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06/15/2015 15:00 7637840082 CENTENNIALLAKES PD PAGE 16/19 <br /> Avid <br /> 3185 Hamner Ave., Norco CA 92860 Tel 8001336-2843 Fax 951/737-8967 <br /> www.AvidiD.com PETtrac@AvidlD.com <br /> Hennessey, Mary P ETtrac Data <br /> 1682 Lakeland Circle <br /> Centerville,MN 55038 Verification <br /> I.I�I�d�I�I1��rrrll�InlrlJ��l :®e <br /> t;lt� <br /> Keeping your information updated allows us to contact you as soon as your lost pet is found. Your pet <br /> has been registered in PETtrac,the 2417 pet recovery service,since we received your initial information. <br /> In order to provide this protection for your pet,it's our poky to have your initial information scanned into <br /> our system within 24 hours of receipt. <br /> We realize that families move to new homes so we are following up with this verification to make sure <br /> your records are correct and up to date. Please verify your information and N corrections are necessary <br /> please return it by mail or fax. Keep this form for your records N no changes are required. <br /> Please contact Avid as soon as possible should your current information change. A processing fee of <br /> $6.00 is required for change of information. 0 you pet has a change in ownership,a new registration is <br /> required for the new pet parent which costs$19.95. There is no fee for correcting typographical errors. <br /> Registration Membership# 4315051 L Member Since Dec 2010 <br /> owner Name Mary Hennessey <br /> Address 1642 Lakehnd Circle Home <br /> Centerville,MN 55038 Work 951947 4792 <br /> Cell612940 Q047 <br /> Email mcmhennesseyegmall.com Fax <br /> Alternate Name Mary Miller <br /> Contact Address 1677 Lakeland Circle Home 651 407 6976 <br /> Centerville, MN 55038 Work <br /> Cell 651 206 0279 <br /> Email cmzmhQjuno.com Fax <br /> Vet/implanter Name Dr.Heidi Johnson <br /> Facility PAWS Pet Hospital Phone 651400 1180 <br /> Address 4644 Victor Path Fax <br /> Hugo, MN 55039 <br /> Email <br /> Pet Microchip 029610610 Species Dog Gender M <br /> Name Ty Brood Beaple/Itallan Greyhound <br /> Markings Color black,brow. white <br /> Medication Vectra SD,Interceptor <br /> Other Data <br /> Mir 26,2015 (wee wwad) <br /> 19 <br />