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Producer / farm 2. Market / Auction 3. Expo / Fair National Premises ID: Business Name: City: State: Contact Person: Zip: Phone: 911 Address: COLLECTION DATE: City: mm / dd / yyyy State: Zip: Phone: INFORMATION ABOUT SICK ANIMALS Reason for Submission (circle ONE item with the smallest number that applies, Age Class 1. 2. 3. 4. Vaccination Status Sow / boar (breeding animals) Grower / Finisher (8 wks to market) Nursery (weaned to 8 wks) Suckling 1. Not Vaccinated 2. Vaccinated.
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