _ 9 _
ALKP
88
14 111
U/L --{
Attachments1113971Kitty Katt20230112�103549�50044.pdf
18477
Onsior 6mg (Cats only) 943484
3
Give 1 tablet by mouth
ONCE daily for pain
2993
Post Sugical laser treatment
8040
Post -Op Pain Control
4012
General Anesthesia
306
Hospitalization W/Elec Surgery
309
Post -Op Antibiotic Injection
3885
Ovh Feline
4140
Pre Anesthetic Medication
5396
Pre Surgical Exam
2 of 2 5/ 1 /2023, 3:07 PM
Firefox
about:blank
Patient Chart for Pitty Pat Client: Cookie Gittleman
Date: 05-01-23, Time: 2:03p Page: 2
Date By Code Description Qty (Variance) Photo
08-13-22 BOA 6505 Boarding (feline)
6560 Medication Adm With Boarding
08-16-22 TEH DNOTES Dr, Notes
Called for post sx check up. 0 states doing well.. JS: 08-16-22 at 2:21 p:
09-08-22 AL VISIT Patient check -in
vax
APPT$ Appointment notes for 09-08-22
vax
1235 Fvrcp/Pn Third vac
1290 Rabies 1 Year Booster, #73538
ID: 73538 Serial: E007336A Expires: 04/03/23 Type: KIL Mfg: ELANC Admin: SQ
01-12-23 SUR VISIT Patient check -in
spay
spay
APPT$ Appointment notes for 01-12-23
01-12-23
WT
5119
10-Panel - No Electrolytes
IVLSO
Requisition 52606-2308613
Test
Result
Fiaa Normal Range
Measure
Low High
Catalyst_one 01-12-23
10:43a
GLU
92
74 159
mg/dL
CREA
0.8
0.8 2.4
mg/dL
BUN
26
16 36
mg/dL
BUN/CREA
32
TP
6.4
5.7 8.9
g/dL
ALB
2.9
2.2 4.0
g/dL
GLOB
3.5
2.8 5.1
g/dL
ALB/GLOB
0.8
ALT
64
12 130
U/L —��—
ALKP
100
14 111
U/L
Attachments\l 1397\Pitty Pat\20230112_103358_500 df
18477
Onsior 6mg (Cats only) #43483R
3
Give 1 tablet each by mouth ONCE daily for pain
2993
Post Sugical laser treatment
8040
Post -Op Pain Control
4012
General Anesthesia
306
Hospitalization W/Elec Surgery
309
Post -Op Antibiotic Injection
3885
Ovh Feline
4140
Pre Anesthetic Medication
5396
Pre Surgical Exam
2 of 5/1/2023, 3:06 PM
Blair Small Animal Clinic PC
David E. Johnson DVM
1734 Front Street
Blair, Nebraska, 68008
(402) 533-2722
Client ID:
9669
Patient ID:
Client Name:
Caroline Velder
Patient Name
Address:
1616 Adams St
Species:
Apt 17
Breed:
Blair, NE 68008
Sex:
Color:
Phone:
(402)961-0771
Markings:
Birthday:
Weight:
Microchip ID:
Tag Number: 0000 Vaccination Date:
Vaccine: Imrab Rabies Vaccine Expiration Date:
Producer: Merial Lot Number:
Brand: Imrab 3 TF Drug Expiration Date
Tvpe: Killed Virus
inner of Subcutaneously
Administration:
Staff Name: David E. Johnson DVM
License Number: 1893
Doctor Signature:
14588
Peanut Butter
Feline
Domestic Shorthair
Spayed Female
Calico
07/26/2022
10.18 pounds on 8/12/2023
8/12/2023
8/12/2026
18567
9/28/2024
Client ID:
Client Name
Address:
■N!itOTIrT'.
Tag Number:
Vaccine:
Producer:
Brand:
Type:
inner of
mdministration:
Staff Name:
License Number:
Doctor Signature:
9569
Caroline Velder
1616 Adams St
Apt 17
Blair, NE 68008
(402)961-0771
0000
Imrab Rabies Vaccine
Merial
Imrab 3 TF
Killed Virus
Subcutaneously
David E. Johnson DVM
1893
Blair Small Animal Clinic PC
David E. Johnson DVM
1734 Front Street
Blair, Nebraska, 68008
(402) 533-2722
W.Ilfrzrl�fm
Patient ID:
Patient Name:.
