1. TYPE OF ANIMAL SHIPPED (select 2. CERTIFICATE · PDF fileAccording to the Paperwork...
Transcript of 1. TYPE OF ANIMAL SHIPPED (select 2. CERTIFICATE · PDF fileAccording to the Paperwork...
According to the Paperwork Reduction Act of 1995, an agency may not conduc or sponsor, and a person is not requ red to respond to, a collection of information unless it displays a valid OMB control number. The valid OMB control numbers for this information coltecti n are 0579-0036 and 0579-0333. The time required to complete this information collection is estimated to average .25 hours per response, including t e time for reviewing Instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information,
No dog, cat, nonhuman primate, or additional kinds or classes at animals designated by USDA regulation shall be delivered to any intermediate handler or carrier for transportation in commerce. unless accompanied by a health certificate executed and issued by a licensed veterinarian 17 U.S.C. 21.43.9; CFR, Subchapter A, Part 2).
0m9 APPROVED 0579-0036 0576-0333
UNITED STATES DEPARTMENT OF AGRICULTURE ANIMAL AND PLANT HEALTH INSPECTION SERVICE
UNITED STATES INTERSTATE AND INTERNATIONAL CERTIFICATE OF HEALTH EXAMINATION
FOR SMALL ANIMALS
WARNING: Anyone who makes a false, fictitious, or fraudulent statement on this document, or uses such document knowing it to be false, fictitious, or fraudulent may be subject to a fine of not more than $10,000 or Imprisonment of not more than 5 years or both (18 U.S.C. 1001).
1. TYPE
X
OF ANIMAL SHIPPED (select one only)
Dog Cat Other
2. CERTIFICATE NUMBER
1
Nonhuman Primate Ferret Rodent
3. TOTAL NUMBER OF ANIMALS j
4. PAGE
1
5. NAME, ADDRESS, AND TELEPHONE NUMBER OF OWNER (CONSIGNOR)
Northeast Georgia Animal Shelter 870 Bear Creek Rd Lavonia, GA 30553 706-356-5363
USDA License/or Registration Number (if applicable)
6. NAME, ADDRESS, AND TELEPHONE NUMBER OF RECIPIENT AT DESTINATION (CONSIGNEE)
Whispering Pines 1640 Lewis Road Waterville, NY 13480 570-350-2642
7. ANIMAL IDENTIFICATION 8. PERTINENT VACCINATION, TREATMENT, AND TESTING HISTORY
NAME, AND/OR TATTOO NUMBER OR OTHER IDENTIFICATION
BREED - COMMON OR SCIENTIFIC
NAME AGE SEX
COLOR OR DISTINCTIVE MARKS OR MICROCHIP
X
RABIES VACCINATION
YEAR 1 YR 2 YEARS 3 YEARS
OTHER VACCINATIONS, TREATMENT, AND/OR TESTS AND RESULTS
Vaccination Date Product Date Product Type and/or Results
Apollo Siberian Husky 4y M/N Black/Mike 08/28/17 Defensor 1 „ . ..... . ..... .... ,..
, ... ,s ,„-,„,„i I, ,tt art oi Cirarr.2 Luna Siberian Husky 3y NS VVhite 8/28/17 Defensor 1
I
I I
sEP 5 2017 I I I
I I I I 9. REMARKS OR ADDITIONAL CERTIFICATION STATEMENTS (WHEN REQUIRED) C. 144' 1 ",-- tmerthis date, that ttfe VETERINARY CERTIFICATION: I certify that the animals described in letox 7 have beek;eldamainerilipy -
information provided in box 8 is true and accurate to the best of my knoWledgerandithatthaillowingifindirigat) ade
CX" applicable statements).
1;13
animal
X for rabies
I have verified the presence of the microchip, if a microchip is listed in box 7.
I certify that the animal(s) described above and on continuation sheet(s), if applicable, have been inspected by me on this date end ar to be free of any Infectious or contagious diseases and to the best of my knowledge, exposure thereto, which would endanger the
or other animals or would endanger public health.
To my knowledge, the animal(s) described above and on continuation sheet(s) if applicable, originated from an area not quarantined and has/have not been exposed to rabies
ENDORSEMENT FOR INTERNATIONAL EXPORT (IF NEEDED) NAME, ADDRESS, AND TELEPHONE NUMBER OF ISSUING VETERINARIAN
Dr. Doris Cato, DVM Royston Animal Hospital 2888 W Main Street Royston Ga, 30662 706-245-6850
NOTE: International shipments may require certification by an accredited veterinarian.
LICENSE NUMBER AND STATE 3475 GA PRINTED NAME OF USDA VETERINARIAN
Accredited If yes, please NATIONAL 019700
X complete
ACCREDITATION
Yes No e ow
NUMBER
SIGNATURE OF USDA VETERINARIAN Apply USDA Sealer Stamp here DATE SIGNATURE 0 ISSUING VETERINARIAN DATE
08/28/17
C 1)
111/4) ctrta 9. . APHIS Form 7001 (APR 2010) PARTS - USDA OR STATE VETERINARIAN This certificate is valid for 30 days after issuance
According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not requ red to respond to, a collection of information unless it displays a valid OMB control number. The valid OMB control numbers for this Information collection are 0579-0036 and 0579-0333. The time required to complete this information collection iteStIrllated to average .25 hours per response, including t e time for reviewing Instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of Information,
No dog. cat, nonhuman pdmate, or additional kinds or dosses of animals designated by USDA regulation shall be delivered to any interMediate handler or canter for transportation in commerce, unless accompa Led by a health certificate executed and issued by a licensed vetednerian (7 U.S.C. 21.43.9 CFR Subchapter A, Pad 2).
OMB APPROVED 0579-0036 0579-0333
UNITED STATES DEPARTMENT OF AGRICULTURE ANIMAL AND PLANT HEALTH INSPECTION SERVICE
UNITED STATES INTERSTATE AND INTERNATIONAL CERTIFICATE OF HEALTH EXAMINATION
FOR SMALL ANIMALS
WARNING: Anyone who makes a false, fictitious, or fraudulent statement on this document, or uses such document knowing It lobe false, fictitious, or fraudulent may be subject to a fine of not more than $10,000 or imprisonment of not more than 5 years or both (18 U.S.C. 1001).
1. TYPE OF Dog X
ANIMAL SHIPPED (select one only) Cat Other
2. CERTIFICATE NUMBER
1
Nonhuman Primate Ferret Rodent
3. TOTAL NUMBER OF ANIMALS .1
4. PAGE
1
6. NAME, ADDRESS, AND TELEPHONE NUMBER OF OWNER (CONSIGNOR)
Northeast Georgia Animal Shelter 870 Bear Creek Rd Lavonia, GA 30553 706-356-5383 •
USDA License/or Registration Number (if applicable)
6. NAME, ADDRESS, AND TELEPHONE NUMBER OF RECIPIENT AT DESTINATION (CONSIGNEE)
IAThispeting Pines 1640 Lewis Road Waterville, NY 13480 570-350-2642
7. ANIMAL IDENTIFICATION B. PERTINENT VACCINATION, TREATMENT, AND TESTING HISTORY
NAME, AND/OR TATTOO NUMBER OR OTHER IDENTIFICATION
BREED -COMMON OR SCIENTIFIC
NAME AGE SD(
COLOR OR DISTINCTIVE MARKS OR MICROCHIP
X
RABIES VACCINATION
2 3 EARS 1 YEAR YEARS YEARS
OTHER VACCINATIONS, TREATMENT, AND/OR TESTS AND RESULTS
Vaccination Date Product Date Product Type and/or Results
Lil Bit Siamese 2y F/S . Seal Point 08/09/17 Defensor 1
9. REMARKS OR ADDITIONAL CERTIFICATION STATEMENTS (WHEN REQUIRED) VETERINARY CERTIFICATION: I certify that the animals described in box 7 have been examined by me this date, that the information provided in box 8 is true and accurate to the best of my knowledge, and that the following findings have been made ("X" applicable statements).
I;1
animal
X for rabies
I have verified the presence of the microchip, if a microchip is listed in box 7.
I certify that the animal(s) described above and on continuation sheet(s), if applicable, have been inspected by me on this date and ar to be free of any infectious or contagious diseases and to the best of My knowledge, exposure thereto, which would endanger the
or other animals or would endanger public health.
To my knowledge, the animal(s) described above and on continuation sheet(s) if applicable, originated from an area not quarantined and has/have not been exposed to rabies. Th.. , ,,,,,,,,,,i, r,kui ng 1 his —I
ENDORSEMENT FOR INTERNATIONAL EXPORT (IF NEEDED) NAME, ADDRESS, AND TELEPHONE NUMBER OF ISSUINGVETERINARIAR "I'' .,..— , LICENSE NUMBER AND STATE 475 3 GA'
I PRINTED NAME OF USDA VETERINARIAN
s
Dr. Doris Cato Royston Animal Hospital
1
i 2868W Main Street AUG 1 5 2017 1
Royston Ga , 30662 II i
•
706-245-6650 I 1
I I
Acc.pditId If yes, please NATIONAL
1 019700 I
I
., ,1/4 complete
ACCREDITATION
Yes No below
NUMBER
NOTE: International shipments ma ii • uire certification by an accrechtedNeterinariankt SIGNATURE OF USDA VETERINARIAN Apply USDA Sea/ or Stamp here DATE SIGNA • G - RI RI N 1.—...___.t
(7., CM All
L..,...,S.LcislaulL-------- DATE
08/09/17
APHIS Form 7001 (APR 2010)
This certificate is valid for 30 days after issuance
PART 3 - USDA OR STATE VETERINARIAN
CERTIF The
TE OF OWNER A EN in this shipment are those ertified an isted on this certificate
Owne
State Veterinarian's Office Agriculture Building Capitol Square Atlanta, Georgia 30334
GEORGIA DEPARTMENT OF AGRICULTURE CERTIFICATE OF VETERINARY INSPECTION No. CF- 00246
CERTIFICATE VOID 30 DAYS FROM INSPECTION DATE
CONSIGNOR OR SHIPPER rnces
-3C-)
CONSI G E OR EC VI II 1,
0 6-1-1,1
DATE ANMALS.INSFECTED
V "
CONSIGNOR'S NAIS PREMISES ID.
fl.0 • 1-30 C 14 ° 614. eft-fbill PrVei •
DATE CgITIFICATE ISSUED
to • I . I
VI—JeaCbt (;1k-PC elyoulativ 1, 01. Rue. No. ANIM SHIPMENT ENTRY PERMIT NUMBER
X Species X Species X Purpose of Movement X i Area Status Herd or Flock Status
Cattle Ratite Breeding Accredited Free TB Accredited Herd No.
Horses Cervidae Feeding Modified Accredited TB ii Certified Herd No.
Swine Dogs Show Free - Brucellosis Validated Herd No.
Goats Cats Slaughter Class A - Brucellosis Qualified Herd No.
Sheep Other ‘if. Other ( aS CU ii) Class B Brucellosis Monitored Feeder Pig Herd No.
Poultry
Individual ID: Official Eartag, Breed Individual Registration Ear Tattoo or Breed
Registration Firebrand
-t-o_v.t.ie, .,ane../
Description of Animal or Registry Name and Number
A g e
S e x
B r e e d
Bruc. Vac.
Tattoo
Brucellosis Test Date
TB s 1- OA icloadt•A°
EIA Test Date
P:att
faa--174 (,)
Other Test / Immunization Date
fOPPPir t-11
Other Test / Immunization Date
lotae40...
Results
Lab liir iithi- ets Results Include Lab & Accession No. Results Results Results 72 I I,. n,oui,...
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CERTIFICATE OF ISSUING VETERINARIAN I certify as an accredited veterinarian tha the described animals have been inspected by me and that they are not showing signs of infectious contagious and/or comm icable disease. The vaccination and results of tests are as indicated on the certificate. To the est of my knowledge, the animals listed on this certificate
eet t state of destin tion and ederal iterstate requirem ts. No further warranty is made or im lied. t
(1-) mneuxce, Gooui Ac\re3OW‘ i °Ft L33414 %-1 (41 City, State, Zip l_f Ga. License No.
Original and Blue copies to be forwarded to State Veterinarian's Office. Retain Pink. Yellow copy to accompany shipment
ccreciltid Vetch na (Signr rv Orr
Print Name
CERTIFICATE VOID 30 DAYS FROM INSPECTION DATE
State Veterinarian's Office Agriculture Building Capitol Square Atlanta, Georgia 30334
No. CF- 00201 GEORGIA DEPARTMENT OF AGRICULTURE CERTIFICATE OF VETERINARY INSPECTION
OF OWNER/AGENT CERTIFICA The animal
Owner/Agit (Sig
Original and Blue copies to be forwarded to State Veterinarian's Office. Retain Pink. Yellow copy to accompany shipment
CONSIGNOR OR SHIPPER
Sulf5 CONSIGNEE OR RECEIVER
15steic-cc ---- irook_c_zy, DATE ANIMALS INSPECTED
eb - O. n CONSIGNOR'S NAIS PREMISES ID.
30L-I Ccuicvl Rye. DATE CERTIFICATE ISSUED
e • q • ( -7 v ;-actitte, 5A -304---6— ri)ropuiln, lc . 'tits
No. ANIM IN PMENT ENTRY PERMIT NUMBER
X Species X Species X Purpose of Movement X Area Status Herd or Flock Status
Cattle Ratite Breeding Accredited Free TB Accredited Herd No.
Horses Cervidae Feeding Modified Accredited TB Certified Herd No.
Swine Ni Dogs Show Free - Brucellosis Validated Herd No.
Goats Cats Slaughter Class A - Brucellosis Qualified Herd No.
Sheep Other ->e Other Cyt c0.4 e ) Class B Brucellosis Monitored Feeder Pig Herd No.
Poultry
Individual ID: Official Eartag, Breed Registration Ear Tattoo or Breed
Registration Firebrand
Description of Animal or Registry Name and Number
CO
O
S e X
B r e e d
Bruc. Vac
Tattoo
Brucell T Date 4......
