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Get CA 77-043 2009-2024

STATE OF CALIFORNIA DEPARTMENT OF FOOD AND AGRICULTURE Animal Health and Food Safety Services 1220 N Street Room A-107 Sacramento CA 95814 Telephone 916 654-1447 Fax 916 653-2215 CERTIFICATE FOR INTERSTATE MOVEMENT OF SMALL ANIMALS USE FEDERAL FORM APHIS Form 7001 FOR FOREIGN SHIPMENTS Consignor or Owner Last Name First Name Initial Address City State Phone Number Zip Consignee or Purchaser Animal Description Species Canine Feline Avian Other Name of Animal Rabies Vaccine Used Important Body Temperature Band Tattoo or Other ID Breed License Number Identifying Marking Manufacturer Lot Body Weight Color Sex Tag Vaccination Date Years / Months I hereby certify that I have examined the above animal and found said animal to be free from apparent clinical signs of contagious or infectious disease s. The above mentioned animal is not being transported from a rabies quarantine area and to the best of my knowledge has not bitten anyone within the past ten 10 days. I also certify that I am licensed by the State of California and accredited by the California Department of Food and Agriculture and the U*S* Department of Agriculture for the issuance of this certificate. I further certify that to the best of my knowledge this certificate is issued in compliance with the requirements of the state of destination* Signature of Accredited Veterinarian State License Clinic Name Name Print Date Clinic Address Optional Information Other Vaccinations Other Treatments Yes No Results Fecal Examination within Past 12 Months Yes Heartworm Test within Past 12 Months Communicable External Parasitism / Dermatopathy Debilitating Condition Additional Comments FOREIGN SHIPMENTS including to Canada and Mexico CONTACT United States Department of Agriculture-Animal and Plant Health Inspection Service-Veterinary Services 10365 Old Placerville Road Suite 210 Sacramento CA 95827 77-043 Rev* 12/09. The above mentioned animal is not being transported from a rabies quarantine area and to the best of my knowledge has not bitten anyone within the past ten 10 days. I also certify that I am licensed by the State of California and accredited by the California Department of Food and Agriculture and the U*S* Department of Agriculture for the issuance of this certificate. I also certify that I am licensed by the State of California and accredited by the California Department of Food and Agriculture and the U*S* Department of Agriculture for the issuance of this certificate. I further certify that to the best of my knowledge this certificate is issued in compliance with the requirements of the state of destination* Signature of Accredited Veterinarian State License Clinic Name Name Print Date Clinic Address Optional Information Other Vaccinations Other Treatments Yes No Results Fecal Examination within Past 12 Months Yes Heartworm Test within Past 12 Months Communicable External Parasitism / Dermatopathy Debilitating Condition Additional Comments FOREIGN SHIPMENTS including to Canada and Mexico CONTACT United States Department of Agriculture-Animal and Plant Health Inspection Service-Veterinary Services 10365 Old Placerville Road Suite 210 Sacramento CA 95827 77-043 Rev* 12/09. .

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