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�V <br />ADAM H. PUTNAM <br />COMMISSIONER <br />k <br />Florida Department of Agriculture and Consumer Services <br />Division of Animal Industry <br />Bureau of Animal Disease Control <br />OFFICIAL CERTIFICATE OF VETERINARY INSPECTION <br />Chapter 585, F.S. <br />5C-24.003, F.A.C. <br />N 0. _5B D <br />Name & Address of ConsignonShipper <br />Name & Mail;. -Ig Address of ConsigneeiPurchaser <br />Note: All documents and attachments submitted with this request are subject to public review pursuant to Chapter 119, F.S. <br />SPECIES <br />❑ Cattle ❑ Sheep ❑ Swine <br />❑ Horscs ❑ Poultry ❑ Other <br />AREA STATUS <br />❑ Accredited Free (TB) <br />❑ Class Free (Bruc) <br />❑ Class A (Bruc) <br />❑ Class B (Bruc) <br />❑ Class C (Bruc) <br />HERD OR FLOCK STATUS <br />❑ Accredited Herd <br />❑ Certified Herd <br />❑ Validated Herd <br />❑ Qualified Neg. Herd <br />QUALIFYING ; A. <br />TEST DATES C. <br />No. <br />No. <br />No. <br />No. <br />B. <br />D. <br />CARRIER <br />❑ Air ❑ Rail 3 Truck <br />❑ Trail ❑ Vater <br />NAME & ADDRESS <br />- - - <br />VACCINATION STATUS <br />VACCINATED FOR: <br />— <br />ORIGIN OF SHIPMENT <br />COUNTY <br />DATE: <br />- "--" - <br />--�- - PRODUCT, <br />MARKET <br />MARKET <br />PERMIT NUMBER <br />INDIVIDUAL Ai�ITMAL IDENTIFICATION & TESTS <br />TUBERCULIN TEST <br />(INTRADERMAL) <br />BRUCELLOSIS <br />TEST <br />%ACCINATION <br />OTHER TESTS <br />EAR TAG NO. <br />TATTOO <br />OR OTHER <br />PERMANENT <br />IDENTIFICATION <br />L <br />I <br />No. <br />REGISTRY NLTMBER <br />OR DESCRIPTION <br />(ALL ANIMALS PRESENTED FOR <br />TEST MUST BE LISTED) <br />A <br />G <br />E <br />S <br />E <br />x <br />B <br />R <br />n <br />1 <br />N <br />H <br />s <br />DATE: <br />DATE: <br />DATE <br />TATTOO <br />SYMBOL <br />DArb: R <br />H <br />Laboratory: L <br />T <br />s <br />HOUR: <br />I AR: rNnmo K Loca:;oniOR <br />DATE: <br />HOUR: <br />Test Results <br />Test Results <br />1 <br />3 <br />4 <br />6 <br />7 <br />8 <br />9 <br />10 <br />11 <br />_ <br />12 <br />13 <br />-- - <br />14 <br />14 <br />_ <br />ISSUING I"ETERMARIAN'S CERTIFICATION: I certify, as an &ccr dited veterinarian, that th- ove described an' is Iv: <br />vaccinations & results of tests are as indicatai on the certificate. To the best of my knowledge, tt umals Iiswhv* tis c <br />Printed Name of Veterinarian Veterinarian's Signature <br />cxd by me & that they are not sW%%ing signs of infectious, contagious &'or communicable disease, (except where noted) The <br />d stivatien &federal intetstete roquirements. oto ftuther warranty is made er implied <br />Florida License Number National Accreditation Number Date <br />Owner `Agent Statement: ( When applicable): The animals in this shipment are those certified to & listed on this certificate. <br />State Veterinarian's Office, Division ofAnitnal Industry, 40:' S. Ca:houn St. Room 3:5, 7aPatiassee, Florida 32399.0&00 • Questions: 830.410.0900 • Hwa TO ACCOMPANY S H I P M E N I <br />FDACS - 09000 Rev. 07108 Distribution: White. Canary: State Veterinarian Plnk: Shipment Golklenroj; DVM <br />SN -6000 <br />