Species:
Breed:
Sex:
Color:
Markings:
Birthday:
Weight:
Microchip ID:
Vaccination Date:
Expiration Date:
Lot Number:
Drug Expiration Date
14589
Shortbread
Feline
Domestic Shorthair
Spayed Female
Calico
07/26/2022
8/12/2023
8112/2026
18567
9/28/2024
01/13/2023
2023 PET L19,;t:1%J:St
VERIFICATION/APPLICATION FOR CITY OF BLAIR
IF YOU LIVE IN BLA19 CITY LIMITS AND OWN A bOG(S) AND /OR CAT(S),
COMPLETE THIS FORM AND RETURN WITH A CHECK PAYABLE TO:
CITY OF BLAIR — 218 S. 16TH ST — BLAIR, NE 68008
YOU MAY LEGALLY OWN A COMBINATION OF FOUR (4) ADULT PETS,
BUT NO MORE THAN THREE (3) ADULT DOGS OR THREE (3) ADULT CATS PER RESWENTIAL OR DWELLING UNIT,
09:59 4024260101
HOLSTEIN VET CLINIC
PAGE 02/02
***PLEASE READ CAREFULLY —
YOU ARE REQUIRED -13—YLAW TO LICENSE YOUR PETS THE C yAIR RECZUIRES pIi00F OF RABIES vwcmnm
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,
Pki LICENSE IRENEWALgARE _DUE b}( 8/15/2Q�3,
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.
NEW PET LjQE_NSj_NG Must be licen'sed within 10 days of ownership (OR) at 6 Months of age if puppy or kitten
NEW -RESIDE -NI-S-TO B J,AIR Must register pets within 10 days of residency
Pei Name:' Daisy
Age: 7Y
DOE: -09-9o.15
Breed; Lab
Sex: Spayed Female
Microchip #
TPLEASE INCLUDE CITY TAG NUMBER IF
RABIES VACCINAT16N DONIE ON
R6.1bles". Description: I YEAR
A
Tag #3758
Colon-, Yellow
Rabies Tag # 24520
NJEWAL (IF AVAILABLE): #
07-21-22
''Holstein Veterinary Clihic
Dr-. Lisa Schrum D VA4 : Dr. K6,9ta Holstein D VA4
718 South, 1 9th Street Blair, NE 68008
402-426-7387 402-426-0101 Fax
hoistainclinic@gmail.com
3
LICENU FEES
Intact,
Dog or Cat: $16.00
A/t red
Door cat: $11.00
Replacement Tag
$6.00
Total $jL_
eM THA TARE ON T14EACTjVEP0LENnALLyDANG,6fl0U5 OR
DAN6ERoLISDOG LIST ivFFr),rnREGISTER tYIRECTLYATrITYHALL.
FAXED 01-13-23
BY
CITY OF BLAIR - 2023 PET LICENSE APPLICATION d
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: tA"ayA V,av-;ov-
Owner Address: ` V'l
City/State/Zip: Blair, NE 68008
Phone # —oup 61-
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 reauires 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 Progrem
PET # 1 L Dog ❑ Cat ❑ Spayed/Neutered License Fee $ )
Pet Name "5W.Ack Birthdate D rA ., gSex Lkvlakc
Color Breed** L-IffReplacement$ **
Declared Dangerous or Potentiall Dangerous Dog: ❑ Y ii N
MICROCHIP # 4 (If applicabl SUBTOTAL: $_
RABIES VACCINATION DATE. 5124 1 (3 yr) V (1 yr) City Tag # —Li 0—A
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) _
License Fee $
Replacement $
❑N
SUBTOTAL: $
(1 yr) City Tag #
MIR
(1 yr)
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 $ W-
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 for newpets/newresidenls)
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.
Date of Rabies Vaccination:05-25-22
Next Rabies Vaccination On:05-24-25
VETERINARY CLINIC
Fort Street Veterinarian
14345 Fort St., Suite 500
Omaha, NE 68164
402-884-3383
OWNER OF ANIMAL
Haydan Vofburgh
3925 N 154th Ct
Omaha, NE 68116
County: Douglas
This is to certify...
THAT I HAVE VACCINATED AGAINST RABIES THE ANIMAL DESCRIBED BELOW.
Patient information...
PATIENT: Astrid
TAG NO: 155019
SPECIES: Canine
SEX: S
AGE: 17M
BREED:Great Pyrenees
WEIGHT: 46.00
COLOR: Red and White
MICROCHIP:
Signed CA40ta C&jw,&"
Christie Banks License: 3643
Vaccinations done...
