Florida Department of Agriculture and Consumer Services

Division of Animal Industry

NO. 58 D 110159 C
Name & Address of Consignor/Shipper Name & Mailing Address of Consignee/Purchaser
Bureau of Animal Disease Control

OFFICIAL CERTIFICATE OF VETERINARY INSPECTION

ADAM H. PUTNAM Chapter 585, F.S.
COMMISSIONE R
5C-24.003, F.A.C.

Note: All documents and attachments submitted with this request are subject to public review pursuant to Chapter 119, F.S.

SPECIES AREASTATUS HEI!J)-OR FLOCK STATUS CARRIER VACCINATION STATUS

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D Sheep D Swine D Accredited Free (TB) ~edited Herd No. D Rail □ Truck VACCINATED FOR:
~e
orses D Poultry D Other D Class Free (Brue) Certified Herd No. rail □ Water
D Class A (Brue) D Validated Herd No.
ORIGIN OF SHIPMENT NAME & ADDRESS DATE:
□ Class B (Brue) D Qualified Neg. Herd No.
COUNTAA -
firkM. D Class C (Brue) ~;f!UV PRODUCT:
MAR.KET PERMIT NUMBER QUALIFYING I A. B.
TEST DATES IC. D.
TUBERCULIN TEST BRUCELLOSIS
INDIVIDUAL ANIMAL IDENTIFICATION & TESTS VACCINATION OTHER TESTS
(INTRADERMAL) TEST
EAR TAG NO. L REGISTRY NUMBER A s B I DATE: DATE: DATE R
I G E R N
HOUR: LAB: (Name & Location) Dfl/2R:Jr-; E
TATTOO OR DESCRIPTION J OR s
N E X E
OR OTHER
PERMANENT
E
No.
(ALL ANIMALS PRESENTED FOR
TEST MUST BE LISTED)
E
D
0
B
s
DATE:
HOUR:
TATTOO
SYMBOL
GeryH u
L
T
£'VVJc.O
IDENTIFICATION
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,~ - Test Results Test Results s

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ISSUING VETERINARJAr,rs CERTIFICATION: I certify, as an accredited veterinarian, thal the above described animals have been iospected by me & that they are not showing signs ofinfcctious, contagious &/or communicable disease, (except where noted). The
vacc=r-

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~75;~~~;dicatedoj~ficate. To the best ofmy~ wled2e-l the • ~ ~ ~ : :caw :eet the s~teof destmation & ~m(i~~ men~. No furuQ Z ~i
3 ~ed. ,a/28'
I Printed Name of Veterinarian " ' Veterinarian's Signature Florida License N~ber National Accreditation Number _ ~ .pate
Owner/A gent Statement: (When a pplicable) : T he animals in this ship ment are those certified to & listed o n this certificate.
State Vcterinario.n's Office. Division of Animal Industry, 407 S. Calhoun St. Room 315, Tallahas.sce, Florida 32399-0800 • Questions: 850-410-0900 • www FrcshFromElocid3 com/ai STATE VETERINARIAN
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FDACS • 09000 Rev. 07108 Distribution: White. Canary: State Veterinarian fink.:. Shipment Goldenrod· DVM SN-6000