, pa t
kboolAie EIA Test Date
PeFcly„..TeSer te imppv I--
Other Test / Immunization Date
3 v-le-Ict lA
Other Test / Immunization 0 te
'co -684,--LtP4v Abe, je. Results Include Lab & Accession No.
,--1=1,1—
Results Results Results aster 721;1:—RestrIts—
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' CERTIFICATE OF ISSUING VETERINARIAN I certify as an accredited veterinarian tha the described animals have been inspected by me and that they are not showing signs of infectious contagious and/or communic ble disease. The vaccination and results of tests a e as i dicated on the certificate. To the best of my knowledge, the animals listed on this certificate meet the te of destioati
enur
n and Fed ral interstate requireme t N further war anN is made or im lied
wtra, vicur n (Sign kata) M4e.s8
V I at' icks A- atflif 0 City, State, Zip Ga. Lic nse No.
ifS this shipment are thoirc ified,ardllste on-this dellificate
—
CERTIFI The ani
TE OF OWNER/ AG in this shipment are
_
ose certified an isted on this certificate
Owner! (Owner/ ent gnat
State Veterinarian's Office Agriculture Building Capitol Square Atlanta, Georgia 30334
GEORGIA DEPARTMENT OF AGRICULTURE CERTIFICATE OF VETERINARY INSPECTION No. CF- 00207
CERTIFICATE VOID 30 DAYS FROM INSPECTION DATE
CONSIGNOR OR SH ER CONSIGNEE OR RECEIVER
?n1 /44 CEin.
23r>4--1-a-C 5kira nie- .
DATE ANIMALS
21 DATVERIgICATE
io-tt
INSPECTED
17 ISSUED
CONSIGNOR'S NAIS PREMISES ID.
P-o-eT)op 2(.0 i .
VI JAW' 01/4_,ç7tç-j - 30-r1S— 3v-co n 01 k(ZAS No. ANIMA HIPMENT ENTRY PERMIT NUMBER
_x Species X pecies X Purpose of Move X Area Status Herd or Flock Status
Cattle Ratite Breeding Accredited Free TB Accredited Herd No.
_ Horses Cervidae Feeding Modified Accredited TB Certified Herd No.
Swine Dogs Show Free - Brucellosis Validated Herd No. _ Goats Cats Slaughter Class A - Brucellosis Qualified Herd No.
Sheep Other y Other ereScAke., Class B Brucellosis Monitored Feeder Pig Herd No.
Poultry
Individual ID: Official Eartag, Breed Registration Ear Tattoo or Breed
Registration Firebrand
Description of Animal or Registry Name and Number
A g e
S e x
B r e e d
BruC. Vac
Tattoo
Brucellos's Test Date
TB T
iMitkOCIAir
EIA Test Date
PRV ef. e
p 14.{ pp
Other Test / Immunization Date
39(-Scita
Other Test / Immunization Date
1.011A__ Results
Lab GS,- -4:k ._ Results Include Lab & Accession No. Results Results Results 72 k4r Reg Im
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i CERT FICATE OF ISSUING VETERINARIAN I certify as an accredited veterinarian that the described animals have been inspected by me and that they are not showing signs of infectious contagious and/or comnfjnicable disease. The vaccination and results of tests are as indicated on the certificate. To the best of my knowledge, the animals listed on this certificate
eet he state o de nation F er I interstyguirements. No further warranty ' de or im lied.
DirnMerriC ' Accra ' ed Vetedna 'an (Si natur
eilirri Ylli
Address
Name City, tate, Zip i ojiLla, fp- goo,
Ga. License No. Print _ Original and Blue copies to be orwarde to State Veterinarian's Office.
Retain Pink. Yellow copy to accompany shipment.
No. CF- 00247 CERTIFICATE VOID 30 DAYS FROM INSPECTION DATE
Other Test / Immunization Date
°Iffy Results 72 Hr. Results
CERTIFIC E OF OWNER/AGENT The a s in this shipment are those certified and listed on this certificate
Original and Blue copies to be forwarded to State Veterinarian's Office. Retain Pink. Yellow copy to accompany shipment.
State Veterinarian's Office Agriculture Building Capitol Square Atlanta, Georgia 30334
GEORGIA DEPARTMENT OF AGRICULTURE CERTIFICATE OF VETERINARY INSPECTION
CONSIGNOR OR SHIPPER St 0 prey CONSIGNOR'S NAIS PREMISES ID. DATE ANIMALS INSP,ITED CONSIGNEE OR RECEIVER
Scu/Q, P1-11Y-01
OR) 0 ti-. Ofiln DATE C RTIFICATE ISSUED
-0 • Po 01/4F el, co ENTRY PERMIT NUMBER No. ANIM HIPMENT
tAclatick„ On- n—rif141ri 12-9ea ki Area Status Herd or Flock Status X X X X Purpose of Movement Species Species
Accredited Herd No. CattleCattle Acc edited Free TB Ratite Breeding Certified Herd No. Modified Accredited TB Cervidae Feeding Horses
Nic Validated Herd No. Free - Brucellosis Swine Dogs Show Qualified Herd No. Cats Class A - Brucellosis Goats Slaughter
OrmAkt) Monitored Feeder Pig Herd No. Class B Brucellosis Sheep Other Other Poultry
Other Test / Immunization Date
PRV Test Date
TB Test Inj.
EIA Test Date
Brucellos's Test Dale
A Bruc. Vac.
Tattoo
Individual ID: Official Eartag, Breed Registration Ear Tattoo or Breed
Registration Firebrand
Description of Animal or Registry Name and Number Tovcia,u9.- Results
Include Lab & Accession No.
Lab Ohs.
Results Results Results
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3
2)-241 'Ho-fl vyr
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' CERTIFICATE OF ISSUING VETERINARIAN I certify as an accredited veterinarian tha the described animals have been inspected by me and that they are not showing signs of infectious contaoious and/or communica.disease. The vaccination and results of tests are as indicated on the certificate. To the best of my knowledge, the animals listed on this certificate iii.: me the st ? of destination i nd Federal in rstate requirements. No further warranty is made or irylied. s.
L_ A Alm s. Int Acciected r- ermarian Signature)
Mem t,11.coei - )0nrinleriti 12)
(\titirAld141- gettlq City, State, Zip Ga. License No. Print Name
CERTIFICATE
Original and B ue copies to be forwarded to State Veterinarian's Office. Retain Pink. Yellow copy to accompany shipment.
The an als in this shipment are those certified and listed on this certificate
Signa ) 0
State Veterinarian's Office Agriculture Building Capitol Square Atlanta, Georgia 30334
GEORGIA DEPARTMENT OF AGRICULTURE CERTIFICATE OF VETERINARY INSPECTION No. CF- 00204
CERTIFICATE VOID 30 DAYS FROM INSPECTION DATE
CONSIGNOR 0 IPPER 5 CONSIGHWECEIVE__,
Litto )24-,
j
1
\o/Of 4
Ho lith 1DATE
DATE ANIMALS INSPUTED
CERTIFICATLISSUED
0 AY 1 7
CONSIGNOR'S NAIS PREMISES ID.
P-0. ;0)6 ?to
16daditi ` " o q go in r co .----„,,-f-t_, ND Li , t 20 2-2. No. ANIMALS IN SHIPMENT .3 ENTRY PERMIT NUMBER
X Species X Species X Purpose of Movement X Area Status Herd or Flock Status
Cattle Ratite Breeding Accredited Free TB Accredited Herd No.
Horses Cervidae Feeding Modified Accredited TB Certified Herd No.
Swine Dogs Show Free - Brucellosis Validated Herd No.
Goats 1E
Cats Slaughter Class A - Brucellosis Qualified Herd No.
Sheep Other t Other Crt fa(t) Class B Brucellosis Monitored Feeder Pig Herd No.
Poultry
Individual ID: Official Eartag, Breed Registration Ear Tattoo or Breed
Registration Firebrand
Description of Animal or Registry Name and Number
A g e
S e x
,
B r e e d
Bruc. Vac.
Tattoo
Brucellosis Test Date
TB Test Inj.
r fr te
(2-CFWAV
PRV t
ta. '
Other Test / Immunization Date
.•60.,
Other Test / Immunization Date Dore
Lab Obs. Results Includ ab & Ac ssion No. Results Results Results Results 72 Hr. Results
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CERTIFICATE OF ISSUING VETERINARIAN I certify as an accredited veterinarian t a the described animals have been inspected by me and that they are not showing signs of infectious contagious and/or corm icable disease. The vaccinatio and results of tests are as indicated on the certificate. To the best of my knowledge, the animals listed on this certificate meet state o de ination a d Feet I interstate requirements. No further warranty is made or im led,
PVInVirefr W
err Ve eri arian (ag2a_ttit ilr:'
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Addrersagi
ikiCirk ALtiti Print
— Print Name City, State, Zip U Ga. License No.
WV 01:31 L00?-VZ-NVI
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dreachiae tie Rebmann neibcdcil net of list an agency nay not carded or sponsor. and a personIs net required lo respond Spa octlecbon of No deg, cal, neelemen pima re Signed Irkels or classes or mewls Mingretted by was AppRovEn
Mforrodlion uriess II disykrys a mkt OMB central amber. The valid OMB conitol WAWA, topthis Infairmeal collo:ow we ( slm6aigrna USDA t opiate sh alad he impede* awl reemeerate tart or cm rim ix 0579-0036 " ' tan 5ntlla in commerct unless eacengesiimi by a heath emirate eteculed add 11579,0333 _
ine distention. I issued by a Lensed Wainer= (7 U.S.C. 21.43* cily wawa a. ra.... cud resin/hip cellecin emoting wheel dab menes,011Efillg and winbibm Me dela maide4 and complebm 2. CER1FICA1E MEMBER -Of POOL USE OILY
IWURIaNG: Arbon mho makes 1. TYPE OF ANIMAL SHIPPED Bides:tone <Idyl ITTE UNITED STATES DEPARTMENT OF AGMCULTURE a Nam brava ortamMeral 14_4 Ong i cat Other
ANIMAL AND PLANT HEALTH INSPECTION SERVICE
STATES INTERSTATE AND INTERNAIIONAL
3181011)04 CC at docatavad, or uses s-uch dommeal lamina il
l'' be taise• *elm." 0 Nonhuman Primate NI Ferrel 0 Rodent
41132017-0168
UNITED CERTIFICATE Of HEALTH SUMMATION
FOR SIAALL ANIMALS
revoideld may be subject b a fres mum, th"0.000 or iriplisimmeat al nal nicre len h. years cr bath ylEi USG. 140110
J. TOT. AL MEMBER OF AMENS
—'''s : 4. •
4. PAGE
one of one
5. NAME. ADDRESS, AND TELEPHIME NUISBER OF OWNER (CONSEGNOR) -..--4-' 4'
Floyd County Animal C entral . ,
Publchniasel Melee Sentes .
99 North Ave Rome Ga 30161 704.236-4531
ilithee,APCIRESS. AND TELEPHONE NUMBER OF RECIPIENT AT DESTINATION I CONSIGNEE) - I- -
Pew/ Colones
— . = : - 941136 Route S2
." Hobbes NY 125314105 --41;;- .
84.5 22.5.6629 USDALicense/or Registration Number (taps:C=61e)
VACCINATECM, TREATMENT AND TESTING HISTORY 7. ANIMAL IDENTIFICATION I. PERTINENT
. MAINE, MOOR TATTOO NUMBER
- OR OTHER IDODIROATION
BREED— COMMON OR SOENTIFIC AGE SEX
COLOR OR DISTINCTIVE MARKS OR X 1 YEAR 2 YEARS
RABIES VACCINATION
I. 3 YEARS
OTHER VACCINATIONS. . TREATMENT. MOTOR TESTS MID RESULTS
NAME MICROCHIP Vaccinalbn Date Prodsoz! Date Product Type andibr Reines
(11 171877 933600120122967 1-0656 Emly net 48 Is edit FfS Faun 8/15(17 Nimbus 1 Rabies TEMPI_ btratraM 8115M7 Oast Headiacrm Negative. Pyres/el
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(h)
010
9. REMARKS OR ADDITIONAL CER11HCATCON STATEMENTS (WHEN RECNJEREEN VETERINARY CERTIFICATION: I taffy Mal the animals desabed in lea? have been eabuntriad by me this date, that tie
infamation provided in box 61s true and 200211B to the Ira al my lubadedga. and that the ItalorMg fading have been made
Tr applicable statements).
far rabies
I XL
El appear arienat
El To
thaw wafted the pimento of lie grktochip. Ifs macroch4il5 lisliM is Danl.
I Cedifylbel the strings) descried Wave mid on ouninuelten streeitENJ applicable. haw hew impacted by mean Its dide mid to be free dab Median or Olidaglous &senses ad to the bent ei My knowledge. examine beset° atter egaittl enamel Yee
ix ether animals er would endanger Venne Sank
My bweledipe. the &bea(s) desabed thew and an exrdnuaem she EMI bankable. adgbated horn an Stan nal isiasolned aid hasibave eat Wen ....wpm,' la raies.
ENDORSEMENTFOR INTERNATIONAL EXPORT VF NEEDED/ NAME. ADORF_SS, AND TELEPHONE NUMBER OF ISSUING VEIERINAMAN LICENSE IMBIBER AID STATE
PRINTED NAME OF USDA VE1ERMARIAN Hal Bathe! DWI GA 009196
Noah Bread Ana's." Oink 1819 N. Broad SI Rome GA 30161
706-295-2349
NOTE:1 shipments Teo • • ,ffip:F : I P • by an ,
AcceeditedElYes ff yes, please compleb
NATIONAL ACCREDITATION
065111
II. Mow
No
NUMBER
SISNAILRE OF USDA VETERINARIAN ApplyUSDA Seel or Stamp hese DATE SIGNATU ISSUING '' ' —'41fft .