05-25-22 CBA Rabies Vaccination 3yr, #155019
05-24-25
07-26-21 *** LeptoVax (Annual) 07-26-22
07-26-21 *** DA2PP 1 year
06-21-21 *** Rabies Vaccination 1yr
05-26-21 *** Bordetella 05-26-22
Rabies Vaccine Information...
MFG BY: NOBIV SER.NO: 06/06/23
LOT EXP:566318 ADM: SQ
-� I -�- l'k kA s-I
4
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 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, 202
Owner Name: J—;,X(A V) A 114" %
Owner Address: J �2
City/State/zip: Blair, NE 68008
Phone #
LICENSE FEES: Dog or Cat: $16.00
Ailfdai-g%ri nn or rmt.. (til oo
***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.
fteplacemeat Fee for Lost Tag: $5.00
Included is a to Fee of $1.25 being collected to fund the Nebraska Dog & Cat Operator Inspection Program
PET #1 Ll Dog 111 Cat Q' Spayed/Neutered License Fee $
Pet Name Birthdate:6 It Sex
Color Breed** Itzi Replacement $
Declared 'Dang4ous or Potentially Dangerous Dog: Ll Y LJ N
MICROCHIP # (If applicable) _ SUBTOTAL:$
RABIES VACCINATION DATE: 7 2, C", 2- 1 (3 yr) (1 yr) _ City Tag # .?3
PET #2 - LJ Dog a Cat LA Spayed/Neuterecl License Fee
Pet Name ,L Birthdate Sex
Color e i, i Lr Breed" 7-S' /I Replacement $
Declared Dangerous or Potentially Dangerous Dog: LJ Y LJ N
MICROCHIP # (If applicable) SUBTOTAL:$
RABIES VACCINATION DATE: -7 1,2 c, z, � (3 yr) ,!- (1 yr) — City Tag
PET #3 L11 Dog Ll Cat U� Spayed/ Neutered License Fee $
Birthdate 12 -,.,Sex /Pl
Pet Name �, k,,# —
Color Breed" Replacement$
Decla4d D26gerous or Potentially Dangerous bog: 0 Y EJ N
MICROCHIP # (If applicable) SUBTOTAL:$
RABIES VACCINATION DATE: -2 (3 yr) (1 yr) — City Tag #,LL,--& �L-*
*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 $ -`3? 'i
If you have questions, please contact Blair Police Department at (402) 426-4747
..............................................................................
NEW PET/ NEW RESIDENT LICENSING REQUIREMENTS (March 151ate fee date not applicable for newpelylnew resIdenty)
Newly Acquired Pets: - New Residents to Blair:
m Must be lioensed within 10 days of ownership 0 Must register pets within 10 days of
N <OR> at 6 months of age if puppy/kitten residency.
Client ID:
Client Name
Address:
Phone
Tag Number:
Vaccine:
Producer:
Brand:
Type:
inner of
Administration:
5319
Luann Voss
2100 Herman Blvd.
Blair, NE 68008
(402)680-2898
0000
Imrab Rabies Vaccine
Merial
Imrab 3 TF
Killed Virus
Subcutaneously
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
11225
Agnes
Feline
Domestic Shorthair
Spayed Female
Brown Tabby
09/23/2009
9.93 pounds on 8/1/2022
7/31 /2021
713l /2023
18507
1 /20/2023
Client ID:
Client Name
Address:
Phone
Tag Number:
Vaccine:
Producer:
Brand:
Type:
inner of
Administration:
5319
Luann Voss
2100 Herman Blvd.
Blair, NE 68008
(402)680-2898
0000
Imrab Rabies Vaccine
Merial
Imrab 3 TF
Killed Virus
Subcutaneously
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 I D:
Patient Name
Species:
Breed:
Sex:
Color:
Markings:
Birthday:
Weight:
Microchip ID:
Vaccination Date:
Expiration Date:
Lot Number:
Drug Expiration Date:
4324
Princess Lea
Feline
Domestic Shorthair
Spayed Female
Calico
05/01 /2010
10.87 pounds on 8/1/2022
7/31 /2021
7/31 /2023
18507
1 /20/2023
Client ID:
Client Name:
Address:
Phone:
Tag Number:
Vaccine:
Producer:
Brand:
Type:
inner of
Administration:
5319
Luann Voss
2100 Herman Blvd.
Blair, NE 68008
(402)680-2898
0000
Imrab Rabies Vaccine
Merial
Imrab 3 TF
Killed Virus
Subcutaneously
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
11223
Rocky
Feline
Domestic Longhair
Neutered Male
Grey
White
09/23/2009
9.50 pounds on 8/1/2022
7/31 /2021
7/31/2023
18507
1 /20/2023