HomeMy WebLinkAboutAshly Dale 8.5.21 Attachment 51 - Copy To Accompany Shipment 1 - Copy To Veterinarian File
2 - Copies State Veterinarian
STATE OF IOWA DEPARTMENT OF AGRICULTURE AND LAND STEWARDSHIP
Bureau of Animal Industry Official Health Certificate
For Cats and Dogs
Certificate No:
Date Of Issue:
Interstate Shipment
Exhibition
Sale
Permit #:
Invoice:
CONSIGNOR
Address
CONSIGNEE
Address
Car
Air
Rail
Transported By:
Truck
BREED/COLOR & MARKINGS D.O.B SEX U.S.D.A NO.VACCINATIONS / WORMINGS SPECIES
Does Shipment of Animals originate from an area that is under quarantine for rabies?
Yes No
OTHER REMARKS:
I have on this date examined the animals described hereon and find them to be free from visual evidence of communicable desease, and to the best of my
knowledge, exposure thereto.
Veterinarian Address
Total Animals:
Vet Code #
IA HLTH (05/12/2020)Page
Last feed and water received:
Date:Time:
Signature:
Clinic Name
Exam Date:
Signature Of Veterinarian
Print Name
1 - Copy To Accompany Shipment 1 - Copy To Veterinarian File
2 - Copies State Veterinarian
STATE OF IOWA DEPARTMENT OF AGRICULTURE AND LAND STEWARDSHIP
Bureau of Animal Industry Official Health Certificate
For Cats and Dogs
Certificate No:
Date Of Issue:
Interstate Shipment
Exhibition
Sale
Permit #:
Invoice:
CONSIGNOR
Address
CONSIGNEE
Address
Car
Air
Rail
Transported By:
Truck
BREED/COLOR & MARKINGS D.O.B SEX U.S.D.A NO.VACCINATIONS / WORMINGS SPECIES
Does Shipment of Animals originate from an area that is under quarantine for rabies?
Yes No
OTHER REMARKS:
I have on this date examined the animals described hereon and find them to be free from visual evidence of communicable desease, and to the best of my
knowledge, exposure thereto.
Veterinarian Address
Total Animals:
Vet Code #
IA HLTH (05/12/2020)Page
Last feed and water received:
Date:Time:
Signature:
Clinic Name
Exam Date:
Signature Of Veterinarian
Print Name
1 - Copy To Accompany Shipment 1 - Copy To Veterinarian File
2 - Copies State Veterinarian
STATE OF IOWA DEPARTMENT OF AGRICULTURE AND LAND STEWARDSHIP
Bureau of Animal Industry Official Health Certificate
For Cats and Dogs
Certificate No:
Date Of Issue:
Interstate Shipment
Exhibition
Sale
Permit #:
Invoice:
CONSIGNOR
Address
CONSIGNEE
Address
Car
Air
Rail
Transported By:
Truck
BREED/COLOR & MARKINGS D.O.B SEX U.S.D.A NO.VACCINATIONS / WORMINGS SPECIES
Does Shipment of Animals originate from an area that is under quarantine for rabies?
Yes No
OTHER REMARKS:
I have on this date examined the animals described hereon and find them to be free from visual evidence of communicable desease, and to the best of my
knowledge, exposure thereto.
Veterinarian Address
Total Animals:
Vet Code #
IA HLTH (05/12/2020)Page
Last feed and water received:
Date:Time:
Signature:
Clinic Name
Exam Date:
Signature Of Veterinarian
Print Name
1 - Copy To Accompany Shipment 1 - Copy To Veterinarian File
2 - Copies State Veterinarian
STATE OF IOWA DEPARTMENT OF AGRICULTURE AND LAND STEWARDSHIP
Bureau of Animal Industry Official Health Certificate
For Cats and Dogs
Certificate No:
Date Of Issue:
Interstate Shipment
Exhibition
Sale
Permit #:
Invoice:
CONSIGNOR
Address
CONSIGNEE
Address
Car
Air
Rail
Transported By:
Truck
BREED/COLOR & MARKINGS D.O.B SEX U.S.D.A NO.VACCINATIONS / WORMINGS SPECIES
Does Shipment of Animals originate from an area that is under quarantine for rabies?
Yes No
OTHER REMARKS:
I have on this date examined the animals described hereon and find them to be free from visual evidence of communicable desease, and to the best of my
knowledge, exposure thereto.
Veterinarian Address
Total Animals:
Vet Code #
IA HLTH (05/12/2020)Page
Last feed and water received:
Date:Time:
Signature:
Clinic Name
Exam Date:
Signature Of Veterinarian
Print Name