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NYCHA 040. 505A Rev. 8/06 NEW YORK CITY HOUSING AUTHORITY DOG AND CAT VETERINARIAN CERTIFICATION TENANT OF RECORD FOR OFFICE USE ONLY PET TRACKING STREET ADDRESS ACCOUNT 9 digit NOTE TO TENANT After you submit the Dog and Cat Registration form to NYCHA bring your pet to a veterinarian for examination and ask the veterinarian to complete this form. You must return the completed form to your management of ce no later than 90 days after form is given to tenant. You will not have to submit a new Veterinarian form again unless you get a new pet. However you are required by the New York City Department of Health and Mental Hygiene to have your dog or cat revaccinated upon expiration of the vaccination certi cate. PET DESCRIPTION PET TYPE PET S DATE OF BIRTH BREED DOG DESCRIPTION e.g. color markings CAT CURRENT WEIGHT EXPECTED WEIGHT WHEN FULLY-GROWN LBS. HEALTH REQUIREMENTS NYC DEPARTMENT OF HEALTH AND MENTAL HYGIENE DOG LICENSE NUMBER A dog must be licensed and must wear its license tag when in public SPAYED OR NEUTERED NO YES Dogs and cats must be spayed or neutered RABIES VACCINATION CURRENT YES TAG VETERINARIAN CERTIFICATION I the undersigned veterinarian examined the above described pet and certify that the information given is accurate. NYCHA 040. 505A Rev* 8/06 NEW YORK CITY HOUSING AUTHORITY DOG AND CAT VETERINARIAN CERTIFICATION TENANT OF RECORD FOR OFFICE USE ONLY PET TRACKING STREET ADDRESS ACCOUNT 9 digit NOTE TO TENANT After you submit the Dog and Cat Registration form to NYCHA bring your pet to a veterinarian for examination and ask the veterinarian to complete this form* You must return the completed form to your management of ce no later than 90 days after form is given to tenant. You will not have to submit a new Veterinarian form again unless you get a new pet. However you are required by the New York City Department of Health and Mental Hygiene to have your dog or cat revaccinated upon expiration of the vaccination certi cate. PET DESCRIPTION PET TYPE PET S DATE OF BIRTH BREED DOG DESCRIPTION e*g* color markings CAT CURRENT WEIGHT EXPECTED WEIGHT WHEN FULLY-GROWN LBS* HEALTH REQUIREMENTS NYC DEPARTMENT OF HEALTH AND MENTAL HYGIENE DOG LICENSE NUMBER A dog must be licensed and must wear its license tag when in public SPAYED OR NEUTERED NO YES Dogs and cats must be spayed or neutered RABIES VACCINATION CURRENT YES TAG VETERINARIAN CERTIFICATION I the undersigned veterinarian examined the above described pet and certify that the information given is accurate. NYCHA 040. 505A Rev* 8/06 NEW YORK CITY HOUSING AUTHORITY DOG AND CAT VETERINARIAN CERTIFICATION TENANT OF RECORD FOR OFFICE USE ONLY PET TRACKING STREET ADDRESS ACCOUNT 9 digit NOTE TO TENANT After you submit the Dog and Cat Registration form to NYCHA bring your pet to a veterinarian for examination and ask the veterinarian to complete this form* You must return the completed form to your management of ce no later than 90 days after form is given to tenant. You will not have to submit a new Veterinarian form again unless you get a new pet. However you are required by the New York City Department of Health and Mental Hygiene to have your dog or cat revaccinated upon expiration of the vaccination certi cate.