AR All i I
DATE
in ir4
CD
C0
APHIS Faun 7IM1 (140V 2010) This certikate Ls valid for 30 days after issuance
WV
912
1 L
OO
Z-1
7 Z-N
W
rellq
UIV
E8
0.1
8'4
1JO
N
mono lot to Paperwork ftedictlon Oa of 19116, al agency may nor CC Niue cr SpOraSer. ad a person Is rilautina lo respond to, a ealeara of It asplays a mit OMB control is. rata The veil OMB count roman Ire re hfarmabarr cetlaclen ere 0579-0036 and 057973511 inionneten unless
Pb des cal mama, ranee or adetiatal Mak or classes of sattals designated by IISCIA r calm Si a be del WS6 on, I olom.7907a tar Ca riellar
D 05794030
The 9 ire regaled to complete Ilis Irrhsnafan Slake is est mated to wear .2.5 beans re ramose, lockring to g tee We reviewing irdnoirionk
data aid nadraalng the data neexted, ad eamatellrg and retreatte Oro alectori at frtidflmt hanspotalon In commerce, urOuer soarritartert by a test In °enrage reoutler) and hated try • Famed ateleara (706.6.21.43R eft Subaapier A. Pal 2).
OS74-0333 seal:Nag plash WIINSS. galvang
WARPING: Anyone whomale= ficacus. fratalaleni etalso or
1. TYPE OF AMAIN NIPPED (select cme calln 2. CERTFICATE NUMBER - OFFICIAL USE ONLY
UNITED STATES DEPARTMENT OF AGRICULTURE x Dog C.at Ogler
ANIMAL AND PLANT REALM! INSPECTION SERVICE
UNITED STATES INTERSTATE AND INTERNATIONAL
sialeinart on this dominant. or sees sorb document karnairay A
110 lie it°. la orRodent
Nonhuman Praire Ferrel
NEI2017-01131
CERTIFICATE OF HEALITI EXAMINATION
FOR S AI NS ANIMALS
franclukrat may be subject to a an as „,r, un., moo of
Inurrkormail al oat moos tht•AIN years or bath (111U.S.C.40r7
3, TOTAL NUMBER OF ANIMALS ., Kir . - -
4. PAGE
one of one
S. NAME. ADDRESS. MID TIB_EPHONE NUMBER OF OWNER (CONSIGNOR) -11Mialilk:ADDRESS,
Floyd County Mina Googol
Pubic Animal VVellana Services
99 North Ave
Rome Ge 30161
7013-739-4S37
USDA Licensellar Rena:bake Number (Fappbcable)
,•7
2.-
AND TELEPHONE NUMBER OF RECFDENT AT DESTINATION (COMSNINEE)
n r.,-",' .; Swabia Dog Resat -. itz."-- ' 2S North Fnny Rd
Pr-. I Steelier Island NY 11964 ‘..-
tz• -- 631 749-5533
7 ANIMAL IDENTIFICATION B. PERTINEKTVACCMATION, TREATBENT AND TESTING HISTORY
OR OTHER IDENTIFICATION MAW, ANWOR TATTOO NUMBER DISTRICIWE BREED — COMMON
OR SCIENTIFIC NAME
ACE SEX
COLOR OR
MAFOCS OR
RABIES VACCINATTON
n 1 YEAR 2 YEARS 3 YEARS
OTHER VACCINATIONS.
_ TREAThUENT. AND/OR TESTS MID RESULTS
MICHOCHP Product Date Pruden Type awitor Rawls %Amain alien Dale
fin 177189 9330001201224/1111-0613 mix 23 lbs adult WC bLsclitwbb 8AL/17 Nato 1 Rabiers OHM, Intralraci 875/17 Oast Heeitosam Negative, Pyranlel
C21
Pi
(8)
I. RENNIN-5 CH ADDMONAL CERTIFICATION STATEMENTS (WHEN REC(RRED) VETERINARY CERTIFICATION: I sedgy that the flak &sated In box 7 have been examined by moltis data. Int the Norman plevided in box 13 is toe ond monde to the best el raw lonledge. and tat the Mowing frufags have been male rlr applicable staIerne.nls).
H I
Egppear earns
X tumbles
have lit the presence at tee niceoli8. fa mtatchip is Wed In ma?.
I catty that the /stil(s) demist above and al oontkualion dwells). 1 ;pert& have been isspracted by ina an tots date and
to is Pea ot my Swam as conlaplaus disease) and Ps the bed day Dussleslae. ear:Ma He thegeb • .in Wet" eralallgar to art animals anomie:I endanger Poblo let
To my knowledge. the ambwil(s) desatred if a n said on conlinualiaa cheats) il aPPIlliable, origlarded inn an alramlilonialldo4 and haslhave on been earned to rabies.
ENDORSEMENT FOR PRERNATIOPIAL EXPORT OF NC-EDEO) NAME, ADDRESS. AND TELEPHONE NUMBER OF ISSUING VETESINNUAN LICENSE NUMBER AND STATE
PRINTED NAME OF USDA VETERINARIAN Neal /Imaged D1/14 GA 006196
North Broad Animal Cita
ISIS H. Broad St
Roma GA 30161
706295-2344 /
by shipments may comae on anal:railed
Accredied0Yes K yes. please complete
NATIONAL ACCREDITATION
065111
IN below
No
PRIMER
SIGNATURE OF USDA VETERINARIAN Apply USDA Sealer Stump bare DATE AC 5t
CSSIHNG VETE
i
DATE /
07
CO C31 tx.) CO
—0
APHIS Form 7001 INOV 2010) This oeitiscale is valid 50(0 days after issuance , -
CO
CERTIFICATE VOID 30 DAYS FROM INSPECTION DATE
State Veterinarian's Office Agriculture Building Capitol Square Atlanta, Georgia 30334
No. CO- 08220 GEORGIA DEPARTMENT OF AGRICULTURE CERTIFICATE OF VETERINARY INSPECTION
CONSIGNOR OR SHIPPER
(2/4 047-7-00 ,4 Co . Aft i 4.4i I 4) vac., in CONSIGNEE OR RECEIVER
i 77--nr Ccy CC- [PI I ,',..
DATE A MALS INSPECTED
r 1-v/ toil
CONSIGNOR'S NAIS PREMISES ID.
4 (0 q -74.Th on_ k eR09) 7° Co --1)A. #4 t_ i At ve- DATE CERTIFICATE ISSUED
721 ) To i 7 ,;eD
SUAiwk aVi I(c- 64 3c33- q-3- f Mis—r fc--- ciaci is/ / 1 ' /r/ No. ANIMALS IN SHIPMENT ENTRY PERMIT NUMBER
X Species X Species X Purpose of Movement X Area Status Herd or Flock Status
Cattle Ratite Breeding Accredited Free TB Accredited Herd No.
Horses Cervidae Feeding Modified Accredited TB Certified Herd No.
Swine ---gs Show Free - Brucellosis Validated Herd No.
Goats Cats Slaughter Class A - Brucellosis Qualified Herd No.
Sheep Other ----CIF& /4, cc...4_ Class B Brucellosis Monitored Feeder Pig Herd No.
Poultry
Individual ID: Official Eartag, Breed Registration Ear Tattoo or Breed
Registration Firebrand
Description of Animal or Registry Name and Number
A g e
S e x
CO
i- 0 0 p
Bruc. Vac
Tattoo
Brucellos's Test Date
TB Test Int.
EIA Test Date
PRV Test Date
Other Test / Immunization Date
SA in
Other Test / Immunization Date
Lab Obs. Results Include Lab & Accession No. Results Results Results Results 72 Hr. Results
/7 -09 5 ))//1-emewb CI 5 r ei-i‘ 77..- /c.) 2.7 Allent4 rail- -4.4x- 2
3 /7- or itt g4.67
C, cc 'I c&. 4 PA-73; kJ.
5 / 7 — o?-75— opke 3, 54 cm, r 1--- /0,--- 6
7 / 7 --. a t? 6 PP-4- —.5-1,r,p) ire_ 4ii km, m,y T.-- no 7 - F-a-5,L7 8 — . rnat i•
10
11 SEF 3 201/
12 1 I I
13 Z -rd- I
14 L
15
CERTIFICATE OF ISSUING VETERINARIAN I certify as an accredited vete arian tha the described animals have been inspected by me and that they are not showing signs of infectious contagious and/or communica disease. The ccination and results of tests are as indicated on the certificate. To the best of my knowledge, the animals listed on this certificate meet of desfinatio and Federal interstate requirements. No further warranty is made or I plied.
q of-) b ,y A n (Signature Address
4 , it °p, "ts /7) yr/ eyz City, State, Zip
CERTIFICATE OF OWNER/AGENT The animals in this shipment are those certified and listed on this certificate
Owner gent (Signature)
Original and Blue copies to be forwarded to State Veterinarian's Office. Retain Pink. Yellow copy to accompany shipment. Print Name
g°2 Ga. License No.
f
According to the Paperwork Reduction Act of 1995! an agency may not cond Litt or sponsor, and a person is not required to respond to, a collection of information unless it displays a valid OMB control number. The valid OMB control numbers for this information collection are 0579-0036 and 0579-0333. The time required to complete this information collection is estimated to average .25 hours per response, including the ti me for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection f information,
No dog, cat, nonhuman primate, or additional indoor classes of animals designated by USDA r egulation sh all be del ivered to any i ntermediate handler or car rier for transportation in commerce, unless accompa ied by a health certificate executed and issued by a licensed veterinarian (7 U.S.C. 21.43.9; CFR, Subchapter A, Pan 21.
OMB APPROVED 0579-0036 0579-0333
UNITED STATES DEPARTMENT OF AGRICULTURE ANIMAL AND PLANT HEALTH INSPECTION SERVICE
UNITED STATES INTERSTATE AND INTERNATIONAL CERTIFICATE OF HEALTH EXAMINATION fine
FOR SMALL ANIMALS
WARNING: Anyone who makes a false, fictitious, or fraudulent statement on this document, or uses such document knowing it to be false, fictitious, or fraudulent may be subject to a
of not more than $10,000 or imprisonment of not more thani,8‘ years or both (18 US.C. atioiVr ':
1. TYPE OF ANIMAL SHIPPED (select one only)
1 Dog Cat COther
2. CERTIFICATE NUMBER - OFFICIAL USE ONLY
Nonhuman Primate Ferret Rodent
,„p TOTAL NUMBER OF ANIMALS Ta-, 1 •air.a,Th,„
1 of 1i
4. PAGE
5. NAME, ADDRESS AND TELEPHONE NUMBER OF OWNER (CONSIGNOR)
Lake Hartwell Veterinary Clinic 1087 E. Franklin Street Suite K Hartwell, GA 30643
- USDA License/or Registration Number VI applicable)
. C6XNAME);ADDRESS, AND TELEPHONE NUMBER OF RECIPIENT AT DESTINATION (CONSIGNEE) ..k• . K `0.123..
Stacey,61Iverstein ' Jet nih Street , ,
0A _fr A, pt 12i kfieviiitibrk, NY 10075 171.' •
7. ANIMAL IDENTIFICATION 8. PERTINENT VACCINATION, TREATMENT, AND TESTING HISTORY
NAME, AND/OR TATTOO NUMBER OR OTHER IDENTIFICATION
BREED — COMMON OR SCIENTIFIC
NAME AGE SEX
COLOR OR DISTINCTIVE MARKS OR MICROCHIP
RABIES VACCINATION
1 YEAR fJ 2 YEARS 3 YEARS
OTHER VACCINATIONS, TREATMENT, AND/OR TESTS AND RESULTS
Vaccination Date Product Date Product Type and/or Results
") Bourdeaux Blue Heeler 11w N 985112009396844 Not Yet Old Enough 6/30/2017 DHPP
(2) 7/17/2017 DHLP
13)
9. REMARKS OR ADDITIONAL CERTIFICATION STATEMENTS (WHEN REQUIRED) VETERINARY CERTIFICATION: I certify that the animals described in box 7 have been examined by me this date, that the information provided in box 8 is true and accurate to the best of my knowledge, and that the following findings have been made (IL" applicable statements).
i
if appear animal
I for rabies
I have verified the presence of the microchip, a a microchip is listed in box 7.
I certify that the animal(s) deathbed above and on continuation sheet(s), if applicable, have been inspected by me on this date and to be free of any infectious or contagious diseases and to the best of my knowledge, exposure thereto, which would endanger the or other animals or would endanger public health.
To my knowledge, the animal(s) described above and on continuation sheet(s) if applicable, originated from an area not quarantined and has/have not been exposed to rabies.
ENDORSEMENT FOR INTERNATIONAL EXPORT (IF NEEDED) NAME, ADDRESS, AND TELEPHONE NUMBER OF ISSUING VETERINARIAN :
Jaime Terry 1087 E Franklin Street Suite K Hartwell, GA 30643
NOTE: emational shipments may equire cenification by an accredited veterinarian.
LICENSE NUMBER AND STATE
7691 GA PRINTED NAME OF USDA VETERINARIAN
Accredited If yes please
NATIONAL
01 0467
i complete
ACCREDITATION
Yes No below
NUMBER
SIGNATURE OF USDA VETERINARIAN Apply USDA Seal or Stamp here DATE SIG URE OF ISSUING YE RINARIAN
j
.
a
PATE
8/1/2017
API-US Form 7001 (NOV 2010)
This certificate is valid for days after issuance
According to the Paperwork Reduction Act of 1995, an agency may not cond uct or sponsor, and a person is not required to respond to. a collection of information unless it displays a valid OMB control number. The valid OMB control numbers for this information collection are 05790036 and 05790333. The time required to complete this information collection is estimated to average .25 h ours per response, including the ti me for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information,
No dog, cat, nonhuman primate, or additional inds or classes of animals designated by USDA r egulation sh all be del ivered to a y i ntermediate handler or car tier for transportation in commerce, unless accompanied by a heal th certificate executed and issued by a licensed veterinarian (7 U.S.C. 21.43.9; CFR. Subchapter A, Part 2).
OMB APPROVED 0579-0036 0579-0333
UNITED STATES DEPARTMENT OF AGRICULTURE ANIMAL AND PLANT HEALTH INSPECTION SERVICE
UNITED STATES INTERSTATE AND INTERNATIONAL CERTIFICATE OF HEALTH EXAMINATION ,
FOR SMALL ANIMALS
WARNING: Anyone who makes a false, fictitious, or fraudulent statement on this document, or uses such document knowing it tote false, fictitious, or fraudulent may be subject to a fine of not more than $10,000 or,,.,, imprisonment of not more thaliTem years or both (18 U.S.C.41)013r`'
1. TYPE OF ANIMAL SHIPPED (select one only)
i Dog flcat DOther
2. CERTIFICATE NUMBER - OFFICIAL USE ONLY
Nonhuman Primate Ferret Rodent
TOTAL NUMBER OF ANIMALS
— 1 4. PAGE
1 of 1 5. NAME, ADDRESS, AND TELEPHONE NUMBER OF OWNER (CONSIGNOR)
Lake Hartwell Veterinary Clinic ce
1087 E. Franklin Street Suite K Hartwell, GA 30643
USDA License/or Registration Number (II applicable)
4H1- r.8.-NAME ADDRESS, AND TELEPHONE NUMBER OF RECIPIENT AT DESTINATION (CONSIGNEE) h.0„.
Staceyi5ilverstein 1741 79th Street
Nvl.fkbrk, NY" 10075
7. ANIMAL IDENTIFICATION 8. PERTINENT VACCINATION, TREATMENT, AND TESTING HISTORY
NAME, AND/OR TATTOO NUMBER OR OTHER IDENTIFICATION
' BREED - COMMON
OR SCIENTIFIC NAME
AGE SEX
COLOR OR DISTINCTIVE MARKS OR MICROCHIP
RABIES VACCINATION
i 1 YEAR 2 YEARS 3 YEARS
OTHER VACCINATIONS, TREATMENT, AND/OR TESTS AND RESULTS
Vaccination Date Product Date Product Type and/or Results
(I) India Pit bull - X 3Y F 985112009400055 6/27/2017 Pfizer 6/27/2017 DHPP
(21
9. REMARKS OR ADDITIONAL CERTIFICATION STATEMENTS (WHEN REQUIRED) VETERINARY CERTIFICATION: I certify that the animals described in box 7 have been examined by me this date, that the information provided in box 8 is true and accurate to the best of my knowledge, and that the following findings have been made ("X" applicable statements).
i
I appear animal
i for rabies
I have verified the presence of the microchip, if a microchip is fisted in box 7.
I certify that the animal(s) described above and on continuation sheet(s), if applicable, have been inspected by neon this date and to be free of any infectious or contagious diseases and to the best of my knowledge, exposure thereto, which would endanger the or other animals or would endanger public health.
To my knowledge, the animal(s) described above and on continuation sheet(s) if applicable, originated from an area not quarantined and has/have not been exposed to rabies.
ENDORSEMENT FOR INTERNATIONAL EXPORT (IF NEEDED) NAME, ADDRESS, AND TELEPHONE NUMBER OF ISSUING VETERINARIAN
Jaime Terry 1087 E Franklin Street Suite K HartweIl4GA 30643
NOTE- n emational shipments ma equire certification by an accredited veterinarian.
LICENSE NUMBER AND STATE
7691- GA' PRINTED NAME OF USDA VETERINARIAN
Accredited If yes, please
NATIONAL
010467
i complete
ACCREDITATION
Yes No below
NUMBER
SIGNATURE OF USDA VETERINARIAN Apply USDA Seal or Stamp here DATE SIG RE OF ISSUING V RINARIAN ...
-------
DATE
8/1/2017 APHIS Form 7001 (NOV 2010)
This certificate is valid for 30 dats after issuance
According to the Paperwork Reduction Act of 1995, an agency may not cond uct or sponsor, and a person is not requ information unless it displays a valid OMB control number. The valid OMB contr I numbers f or this information collecti The time required to complete this information collection is estimated to average .25 hours per response, including the searching existing data sources, gathering and Maintaining the data needed, and completing and reviewing the collection
red to respond to, a collection of n are 0579-0036 and 0579-0333.
ti me for reviewing instructions, f information.
No dog, cat, nonhuman primate, or additional inds or classes of animals designated by USDA r egulation sh all be del ivered to a y i ntermediate handler or car rier for transportation in commerce, unless accompa ied by a heal th certificate executed and issued by a licensed veterinarian (7 U.S.C. 21.43,9; CFR, Subchapter A, Part 2).
OMB APPROVED 0579-0036 0579-0333
UNITED STATES DEPARTMENT OF AGRICULTURE ANIMAL AND PLANT HEALTH INSPECTION SERVICE
UNITED STATES INTERSTATE AND INTERNATIONAL
FOR SMALL ANIMALS
WARNING: Anyone who makes a false, fictitious, or fraudulent
this document, statement on or
1. TYPE OF ANIMAL SHIPPED (select one only)
i Dog Cat Other
2. CERTIFICATE NUMBER - OFFICIAL USE ONLY
uses such document knowing it to be false, fictitious, or fraudulent may be subject to a
Nonhuman Primate Ferret C Rodent
CERTIFICATE OF HEALTH EXAMINATION 4. fine of not more than $10,000 or, imprisonment of not more thanl5v years or both (18 U.S.C./IfilliV
....3. TOTAL NUMBER OF ANIMALS ymE 1
PAGE
1 of 1 5. NAME, ADDRESS, AND TELEPHONE NUMBER OF OWNER (CONSIGNOR)
Lake Hartwell Veterinary Clinic 1087 E. Franklin Street e- e- Suite K Hartwell, GA 30643
USDA License/or Registration Number (if applicable)
cit.-NAME' ADDRESS, AND TELEPHONE NUMBER OF RECIPIENT AT DESTINATION (CONSIGNEE) ''.% k la •fl
*l.A; Stiace y,Silverstein clit- -
9th Street .V' A t 121/
Neiaork NY 10075 ....„. ..i. i
7. ANIMAL IDENTIFICATION 8. PERTINENT VACCINATION, TREATMENT, AND TESTING HISTORY
NAME, AND/OR TATTOO NUMBER OR OTHER IDENTIFICATION
BREED — COMMON OR SCIENTIFIC
NAME AGE SEX
COLOR OR DISTINCTIVE MARKS OR
RABIES VACCINATION
1 YEAR 2 YEARS 3 YEARS
OTHER VACCINATIONS, TREATMENT, AND/OR TESTS AND RESULTS
MICROCHIP Vaccination Date Product Date Product Type and/or Results
Sadie Mix llvv F 985112009400049 Not old Enough 7/17/2017 DHPP
7/31/2017 DHPP
(Si
(6)
9. REMARKS OR ADDITIONAL CERTIFICATION STATEMENTS (WHEN REQUIRED) VETERINARY CERTIFICATION: I certify that the animals described in box 7 have been examined by me this date, that the information provided in box 8 is true and accurate to the best of my knowledge, and that the following findings have been made (X" applicable statements).
i
1 app animal
1 for rabies
I have verified the presence of the microchip, if a microchip is listed in box 7.
I certify that the animal(s) described above and on continuation sheet(s), if applicable, have been inspected by me on this date and ar to be free of any infectious or contagious diseases and to the best of my knowledge, exposure thereto, which would endanger the
or other animals or would endanger public health.
To my knowledge, the animal(s) described above and on continuation sheet(s) if applicable, originated from an area not quarantined and has/have not been exposed to rabies.
ENDORSEMENT FOR INTERNATIONAL EXPORT (IF NEEDED) NAME, ADDRESS, AND TELEPHONE NUMBER OF ISSUING VETERINARIAN LICENSE NUMBER AND STATE
7691 GA PRINTED NAME OF USDA VETERINARIAN
Jaime Terry 1087 E Franklin Street Suite K Hartwell, G 0643
NOTE: Into ational shipments may requi certification by an accredited veterinarian.
Accredited If yes, please
NATIONAL
01 0467
i complete
ACCREDITATION
Yes No below
NUMBER
SIGNATURE OF USDA VETERINARIAN Apply USDA Seal or Stamp here DATE SIGNAT E OF ISSUING VETERI RIAN gir
DATE
8/3/2017 .....---
APHIS Form 7001 (NOV 2010)
This certificate is valid for 30 daygfter issuance
ACCOrtfili to the RsPement R soden AM at 1995, on fluency may econeuti of sponsor, ants. p orson is not teemed ta respond ye, s cotlectbn of Information mulcts It dlptays a odd OMB control member. The veld OMB core 1 numbers tor 1115 IdormatIon totkacm are 01379.0036 and 057190333. 'Re time required b compete this Information collodion Is °sanded to ey erne .25 li eon per response. InchatIng tke 0 me for terslontig Indnictia
by Na dog, col, nonhuman puns or 'Math& Mt or chines of imbeab einlgested USDA I nubbin sh all be del Arrive b any 1 revinumbilo londlor es ear Si log InuopeitOlon In commerce, unto/ eau mpleled bye health co elkab ex entod a ed
licensee bieterInerlen17 U,S.C. 21.43.P.CF11, Rubthapter A. Part 2).
01.113 APPROVED 175794935 05794333
teart hIno rottenct Ma coulees, flawing and memlatrilNythe Oala needed, mid comeletrq_ene rerebutb CM collectron of Intone:2ton 1. TYPE OF ANIMAL CHIPPED
Name pr a (signet one only) 2. CERTIFICATE NUMBER • OFFICIAL USE ONLY
UNITED STATES DEPARTMENT OF AdRICULTURE
INAANIVO: Anyone who makes e false, fictilbus, or fraudulent
EN Dog cat Other ANIMAL AND PLANT HEALTH INSPECTION SERVICE
INTERNATIONAL UNITED STATES INTERSTATE AND
otatemeM on this document or uses such document knowing 11 to be GIs°, Iltilibus, or
0 Nonhurran Primate Ferret Rodent
.
CERTIFICATE OF HEALTH EXAMINATION FOR SMALL ANIMALS
fine of not awe than S10 DOD of ., bransonment of not more anal Veers or bath 08 U.S.0, 791311c
fraudulent may be Sateen, a 4. 1. . TOTAL NUMBER OF ANIMALS
nr,v ,, --r- In.\
PAGE
S. NAME, ADDRESS AND TELEPHONE NUMBER OF OWNER (CONSIGNOR) .•44,-
Michelle Williams• we t; 4
4120 Cider Trail I en -...• HaNra, Ga. 31632
n ,.- , ,
229-663-5073 \•t2 .. \ :4-_
. Number if applicable)
tRilNAM13(ADDRESS, AND TELEPHONE NUMBER OF RECIPIENT AT DESTINATION (CONSIGNEE)
thecIde Sullivan _ ifitato
7 eigtreet _a _ontrifti( 10075
..934454;w4 - USDA License/or Registration
7. ANIMAL IDENTIFICATION B. PERTINENT VACCINATION TREATMENT, AND TESTING HISTORY
NAME, AND/OR TATTOO NUMBER OR OTHER IDENTIFICATION
BREED -COMMON OR SCIENTIFIC
NAME AGE SEX
COLOR OR DISTINCTNE MARKS OR
RABIES VACCINATION
IN 1 YEAR 02 YEARS 3 YEARS
. OTHER VACCINATIONS, TREATMENT, AND/OR TESTS AND RESULTS
MICROCHIP Vaccination otot Procttct Date Rocket Type andor Rents
(I) KOMI* Poodle Syr FS Gray 8 white 11/1512016 Pfizer-defamer 1 5058378A-161708 08409/2017 DIstemper/Paivo/Bordetella Oral
(2) 0809(2017 Heartworm Test-Negative
NJ 08/09/2017 - Flotation -Negative •
Hi
(5)
(5)
B. REMARKS OR ADDITIONAL CERTIFICATION STATEMENTS 1 MEN REQUIRED) VETERINARY CERTIFICATION: I certify that the animals described In box? have been examined by me We date, that the informal/on provided in box 8 Is true and accurate to the bast of my knowledge, and DIM the following findings have been Made
rx" applicable statements).
siI
appear animal
Fra4
have verified the presence of the microchip, if a microchip b listed In box 7.
leerily that the animal(s) descrbed above and on Continuation sheet(s). II aPelltaakt. have keen Inspected by me On this dote and to be free of any infeettrus or contagious diseases and to the best of my knowtedge, exposure thereto, with would endanger the or other animals or waled endanger public health,
To my knowledge, the mimet(c) described a • • .• ..• • , eentkotatbn sheet(s) If apple We, ortyneted from an area not quarantined for rattles and has/have not been exposed to rabies.
UMBER AND STATE "IFICIMISEMENT FOR INTERNATIONAL EXPORT (IF NEEDED) NAME, ADDRESS, AND TELEPHONE NUMBERIOF IMMO VETERNARIANI in 0, UCENSE
13A-VET BIAS PRINTED NAME OP USDA VETERINARIAN
' WIN A. VVrIght, D.V.M. 111 E Northakte Dr Valdosta, GA 31602 229-247-2133
NOTE: International shipments may require certificaion
AUG 1 5 Inn LUI /
by an eyelike.] liatergeritre
Accredited II yes, ipleese NATIONAlt
079761
Yes complete
ACCREDITATION
No How
NUMBER
DATE SIGNATURE OF OF USDA VETERINARIAN Apply USDA Seal or swop here OF (WU NO VETERINARIAN I DATE SIGNATURE
....e.--.. de >>------- 08M9/2017
APHIS Form 7001 (NOV 2010) This certificate Is vend for 30 days attar issuance
CERTIFICATE OF OWNER/AGENT The ani this shipment are those certified and listed on this certificate
Owner/Agent (S ature)
Original and Blue copies to be forwarded to State Veterinarian's Office. Retain Pink. Yellow copy to accompany shipment
State Veterinarian's Office Agriculture Building Capitol Square Atlanta, Georgia 30334
GEORGIA DEPARTMENT OF AGRICULTURE CERTIFICATE OF VETERINARY INSPECTION No. CH- 00958
CERTIFICATE VOID 30 DAYS FROM INSPECTION DATE
CONSIGNOR OR SHIPPER CONSIGNEE OR RECEIVER
Toven, 1/2-\eksvic le5a. DATE ANIMALS
317.9,1ti DATeRTIFICITE
INSPECTED
ISSUED
CONSIGNOR'S NAIS PREMISES ID.
A3ci A) 14,;(1sSi-- Lk P) iu0 ak4t- SA- lkikotAnn A r.a 501CA 01/4, b(h \ \( \ ba \ Nel0 \t \;
No. ANIMAL IN SHIPMENT ENTRY PERMIT NUMBER
X Species Species X Purpose of Movement X Area Status Herd or Flock Status
Cattle Ratite Breeding Accredited Free TB Accredited Herd No.
Horses Cervidae Feeding Modified Accredited TB Certified Herd No.
Swine X Dogs Show Free - Brucellosis Validated Herd No.
Goats Cats Slaughter Class A - Brucellosis Qualified Herd No.
Sheep Other Other Class B Brucellosis Monitored Feeder Pig Herd No.
Poultry
Individual ID: Official Eartag, Breed Registration Ear Tattoo or Breed
Registration Firebrand
Description of Animal or Registry Name and Number
A g e
S e x
B r e e d
Bruc. Vac.
Tattoo
Brucellos's Test Date
TB Test IN.
EIA Test Dale
PRV Test Date
Other Test / Immunization Date
Other Test / Immunization Date
V Lab Obs. Results Include Lab & Accession No. Results Results i 12•444tfq Results 72 Hr. Results
i 1 L 4(C- AA) \ A:t k .. sg I Neje th cis ethe bsAar 1
2Z. 47.010 1 , "7
ei 151atitAwia-A. 1 Hu zu_ithr s Y 5 121 in
6
7 2Z-0.1 I 7 sae.. 1 I
8
9 ._
i
10
11 .1
12
13
14
15
CERTIFICATE OF ISSUING VETERINARIAN I certify as an accre ' veterinarian tha the described animals have been inspected by me and that they are not showing signs of infectious contagious and/or communicable d' The vaccination and results of tests are as indicated on the certificate. To the best of my knowledge, the animals listed on this certificate
iii
meet the state . i , on and Federal interstate requirements. No further warranty is made or implied.
oaikov‘ 5A-(-0A- A edited Ve yr ian (Sig
1111 • lat.r 10 A 101 6)6-11 Pr ame i City, State, Zip Ga. License No.
According to the P opened* Reduction Actor 1995, an agency may not cond uct or sponsor, and a person is not requ red to respond to, a collection of information unless it displays a valid OMB control number. The valid OMB control numbers for this information collection are 0579-0035 and 0579-0333. The time required to complete this information collection is estimated to average .25 hours per response, including th ti me for rev ieelng instructions, searching existing data sources, gathenng and maintaining the data needed, and completing and reviewing the collection of information
No dog, cat, nonhuman primate, or additional kinds or classes of animals designated by USDA r egulation sh all be del ivered to any i nteneediate handler or car rier for transportation in commerce, unless accompanied by a health certificate executed and issued by a licensed veterinarian 17 U.S.C. 21.43.9: CFR. Suechapter A, Part 2).
ohm APPROVED 0579-0036 0579-0333
UNITED STATES DEPARTMENT OF AGRICULTURE ANIMAL AND PLANT HEALTH INSPECTION SERVICE
UNITED STATES INTERSTATE AND INTERNATIONAL CERTIFICATE OF HEALTH EXAMINATION
FOR SMALL ANIMALS
WARNING: Anyone who makes a false, fictitious, or fraudulent statement on this document, or uses such document knowing it
to be false, fictitious, or fraudulent may be subject to a fine of not more than $10,000 or, • imprisonment of not more thafiho years or both (18 U SC 1001-)i`
1. TYPE
i
OF ANIMAL SHIPPED (select one only)
Dog Cat Other
2. CERTIFICATE NUMBER - OFFICIAL USE ONLY
Nonhuman Primate Ferret CRodent
-3, TOTAL NUMBER OF ANIMALS
s krpp-kk„,, 1 -LLI47̂-0...4t
4. PAGE
1 of 1
5. NAME, ADDRESS, AND TELEPHONE NUMBER OF OWNER (CONSIGNOR) tTr4
Lake Hartwell Veterinary Clinic 1087 E. Franklin Street Suite K Hartwell, GA 30643
.
USDA License/or Registration Number (if applicable)
.. ,
c6:tNAME;;ADDRES5, AND TELEPHONE NUMBER OF RECIPIENT AT DESTINATION (CONSIGNEE)
. Sttc4,18ilverstein 744,9th Street
eF.t..1fAl ewAl - brk NY 10075
7. ANIMAL IDENTIFICATION 8. PERTINENT VACCINATION, TREATMENT, AND TESTING HISTORY
NAME, AND/OR TATTOO BREED NUMBER OR OTHER IDENTIFICATION
- COMMON
OR SCIENTIFIC NAME
AGE SEX
COLOR OR DISTINCTIVE MARKS OR MICROCHIP
RABIES VACCINATION
1 YEAR 2 YEARS 3 YEARS
OTHER VACCINATIONS, TREATMENT, AND/OR TESTS AND RESULTS
Vaccination Date Product Date Product Type and/or Results
Ezra Terrier-X 10w N 981020021416705 Not Old Enough 8/11/2017 DAP
8/11/2017 Bordetelia 8/27/2017 DAP
9. REMARKS OR ADDITIONAL CERTIFICATION STATEMENTS (WHEN REQUIRED) VETERINARY CERTIFICATION: I certify that the animals described in box 7 have been examined by me this date, that the information provided in box 8 is true and accurate to the best of my knowledge, and that the following findings have been made ("X" applicable statements).
i
i appear animal
i for rabies
I have verified the presence of the microchip, if a microchip is listed in box 7.
I certify that the an imal(s) described above and on continuation sheet(s), if applicable, have been inspected by me on this date and to be free of any infectious or contagious diseases and to the best of my knowledge, exposure thereto, which would endanger the or other animals or would endanger public health.
To my knowledge, the animal(s) described abovik(iti----re(OhThiLiation she grff -applicable, originated from an area not quarantined ..,..,...,. inn “Iirod or th , ,.., . e . ._ and has/have not been exposed to rabies. . Sin.. r„ n I
ENDORSEMENT FOR INTERNATIONAL EXPORT (IF NEEDED) NAME, ADDRESS, AND TELEPHONE NUMBER OF ISSUINTVETERINARIAN I
i Jaime Terry I SEP 1 4 2017 : i 1087 E Franklin Street Suite K
I
L Hartwell, GA 30643
cl-n-,_.) 4,-... nob,: M Cobb, V 1)VM
NOTE Intern i nal shipments may re ire certRi Clf la, ylrebikekleilitednieterinarian.
JLICENSE NUMBER AND STATE
7691 GA PRINTED NAME OF USDA VETERINARIAN
'Accredited If yes, please
NATIONAL
010467
v" complete
ACCREDITATION
Yes U No below
NUMBER
SIGNATURE OF USDA VETERINARIAN Apply USDA Seal or Stamp here DATE SIGN ATU F ISSUING VETE1pSNARIAN
-- DATE
8/30/2017 I
APHIS Form 7001 (NOV 2010)
This certificate is valid for 30 days after issuance
According to the Paperwork Reduction Act of 1995! an agency may not cond uot or sponsor, and a person is not required to respond to, a collection of information unless it displays a valid OMB control number. The valid OMB control numbers for this information collection are 0579-0035 and 0579-0333. The time required to complete this information collection is estimated to average .25 h ours per response, including th ti me for reviewing instructions, searching existing data sources, gathenng and maintaining the data needed, and completing and reviewing the collection of information
No dog, cat, nonhuman or additional kinds or classes of animals designated by primate, OMB APPROVED 0579-0036 0579-0333
USDA r egulation sh all be del ivered to any i ntemiediate handler or car tier for transportation in commerce, unless accompanied by a health certificate executed and issued by a licensed veterinarian (7 U.S.C. 21.43.9; CFR, Subchapter A, Part 2).
UNITED STATES DEPARTMENT OF AGRICULTURE ANIMAL AND PLANT HEALTH INSPECTION SERVICE
UNITED STATES INTERSTATE AND INTERNATIONAL CERTIFICATE OF HEALTH EXAMINATION
FOR SMALL ANIMALS
WARNING: Anyone who makes a false, fictitious, or fraudulent statement on this document, or uses such document knowing it to be false, fictitious, or fraudulent may be subject to a fine of not more than 810 000 or imprisonment of not more thaTt5 years or both (18 U.S.C...RW .
1. TYPE OF ANIMAL SHIPPED (select one only)
1 Dog Cat Other
2. CERTIFICATE NUMBER - OFFICIAL USE ONLY
Nonhuman Primate Ferret Rodent
-3. TOTAL NUMBER OF ANIMALS
_ 49/4?-6,. 1
4. PAGE
1 of 1
5. NAME, ADDRESS AND TELEPHONE NUMBER OF OWNER (CONSIGNOR)
Lake Hartwell Veterinary Clinic 1087 E. Franklin Street Suite K Hartwell, GA 30643
i,
USDA License/or Registration Number (if applicable)
6. NAME ADDRESS, AND TELEPHONE NUMBER OF RECIPIENT AT DESTINATION (CONSIGNEE)
Stakcey,Silverstein
7p: 79th Street —i, l
t 121/ aw:Thrk, NY 10075
_
7. ANIMAL IDENTIFICATION 8. PERTINENT VACCINATION, TREATMENT, AND TESTING HISTORY
NAME, AND/OR TATTOO NUMBER OR OTHER IDENTIFICATION
BREED - COMMON OR SCIENTIFIC
NAME AGE SEX
COLOR OR DISTINCTIVE MARKS OR MICROCHIP
RABIES VACCINATION
1 YEAR 02 YEARS 3 YEARS
OTHER VACCINATIONS, TREATMENT, AND/OR TESTS AND RESULTS
Vaccination Date Product Date Product Type and/or Results
(I) Aria Terrier-X 10w S 981020021467343 Not Old Enough 8/11/2017 DAP
8/11/2017 Bordetella
8/27/2017 DAP
9. REMARKS OR ADDITIONAL CERTIFICATION STATEMENTS (WHEN REQUIRED) VETERINARY CERTIFICATION: I certify that the animals described in box 7 have been examined by me this date, that the information provided in box 8 is true and accurate to the best of my knowledge, and that the following findings have been made ('X" applicable statements).
i
1 appear animal
1 for rabies
I have verified the presence of the microchip, if a microchip is listed in box 7.
I certify that the animal(s) described above and on continuation sheet(s), if applicable, have been inspected by me on this date and to be free of any infectious or contagious diseases and to the best of my knowledge, exposure thereto, which would endanger the or other animals or would endanger public heath.
To my knowledge, the animal(s) described above and on continuation sheet(s) if applicable, originated from an area not quarantined and has/have not been exposed to rabies.
ENDORSEMENT FOR INTERNATIONAL EXPORT (IF NEEDED) NAME, ADDRESS, AND TELEPHONE NUMBER OF, ISSUING
Jaime Terry 1087 E Frankfin Street I
Suite K \ Hartwell, GA 30643
NOTE: Internet shipments may re %e certification by.an
II VETERINARIAN'r cii i,
r —
- 1 SEP 1 4 .2
1., r accredited vefeenarianirwrI r ;010467
"LICENSE NUMBER AND STATE
7691 GA PRINTED NAME OF USDA VETERINARIAN
Aciredlted iifi, es, please
ni complete
Yes No below
NAllONAIJACCREDITATION NUMBEir I
\
SIGNATURE OF USDA VETERINARIAN Apply USDA Seal or Stamp here DATE SIGNATUR 0 ISSUING VETE ARIAN I _____" ?.n.a
..-
DATE '
8/30/2017
APHIS Form 7001 (NOV 2010)
This certificate is valid for 30 days er issuance
According to the Paperwork Reduction Act of 1995. an agency may not cond uct or sponsor, and a person is not requ red to respond to, a collection of information unless it displays a valid OMB control number. The valid OMB control numbers for this information colledi n are 0579-0036 and 05790333. The time required to complete this information collection is estimated to average .25 hours per response, including the ti me for reviewing instructions, searching existing data sources, gathering and maintaining the data needed and completing and reviewing the collection of information
No dog, cat, nonhuman primate, or additional kinds or classes of animals designated by USDA r egulation sh all be del ivered to any i ntermedate handler or car tier for transportation in commerce, unless accompanied by a heal th certificate executed and issued by a licensed veterinarian (7 U.S.C. 21.43.9; CFR, Subchapter A, Part 2).
OMB APPROVED 0579-0036 0579-0333
UNITED STATES DEPARTMENT OF AGRICULTURE ANIMAL AND PLANT HEALTH INSPECTION SERVICE
UNITED STATES INTERSTATE AND INTERNATIONAL CERTIFICATE OF HEALTH EXAMINATION
FOR SMALL ANIMALS
WARNING: Anyone who makes a false, fictitious, or fraudulent statement on this document, or uses such document knowing it to be false, fictitious, or fraudulent may be subject to afine of not more than $10,000 or imprisonment of not more thaNni years or both (18 U.S.C.00 -.it,
1. TYPE OF ANIMAL SHIPPED (select one only)
i Dog Cat Other
2. CERTIFICATE NUMBER -OFFICIAL USE ONLY
Nonhuman Primate Ferret Rodent
3. TOTAL NUMBER OF ANIMALS
1
4. PAGE
1 of 1
5. NAME, ADDRESS, AND TELEPHONE NUMBER OF OWNER (CONSIGNOR)
Lake Hartwell Veterinary Clinic 1087 E. Franklin Street Suite K Hartwell, GA 30643
c.,"
6XNAMB„ADDRESS, AND TELEPHONE NUMBER OF RECIPIENT AT DESTINATION (CONSIGNEE) ,
Stacey,Silverstein ',.:74TE rgth Street
, et— Ne"IT
w-Yor§
k, NY 10075 - :
USDA License/or Registration Number (if applicable) 7. ANIMAL IDENTIFICATION 8. PERTINENT VACCINATION, TREATMENT, AND TESTING HISTORY
NAME, AND/OR TATTOO NUMBER OR OTHER IDENTIFICATION
BREED-COMMON OR SCIENTIFIC
NAME AGE SEX
COLOR OR DISTINCTIVE MARKS OR MICROCHIP
RABIES VACCINATION
1 YEAR 2 YEARS 3 YEARS
OTHER VACCINATIONS, TREATMENT, AND/OR TESTS AND RESULTS
Vaccination Date Product Date Product Type and/or Results
(1) Hannah Terrier-X 10w S 981020021845592 Not Old Enough 8/11/2017 DAP
(21 8/11/2017 Bordetella
8/27/2017 DAP
(51
(6)
9. REMARKS OR ADDITIONAL CERTIFICATION STATEMENTS (MIEN REQUIRED) VETERINARY CERTIFICATION: I certify that the animals described in box 7 have been examined by me this date, that the information provided in box 8 is true and accurate to the best of my knowledge, and that the following findings have been made ('X" applicable statements).
i
i appear animal
ke for rabies
I have verified the presence of the microchip, if a microchip is listed in box 7.
I certify that the animal(s) described above and on continuation sheet(s), if applicable, have been inspected by me on this date and to be free of any infectious or contagious diseases and to the best of my knowledge, exposure thereto, witch would endanger the or other animals or would endanger public health.
To my knowledge, the animal(s) described above and on continuation sheet(s) if applicable, originated from an area not quarantined and has/have not been exposed to rabies
ENDORSEMENT FOR INTERNATIONAL EXPORT (IF NEEDED) NAME, ADDRESS, AND TELEPHONE NUMBER OF ISSUINGVETERINARIAN e I
LICENSE NUMBER AND STATE 1 PRINTED NAME OF USDA VETERINARIAN
I Jaime Terry
i 1 1087 E Franklin Street SEP 1 4 2017
Suite K I Hartwell, GA 30643 i
I 1
769(1 GA 1 i I.
Accredited i If yes, iilease complete
Yes No below
NATIONAL ACCREDITATION NUMBER I I
010467ah:— I NOTE: Int atonal shipments may re e certification by an accrldited,Veterinari
SIGNATURE OF USDA VETERINARIAN Apply USDA Seal or Stamp here DATE SIGNAT E OF ISSUING VETE <•,,,. vrta,inarim) I DATE
8/30/2017 e-
This certificate is valid for 30 d /after issuance APHIS Form 7001 (NOV 2010)
According lot he Pope/work Reduction Act of 1995, an agency may not coed In or sponsor and a person is not required to respond to, a collection of information unless it displays a valid OMB cacao( number. The wake OMB control numbers for this Information collection are 0579-0336 and 0579-0333 The time repined to complete this information ad !action Is estimated to average .25 hours per response, Inckeding the time for revievAng instructions, searching Sating data sources, gathering and maintaining the data needed, and completing and reviewha the collection of information.
No dog, cat, nenhuman primate, or additional kinds or classes of animals designated by USDA r adulation sh at be del Nered to a y I ntermedate handler or car der for transportation in corn merce, unless accompa IS by a health cenificate executed and issued by a kensed veterinarian (7 U.S.C. 21.43.9; CFR, Subchapter A, Part 2).
OMB APPROVED 0579-0030 057n.Als3
UNITED STATES DEPARTMENT OF AGRICULTURE ANIMAL AND PLANT HEALTH INSPECTION SERVICE
UNITED STATES INTERSTATE AND INTERNATIONAL CERTIFICATE OF HEALTH EXAMINATION
FOR SMALL ANIMALS
WARNING: Anyone who makes a false, fictitious, or fraudulent slatemeM on this document, or uses such document knovAng It to be false, fictitious. or fraudulent may be subject to a fine of not more than 510 000 or bnpnsonment of not more thariSto years or both (la u.s.c...thenx
i
1. TYPE OF ANIMAL SHIPPED (select one only)
Dog El Cat Cother
2. CERTIFICATE NUMBER -OFFICIAL USE ONLY
Nonhuman Primate Ferret Rodent
-.3. TOTAL NUMBER OF ANIMALS
"Kra, 1 4. PAGE
1 of 1
5. NAME, ADDRESS, AND TELEPHONE NUMBER OF OWNER (CONSIGNOR) re.C3r na
Lake Hartwell Veterinary Clinic se'
. d 1087 E. Franklin Street t—r Suite K t'oK
Q Hartwell, GA 30643
USDA License/or Registration Number (if applicable)
trczNAME;,ADDRESS, AND TELEPHONE NUMBER OF RECIPIENT AT DESTINATION (CONSIGNEE)
Statey,Si ,ys, A iti lyerstein it 74,E ( t- ..- '?
i it7491h Street
1 c.„SlayeAtork, NY 10075
7. ANIMAL IDENTIFICATION 8 PERTINENT VACCINATION, TREATMENT, AND TESTING HISTORY
NAME, AND/OR TATTOO NUMBER OR OTHER IDENTIFICATION
BREED — COMMON OR SCIENTIFIC
NAME AGE SEX
COLOR OR DISTINCTIVE MARKS OR MICROCHIP
RABIES VACCINATION
1 YEAR 2 YEARS 3 YEARS
OTHER VACCINATIONS, TREATMENT, AND/OR TESTS AND RESULTS
Vaccination Date Product Date Product Type and/or Results
(I) Emily Terrier-X 10w S 981020021831819 Not Old Enough 8/11/2017 DAP
8/11/2017 Bordetella
8/27/2017 DAP
9. REMARKS OR ADDITIONAL CERTIFICATION STATEMENTS (WHEN REQUIRED) VETERINARY CERTIFICATION: I certify that the animals described in box 7 have been examined by me this date, that the information provided in box 8 is true and accurate to the best of my knowledge, and that the following findings have been made ("X" applicable statements).
,H appear animal
i for rabies
I have verified the presence of the microchip. if a microchip is listed in box 7.
I certify that the animal(s) desaibed above and on continuation sheet(s), it applicable, have been inspected by moon this date and lo be free of any infectious or contagious diseases and to the best of my knowledge, exposure (hereto. which %mid endanger the or other animals or would endanger public health.
To my knovAedge, the animal(s) described above and on continuation sheet(s) if applicable. originated from an area not quarantined and has/have not been exposed to rabfes t
ENDORSEMENT FOR INTERNATIONAL EXPORT (IF NEEDED) NAME, ADDRESS, AND TELEPHONE NUMBER OKISSUINGVETERINARIAN s 41.I. eil On i f...
EICENSE NUMBER AND STATE
GA I
At
691 credited / PRINTED NAME OF USDA VETERINARIAN
Jaime Terry 1087 E Franklin Street Suite K Hartwell, GA 30643
NOTE: Inte Ilona! shipments may reilre certification
1
SEP 1 4 2017
byklarcreddifletaliiirrian. 610467
If yes, please complete Yes u No
below
NATIONAL ACCREDITATION NUMBER
SIGNATURE OF USDA VETERINARIAN Apply USDA Seal or Stamp here DATE SIGNA OF ISSUING VETE IAN DATE
8/30/2017 _ n APHIS Form 7001 (NOV 2010)
This certificate is valid for 30 da after issuance
According to the Paperwork Reduction Act of 1995, an agency may not cond uct or sponsor, and a person is not regu red to respond to, a collection of information unless it displays a valid OMB control number. The valid OMB conk I numbers for this information collect' n are 0579-0036 and 0579-0333. The time required to complete this inforrnation collection is estimated to average .25 h ours per response, including th ti me for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information
No dog, cat, nonhuman primate, or additional inds or classes of animals designated by USDA r egulation sh all be del ivered to a y i ntermedate handler or car der for transportation in commerce, unless accompanied by a health certificate executed and issued bye licensed veterinarian (7 U.S.C. 21,43.9; CFR, Subchapter A, Part 2).
OMB APPROVED 0579-0036 0579-0333
UNITED STATES DEPARTMENT OF AGRICULTURE ANIMAL AND PLANT HEALTH INSPECTION SERVICE
UNITED STATES INTERSTATE AND INTERNATIONAL CERTIFICATE OF HEALTH EXAMINATION
FOR SMALL ANIMALS
WARNING: Anyone who makes a false, fictitious, or fraudulent statement on this document, or uses such document knowing it to be false, fictitious, or fraudulent may be subject to a fine of not more than $10,000 er-s -It imprisonment of not more than. years or both (18 U.S.CiaborP _
1. TYPE OF
iii Dog MI ANIMAL SHIPPED (select one only)
Cat Cother
2. CERTIFICATE NUMBER - OFFICIAL USE ONLY
Nonhuman Primate Ferret Rodent
3 TOTAL NUMBER OF ANIMALS 7-.-..— - at .._L...-"Pti 1
4. PAGE
1 of 1
5. NAME, ADDRESS, AND TELEPHONE NUMBER OF OWNER (CONSIGNOR)
Lake Hartwell Veterinary Clinic 1087 E. Franklin Street '
Suite K Hartwell, GA 30643
USDA License/or Registration Number (if applicable)
SNAME' ADDRESS, AND TELEPHONE NUMBER OF RECIPIENT AT DESTINATION (CONSIGNEE) htS0A,
' Staceyiailverstein -74-7:61 Street
r Dt 121i Nev7:York, NY 10075 -..-- - .
7. ANIMAL IDENTIFICATION 8. PERTINENT VACCINATION, TREATMENT, AND TESTING HISTORY
NAME, AND/OR TATTOO NUMBER OR OTHER IDENTIFICATION
BREED - COMMON OR SCIENTIFIC
NAME AGE SEX
COLOR OR DISTINCTIVE MARKS OR MICROCHIP
RABIES VACCINATION
illl 1 YEAR 2 YEARS 3 YEARS
OTHER VACCINATIONS, TREATMENT, AND/OR TESTS AND RESULTS
Vaccination Date Product Date Product Type and/or Results
Spencer Terrier-X 10w S 981020021447952 Not Old Enough 8/11/2017 DAP
8/11/2017 Bord etell a (31
8/27/2017 DAP -(4)
9. REMARKS OR ADDITIONAL CERTIFICATION STATEMENTS (WHEN REQUIRED) VETERINARY CERTIFICATION: I certify that the animals described in box 7 have been examined by me this date, that the information provided in box 8 is true and accurate to the best of my knowledge, and that the following findings have been made ("X" applicable statements).
/ _....- 1
appear animal
1 for rabies
I have verified the presence of the microchip, if a Tie/Mail, is listed in box 7. .
I certify that the animal(s) described above and on continuation sheet(s), it applicable, have been inspected by me on this date and to be free of any infectious or contagious diseases and to the best of my knowledge, exposure thereto, which would endanger the or other animals or would endanger public health.
and has/have not been exposed to rabies. ENDORSEMENT FOR INTERNATIONAL EXPORT (IF NEEDED)
slit To My knowledge, the animal(s) described above and on continuationreipip,ej, s, ?re, anpilicable, originated from an area not quarantined
NAME, ADDRESS, AND TELEPHONE NUMBER OF ISSUINGWE' RINARIAM this
rert,(1 ,
.-tr C. Gee' '14
Jaime Terry 1087 E Franklin Street Suite K SEP 1 4 201/ Hartwell, GA 30643
NOTE' Inte ional shipments ma equire certification by a editeaveterinarian
-LICF.NSE NUMBER AND STATE I
7691 pA PRINTED NAME OF USDA VETERINARIAN
7 I I
Accredited I i If yes, please
, v complete
Yes LJ No below
NATIONAL ACCREDITATION NUMBER
01!P41,67 SIGNATURE OF USDA VETERINARIAN Apply USDA Seal or Stamp here DATE SIG "T F ISSUING VE RINARIAN I ''''''' r- 1 D-,--
R0b1•1 i C 17) OVM
O.-
DATE
8/30/2017
APHIS Form 7001 (NOV 2010)
This certificate is valid for 30 s after issuance
According to the Pape k Reduction Act of 1995, an agency may not cond uct or sponsor, and a person is not required to respond to, a collection of Information unless it displays a valid OMB control number. The valid OMB control numbers for this information collection are 0579-0036 and 0579-0333. The time required to complete this information collection is estimated to average .25 h ours per response, including the ti me for reviewing instructions, Searching existing data sources gathering and maintaining the data needed. and completing and reviewing the collection of information
No dog, cat, nonhuman primate, or additional inds or classes of animals designated by USDA r egulation sh all be del ivered to any i ntermediate handler or car ner for transportation in commerce, unless acco mpa ied by a heal th certificate executed and issued by a licensed veterinarian (7 U.S.C. 21.43.9; CFR, Subchapter A, Part 2).
OMB APPROVED 0579-0036 0579-0333
UNITED STATES DEPARTMENT OF AGRICULTURE ANIMAL AND PLANT HEALTH INSPECTION SERVICE
UNITED STATES INTERSTATE AND INTERNATIONAL
FOR SMALL ANIMALS CERTIFICATE OF HEALTH EXAMINATION 4.
WARNING: Anyone who makes a false, fictitious, or fraudulent statement on this document, or uses such document knowing it to be false; fictitious, or fraudulent may be subject to a fine of not more than 810 000 or imprisonment of not more than 01111Ed75y,%, years or both (18 U.S.C.-1/19W
1. TYPE OF ANIMAL SHIPPED (select one only)
i Dog Cat Other
2. CERTIFICATE NUMBER - OFFICIAL USE ONLY
Nonhuman Primate Ferret CRodent
-3. TOTAL NUMBER OF ANIMALS
— 1 •-11 .0-1‘)/ 1
PAGE
1 of 1
5. NAME, ADDRESS, AND TELEPHONE NUMBER OF OWNER (CONSIGNOR)
Lake Hartwell Veterinary Clinic 1087 E. Franklin Street Suite K Hartwell, GA 30643
USDA License/or Registration Number (if applicable)
6xNAME,,,ADDRESS, AND TELEPHONE NUMBER OF RECIPIENT AT DESTINATION (CONSIGNEE)
Icel.-A Sta e y,Silverstein 74tnErOth Street ,4.pt 12, NeYow-rk NY 10075
'
7. ANIMAL IDENTIFICATION 8. PERTINENT VACCINATION, TREATMENT, AND TESTING HISTORY
NAME, AND/OR TATTOO NUMBER OR OTHER IDENTIFICATION
BREED - COMMON OR SCIENTIFIC
NAME AGE SEX
COLOR OR DISTINCTIVE MARKS OR MICROCHIP
RABIES VACCINATION
I.1 YEAR 2 YEARS 3 YEARS
OTHER VACCINATIONS, TREATMENT, AND/OR TESTS AND RESULTS
Vaccination Date Product Date Product Type and/or Results
Farrah Mix 7w F 981020021494095 Not Old Enough 8/6/2017 DHPP
8/6/2017 Bordetella
8/24/2017 DHPP
9. REMARKS OR ADDITIONAL CERTIFICATION STATEMENTS (WHEN REQUIRED) VETERINARY CERTIFICATION: I certify that the animals described in box 7 have been examined by me this date, that the information provided in box 8 is true and accurate to the best of my knowledge, and that the following findings have been made ("X" applicable statements).
1
V appear animator
i for rabies
I have verified the presence of the microchip, if a microchip is listed in box 7.
I certify that the animal(s) described above and on continuation sheet(s), if applicable, have been inspected by me on this date and to be free of any infectious or contagious diseases and to the best of my knowledge, exposure thereto, which would endanger the
other animals or would endanger public health.
To my knowledge, the animal(s) described above and on continuation sheet(s) if applicable, originated from an area not quarantined and hasthave not been exposed to rabies.
ENDORSEMENT FOR INTERNATIONAL EXPORT (IF NEEDED) NAME, ADDRESS, AND TELEPHONE-NUMBEITOFASSUINGVETERINARIAN fiehico• i' "r" • e ' ilie St. I ki utt vir, _
LICENSE NUMBER AND STATE
7691 GA PRINTED NAME OF USDA VETERINARIAN
Jaime Terry 1087 E Franklin Street i Suite K SEP 1 9 2017 Hartwell, GA 30643 I 1
I • 1
NOTE: Inte tional shipments may quire Lertificationty-an-accrezirtedyetednatian
Accredited If yes, please
i complete
Yes No below
NATIONAL ACCREDITATION NUMBER
010467
SIGNATURE OF USDA VETERINARIAN Apply USDA Seal or Stamp here DATE SIGNAT OF ISSUING VET RINARIAN P=-e•••••' ''' • i-1-- Rohr.' ki coif), . ovm I I VOrlthaft'11 s•--
DATE
8/31/2017 .."---7
API-US Form 7001 (NOV 2010)
This certificate is vahd for 30 dayt after issuance
According to t he Paperwork Reduction Act of 1995, an agency may not cond uct or sponsor, and a person is not requ red to respond to, a collection of information unless it displays a valid OMB control number. The valid OMB control numbers for this information collection are 0579-0036 and 0579-0333. The time required to complete this information collection is estimated to average .25 h ours per response, including th lime for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completingand reviewing the collection of information
No dog, cat, nonhuman primate, or additional inds or classes of animals designated by USDA r egulation sh all be del ivered to a y i ntermediate handler or car net for transportation in commerce, unless accompa ied by a health certificate executed and issued by a licensed veterinarian (7 U.S.C. 21.43.9; CFR Subchapter A, Part 2).
mud APPROVED 0579-0036 0579-0333
UNITED STATES DEPARTMENT OF AGRICULTURE ANIMAL AND PLANT HEALTH INSPECTION SERVICE
UNITED STATES INTERSTATE AND INTERNATIONAL CERTIFICATE OF HEALTH EXAMINATION
FOR SMALL ANIMALS
WARNING: Anyone who makes a false, fictitious, or fraudulent statement on this document. or uses such document knowing it to be false, fictitious, or fraudulent may he subject to a
o . fine of not more than $10 000 r imprisonment of not more than:hi years or both (1B '"
1. TYPE OF ANIMAL SHIPPED (select one only)
.4 Dog Cat COther
2. CERTIFICATE NUMBER - OFFICIAL USE ONLY
Nonhuman Primate Ferret Rodent
_1 TOTAL NUMBER OF ANIMALS ism
1
4. PAGE
1 of 1 5. NAME, ADDRESS, AND TELEPHONE NUMBER OF OWNER (CONSIGNOR)
Lake Hartwell Veterinary Clinic 1087 E. Franklin Street Suite K Ha GA 30643
USDA License/or Registration Number (if applicable)
NY 10075rtwell,
ts
.
“
,
NAME,',A,f3DRESS, AND TELEPHONE NUMBER OF RECIPIENT AT DESTINATION (CONSIGNEE) l'i,,i/
4 Stkcex.Silverstein v .74,E 7981 Street
vlitYy ,- riiY,tirk,
7. ANIMAL IDENTIFICATION 8. PERTINENT VACCINATION, TREATMENT, AND TESTING HISTORY
NAME, AND/OR TATTOO NUMBER OR OTHER IDENTIFICATION
BREED - COMMON OR SCIENTIFIC
NAME AGE SEX
COLOR OR DISTINCTIVE MARKS OR MICROCHIP
RABIES VACCINATION
,t 1 YEAR 2 YEARS 3 YEARS
OTHER VACCINATIONS, TREATMENT, AND/OR TESTS AND RESULTS
Vaccination Date Product Date Product Type and/or Results
Panther Boston Terrier-X 12m N 981020021455462 8/14/2017 Merial Ser# 22073 7/27/2017 DHPP 8/10/2017 Bordetella 8/14/2017 DHLP
9. REMARKS OR ADDITIONAL CERTIFICATION STATEMENTS (WHEN REQUIRED) VETERINARY CERTIFICATION: I certify that the animals described in box 7 have been examined by me this date, that the information provided in box 8 is true and accurate to the best of my knowledge, and that the following findings have been made EX" applicable statements).
Ei„(
appear animal
I have verified the presence of the microchip, if a microchip is listed in box 7.
I certify that the animal(s) described above and on continuation sheet(s), if applicabl have been inspected by me on this date and to be free of any infectious or contagious diseases and to the best of my knowledge exposure thereto, which would endanger the or other animals or would endanger public health.
1 To my knowledge, the animal(s) described above and on continuation sheet(s) if app table, originated from an area not quarantined for rabies and has/have not been exposed:to rabies. centr"2.4- '•:' f "1fiffirf ", fit I
ENDORSEMENT FOR INTERNATIONAL EXPORT (IF NEEDED) NAME, ADDRESS, AND TELEPHONE NUMBER-OF1SSUING VETERINARIAN-1
1
Jaime Terry I SEP 19 2017 1087 E Franklin Street 1 Suite K l I Hartwell GA 30643 i
LICENSE NUMBER AND STATE I 7691 GA PRINTED NAME OF USDA VETERINARIAN
4ccredited If yes, please ...L.
V complete
Yes U No below
NATIONAL ACCREDITATION NUMBER
4
0,- 1fci--',t \t 010467
NOT emational shipments y requiretertkicationtyari1abcreditedweterinarian. SIGNATURE OF USDA VETERINARIAN Apply USDA Seal or Stamp here DATE SIG URE OF ISSUING V RINARIAN
--------
DATE
8/31/2017
APHIS Form 7001 (NOV 2010)
This certificate is valid for 30 d#js after issuance
According to the Paperwork Reduction Act of 1995, an agency may not cond uct or sponsor, and a person is not requ information unless it displays a valid OMB control number. The valid OMB control numbers for this information colledi The time required to complete this information collection is estimated to average .25 h ours per response, including the Searching existing data sources, gathering and maintaining the data needed and completing and reviewing the collection
red to respond to, a collection of n are 0579.0036 and 0579-0333.
ti me for reviewing instructions, f information
No dog, cat, nonhuman primate, or additional inds or classes of animals designated by USDA r egulation sh all be del ivered to a y i ntermediate handler or car Fier for transportation in commerce, unless accompanied by a heal th certificate executed and issued by a licensed veterinarian 17 U.S.C. 21.43.9; CFR, Subchapter A, Part 2).
OMB APPROVED 0579-0036 0579-0333
UNITED STATES DEPARTMENT OF AGRICULTURE ANIMAL AND PLANT HEALTH INSPECTION SERVICE
UNITED STATES INTERSTATE AND INTERNATIONAL CERTIFICATE OF HEALTH EXAMINATION
FOR SMALL ANIMALS
WARNING: Anyone who makes a false, fictitious, or fraudulent statement on this or
1. TYPE OF ANIMAL SHIPPED (select one only)
if Dog flCat COther
2. CERTIFICATE NUMBER - OFFICIAL USE ONLY
document, uses such document knowing it to be false, fictitious, or fraudulent be
Nonhuman Pdmate Ferret Rodent
may subject to a fine of not more than $10,000 or, — imprisonment of not more inafistio years or both (16 U S C -1001)X
3. TOTAL NUMBER OF ANIMALS
1 4. PAGE
1 of 1 5. NAME, ADDRESS, AND TELEPHONE NUMBER OF OWNER (CONSIGNOR) 6XNANIE4,'
Lake Hartwell Veterinary Clinic 1087 E. Franklin Street Suite K
Hartwell, GA 30643
USDA License/or Registration Number (if applicable)
ork, NY 10075
ADDRESS, AND TELEPHONE NUMBER OF RECIPIENT AT DESTINATION (CONSIGNEE)
V`. , K (a3 \r,
Stacey,Silverstein i 74,E 79th Street
ewff .
T. ANIMAL IDENTIFICATION 8. PERTINENT VACCINATION, TREATMENT, AND TESTING HISTORY
NAME, AND/OR TATTOO NUMBER OR OTHER IDENTIFICATION
BREED — COMMON OR SCIENTIFIC
NAME AGE SEX
COLOR OR DISTINCTIVE MARKS OR
RABIES VACCINATION
1 YEAR 2 YEARS III 3 YEARS
OTHER VACCINATIONS, TREATMENT, AND/OR TESTS AND RESULTS
MICROCHIP Vacdnation Date Product Date Product Type and/or Results
Bernadette Mix 7w F 981020021405865 Not Old Enough 8/6/2017 DHPP
8/6/2017 Bordetella
8/24/2017 DHPP
9. REMARKS OR ADDITIONAL CERTIFICATION STATEMENTS (WHEN REQUIRED) VETERINARY CERTIFICATION: I certify that the animals described in box 7 have been examined by me this date, that the information provided in box 8 is true and accurate to the best of my knowledge, and that the following findings have been made ('X" applicable statements).
if ,i( Ei appear animator
I have verified the presence of the microchip, a microchip is listed in box 7.
I certify that the animal(s) described above and on continuation sheet(s), if applicable, have been inspected by me on this date and to be free of any infectious or contagious diseases and to the best of my knowledge, exposure thereto, which would endanger the
other animals or would endanger public health.
i To my knowledge, the animal(s) described aboge4fifitgritirrafitiel4heet(s) if applicable. for rabies and has/have not been exposed to rabies. '- 'il,.". at rie,.. :ix
originated from an area not quarantined
ENDORSEMENT FOR INTERNATIONAL EXPORT (IF NEEDED) NAME, ADDRESS, AND TELEPHONE NUMBER OF ISSUING VETERINARIAN' LICENSE NUMBER AND STATE
7691 GA PRINTED NAME OF USDA VETERINARIAN
Jaime Terry 1087 E Franklin Street Suite K
SEF 19 2017 Accredited If yes, please
NATIONAL
i complete
ACCREDITATION
Yes Li No below
NUMBER Hartwell, GA 30643 reva )"---
nvm 1 010467
NOTE: mational shipment may require certification-thi&iiddieditea Wterinarian. SIGNATURE OF USDA VETERINARIAN Apply USDA Seal or Stamp here DATE SIG RE OF ISSUING ETERINARIAN
e-
....-----
DATE
8/31/2017
APHIS Form 7001 (NOV 2010)
This certificate is valid for 3GAavs after issuance
According to the Paperwork Reduction Act of 1995, an agency may not Gond uct or sponsor, and a person is not requ red to respond to, a collection of information unless it displays a valid OMB control number. The valid OMB control numbers for this information colledi n are 0579-0036 and 0579-0333. The time required to complete this information collection is estimated to average .25 hours per response, including the ti me for reviewing instructions, searching existing data sources, gathering and maintaining the data needed and completing and reviewing the collection of information
No dog, cat, nonhuman primate, or additional Inds or classes of animals designated by USDA r egulation sh all be del ivered to any i ntermediate handler or car rier for transportation in commerce, unless acre mpa ied by a health certificate executed and iSSUed by a licensed veterinarian (7 U.S.C. 21.43.9' CFR, Subchapter A, Part 2).
OMB APPROVED 0579-0036 0579-0333
UNITED STATES DEPARTMENT OF AGRICULTURE ANIMAL AND PLANT HEALTH INSPECTION SERVICE
UNITED STATES INTERSTATE AND INTERNATIONAL CERTIFICATE OF HEALTH EXAMINATION
FOR SMALL ANIMALS
WARNING: Anyone who makes a false, tictdious, or fraudulent statement on this document, or uses such document knowing it to be false, fictitious, or fraudulent may be subject to afine of not more than $10,000 or, imprisonment of not more thanLV years or both (18 U.S.C..1601LN .,
1. TYPE OF ANIMAL SHIPPED (select one only)
1 Dag fl Cat COther
2. CERTIFICATE NUMBER - OFFICIAL USE ONLY
Nonhuman Primate Ferret Rodent
_3. TOTAL NUMBER OF ANIMALS
"nlp,.‘,. 1 )' '
4. PAGE
1 of 1 5. NAME, ADDRESS, AND TELEPHONE NUMBER OF OWNER (CONSIGNOR) Firr
"re ,— k Lake Hartwell Veterinary Clinic cti 1087 E. Franklin Street Suite K
ic, r
Hartwell, GA 30643
USDA License/or Registration Number (if applicable)
c6tNAME'$DDRES5, AND TELEPHONE NUMBER OF RECIPIENT AT DESTINATION (CONSIGNEE) ioVi
Stac i eyislyerstein NE 79th Street
—,:i - Apt 12i i hmeA, irk NY 10075
.
7. ANIMAL IDENTIFICATION 8. PERTINENT VACCINATION, TREATMENT, AND TESTING HISTORY
NAME. AND/OR TATTOO NUMBER OR OTHER IDENTIFICATION
BREED —COMMON OR SCIENTIFIC
NAME AGE SEX
COLOR OR DISTINCTIVE MARKS OR MICROCHIP
RABIES VACCINATION
1 YEAR 2 YEARS 3 YEARS
OTHER VACCINATIONS, TREATMENT, AND/OR TESTS AND RESULTS
Vaccination Date Product Date Product Type and/or Results
(I ) Sheldon Mix 7w M 981020021838886 Not Old Enough 8/6/2017 DHPP (21 8/6/2017 Bordetella (3) 8/24/2017 DHPP (9)
9. REMARKS OR ADDITIONAL CERTIFICATION STATEMENTS (WHEN REQUIRED) VETERINARY CERTIFICATION: I certify that the animals described in box 7 have been examined by me this date, that the information provided in box 8 is true and accurate to the best of my knowledge, and that the following findings have been made ('X" applicable statements).
i
V appear animal
I have verified the presence of the microchip, if a microchip is listed in box 7.
I certify that the animal(s) described above and on continuation sheefis), if applicable, have been inspected by me on this date and to be free of any infectious or contagious diseases and to the best of my knowledge, exposure thereto, which would endanger the or other animals or would endanger public health.
1 To my knowledge, the animal(s).describedhbove-an,g,gn continuation sheet(s) if applicable, originated from an area not quarantined for rabies and has/have not been exposed to rabies. do.. i,- i' aL,,. , t .ci ..' the I
ENDORSEMENT FOR INTERNATIONAL EXPORT (IF NEEDED)
1 I
Jaime Terry SEP 1087 E Franklin Street Suite K Hartwell, GA 30643
I i
NOTE: I mational shipment ay require
NAME, ADDRESS, AND TELEPHONE.NUMBER-OETSSUINGVETERINARIAN
1 9 2017
rA. L .-Pc) fid--
certification thLanaccregitedyeterinarian
UCENSE NUMBER AND STATE
7691 GA PRINTED NAME OF USDA VETERINARIAN
Accredited If yes, please
If complete
Yes No below
NATIONAL ACCREDITATION NUMBEV
0104 67 SIGNATURE OF USDA VETERINARIAN Apply USDA Seal or Stamp here DATE SIGN RE OF ISSUING ETERINARIAN
_,...
--------
DATE
8/31/2017
APHIS Form 7001 (NOV 2010)
This certificate is Valid for 30 das after issuance
According to the Pape Reduction Act of 1995! an agency may not conduct information unless it displays a valid OMB control number. The valid OMB control The time required to complete this information collection is estimated to average searching existing data sources, gathering and maintaining the data needed, and
or sponsor and a person is not required to respond to, a collection of numbers for this information collection are 05790036 and 0579-0333. .25 h ours per response including th lime for reviewing instructions,
ompleting and reviewing the collection of information
No dog, cat, nonhuman primate, or additional inds or classes of animals designated by USDA r egulation sh all be del ivered to a y i ntermediate handler or car ner for transportation in commerce, unless accompa 'ad by a heal th certificate executed and issued by a licensed veterinarian (7 U.S.C. 21.43.9; CFR, Subchapter A, Part 2).
OMB APPROVED 0579-0036 0579-0333
UNITED STATES DEPARTMENT OF AGRICULTURE ANIMAL AND PLANT HEALTH INSPECTION SERVICE
UNITED STATES INTERSTATE AND INTERNATIONAL CERTIFICATE OF HEALTH EXAMINATION
FOR SMALL ANIMALS
WARNING: Anyone who makes a false, fictitious, or fraudulent statement on this document, or uses such document knowing it to be false, fictitious, or fraudulent may be subject to a fine of not more than $10,000 or imprisonment of not more thaffhl years or both (18 U.S.C.ADDThi
1. TYPE OF ANIMAL SHIPPED (select one only)
i Dog Cat Other
2. CERTIFICATE NUMBER - OFFICIAL USE ONLY
Nonhuman Pdmale Ferret CRodent
_3. TOTAL NUMBER OF ANIMALS
:ifipA& 1
4. PAGE
1 of 1 5. NAME, ADDRESS AND TELEPHONE NUMBER OF OWNER (CONSIGNOR)
Lake Hartwell Veterinary Clinic t 1087 E. Franklin Street •
Suite K Hartwell, GA 30643 V, ,
USDA License/or Registration Number (if applicable)
67NAMEhADDRESS, AND TELEPHONE NUMBER OF RECIPIENT AT DESTINATION (CONSIGNEE)
et .1' <;01‘11
-ei, ,
- StabeySilverstein —, ..- a '74'E 79th Street
if4t Apt 1"7.1 .2,
Ner.a.drk, NY 10075 .-
._. _ --
7. ANIMAL IDENTIFICATION 8. PERTINENT VACCINATION, TREATMENT, AND TESTING HISTORY
NAME, AND/OR TATTOO NUMBER OR OTHER IDENTIFICATION
BREED - COMMON OR SCIENTIFIC
NAME AGE SEX
COLOR OR DISTINCTIVE MARKS OR MICROCHIP
RABIES VACCINATION
1 YEAR 2 YEARS 3 YEARS
OTHER VACCINATIONS, TREATMENT, AND/OR TESTS AND RESULTS
Vaccination Date Product Date Product Type and/or Results
Penny Mix 7w F 981020021466328 Not Old Enough 8/6/2017 DHPP
8/6/2017 Bordetella P)
8/24/2017 DH PP
9. REMARKS OR ADDITIONAL CERTIFICATION STATEMENTS (WHEN REQUIRED) VETERINARY CERTIFICATION: I certify that the animals described in box 7 have been examined by me this date, that the information provided in box 8 is true and accurate to the best of my knowledge, and that the following findings have been made ("X" applicable statements).
i
i appear animal
I have verified the presence of the microchip, if a microchip is listed in box 7.
I certify that the animal(s) described above and on continuation sheet(s), if applicable, have been inspected by me on this date and to be free of any infectious or contagious diseases and to the best of my knowledge, exposure thereto, which would endanger the or other animals or would endanger public heafth.
..._ 1 1 To my knowledge, the animal(s) described above and on continuatiorfaillet(tjlifapplicable, originated from an area not quarantined
for rabies and has/have not been exposed to rabies. ________ I-__
ENDORSEMENT FOR INTERNATIONAL EXPORT (IF NEEDED) NAME, ADDRESS, AND TELEPHONE NUMBER ,
Jaime Terry 1087 E Franklin Street Suite K
I
OF ISSUING VETERINARIAN
SL I-' 1 9 2017
dICENSE NUMBER AND STATE I I 7691 GA i I
PRINTED NAME OF USDA VETERINARIAN
A 6reldited .4 If jf esIplease complete
Yes U No below
Hartwell, GA 30643 rs...(„<z-A- E('.4-clift'--
----"La"--
NATIONAL ACCREDITATION NUMBER i
-010467 • NOTE Int ational shipments may equire certification by an accredited veterinadan.
SIGNATURE OF USDA VETERINARIAN Apply USDA Seal or Stamp here DATE SIGNA E OF ISSUING VE RINARIAN
c- DATE
8/31/2017
orm 7001 (NOV 2010)
This certificate is valid for 30 d s after issuance
According to the Paperwork Reduction Act of 1995. an agency may not cond ud or sponsor, and a person is not required to respond to, a collection of information unless it displays a valid OMB control number. The valid OMB contr I numbers for this information collectio are 0579-0036 and 0579-0333. The time required to complete this information collection is estimated to average .25 h ours per response, including th ti me for reviewing instructions, searching existing data sources, gathering and maintaining the data needed and completing and reviewing the collection of information
No dog, cat, nonhuman primate, or additional inds or classes of animals designated by USDA r egulation sh all be del ivered to a y i ntermechate handler or car ner for transportation in commerce, unless accompa led by a heal th certificate executed and issued by a licensed veterinarian 17 U.S.C. 21.43.9; CFR Subchapter A, Part 2).
OMB APPROVED 0579-0036 0579-0333
UNITED STATES DEPARTMENT OF AGRICULTURE ANIMAL AND PLANT HEALTH INSPECTION SERVICE
UNITED STATES INTERSTATE AND INTERNATIONAL CERTIFICATE OF HEALTH EXAMINATION
FOR SMALL ANIMALS
WARNING: Anyone who makes a false, fictitious, or fraudulent statement on this document, or uses such document knowing it to be false, fictitious, or fraudulent may be subject to afine of not more than V 0,000. _or_„‘ imprisonment of not more thartito years or both (18 U.S.C.46011i ' .....—"t,/"."62
1. TYPE OF ANIMAL SHIPPED (select one only)
i Dog flCat flOther
2. CERTIFICATE NUMBER - OFFICIAL USE ONLY
Nonhuman Primate Ferret Rodent
.&TZTAL NUMBER OF ANIMALS nip,7:7,N5,, 1
4. PAGE
1 of 1 5. NAME, ADDRESS, AND TELEPHONE NUMBER OF OWNER (CONSIGNOR)
Lake Hartwell Veterinary Clinic 1087 E. Franklin Street Suite K Hartwell, GA 30643
USDA License/or Registration Number (if applicable)
1:6:x-NAME'ADDRESS, AND TELEPHONE NUMBER OF RECIPIENT AT DESTINATION (CONSIGNEE) ' ci4'ist
StaI,
ceyiSilverstein
747E Atli Street ' ee. ...I'd Apt 121,e
elAtYieirk, NY 10075
7. ANIMAL IDENTIFICATION 8. PERTINENT VACCINATION, TREATMENT, AND TESTING HISTORY
NAME, AND/OR TATTOO NUMBER OR OTHER IDENTIFICATION
BREED — COMMON OR SCIENTIFIC
NAME AGE SEX
COLOR OR DISTINCTIVE MARKS OR MICROCHIP
RABIES VACCINATION
i 1 YEAR 2 YEARS 3 YEARS
OTHER VACCINATIONS, TREATMENT, AND/OR TESTS AND RESULTS
Vaccination Date Product Date Product Type and/or Results
(I) Lonnie Hound-X 14w M 981020021507455 8/29/2017 Merial Ser# 22073 8/7/2017 DHPP
8/7/2017 Bordetella
8/24/2017 DHPP
9. REMARKS OR ADDITIONAL CERTIFICATION STATEMENTS (WHEN REQUIRED) VETERINARY CERTIFICATION: I certify that the animals described in box 7 have been examined by me this date, that the information provided in box 8 is true and accurate to the best of my knowledge, and that the following findings have been made (r applicable statements).
1
/ appear animal
I have verified the presence of the microchip, if a microchip is listed in box 7.
I certify that the an imal(s) described above and on continuation sheet(s), if applicable, have been inspected by me on this date and to be free of any tnfedious or contagious diseases and to the best of my knowledge, exposure thereto, which would endanger the or other animals or would endanger public health.
1 To my knowledge, the animal(s) described above and on continuation'sheet(60 applicable, orilginated from an area not quarantined for rabies and has/have not been exposed to rabies. I
ENDORSEMENT FOR INTERNATIONAL EXPORT (IF NEEDED) NAME, ADDRESS, AND TELEPHONE NUMBER 1 I
1 Jaime Terry 1087 E Franklin Street Suite K I
Hartwell, GA 30643 I
-OF-ISSUING VETERINARIAN
BEV 1 9 2017
UICENSE NUMBER AND STATE I I 7691 GA I I
PRINTED NAME OF USDA VETERINARIAN
i i Accredited If kesiplease
i complete
Yes No below
ivii- i 0 ki -At ACCREDITATION NUMBER
_ 0101467 s(ob•-tt cohu,teDvM 1
rvt NOTE: In ational shipment may require certification,by-an:accredited Vitethiarien
SIGNATURE OF USDA VETERINARIAN Apply USDA Seal or Stamp here DATE SIGN E OF ISSUIN ETERINARIAN DATE
8/31/2017
HIS Form 7001 (NOV 2010)
This certificate is valid for 30 da after issuance
According to the Paperwork Reduction Act of 1995, an agency may not cond uct or sponsor, and a person is not requ information unless it displays a valid OMB control number. The valid OMB control numbers f or this information collecti The ti me required to complete this int omiation collection i s estimated to average .25 h ours per response including the searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection
red to respond to, a collection of n are 0579-0036 and 0579-0333.
ti me for reviewing instructions, f information
No dog, cat, nonhuman primate, or additional inds or classes of animals designated by USDA, egulation sh all be del ivered to any i ntermediate handler or car rier for transportation in commerce, unless accompa ied by a heal th certificate executed and issued by a licensed veterinarian (7 U.S.C. 21.43.9: CFR, Subchapter A, Part 2).
OMB APPROVED 0579-0036 0579-0333
UNITED STATES DEPARTMENT OF AGRICULTURE ANIMAL AND PLANT HEALTH INSPECTION SERVICE
UNITED STATES INTERSTATE AND INTERNATIONAL CERTIFICATE OF HEALTH EXAMINATION
FOR SMALL ANIMALS
WARNING: Anyone who makes a false, fictitious, or fraudulent
1. TYPE
1
OF ANIMAL SHIPPED (select one only)
Dog flcat COther
2. CERTIFICATE NUMBER - OFFICIAL USE ONLY
statement on this document, or uses such document knowing it to be false, fictitious, or fraudulent be to
Nonhuman Primate Ferret Rodent
may subject afine of not more than $10,000 or—. imprisonment of not more thaiic) years or both (18 U.S.C.4080'.
0,3.JOTAL NUMBER OF ANIMALS
1
4. PAGE
1 of 1
Lake Hartwell Veterinary Clinic to. itt
5. NAME, ADDRESS, AND TELEPHONE NUMBER OF OWNER (CONSIGNOR) I4M Y Jaw 6XNAME•ADDRESS, AND TELEPHONE NUMBER OF RECIPIENT AT DESTINATION (CONSIGNEE) , -
Sta kcey,4tY
Silverstein ' 79th Street
1087 E. Franklin Street Suite K
Afit'127,
Hartwell, GA 30643
USDA License/or Registration Number (if applicable)
ew.4:Yterk, NY 10075 —tt• ,,,
7. ANIMAL IDENTIFICATION 8. PERTINENT VACCINATION TREATMENT, AND TESTING HISTORY
NAME, AND/OR TATTOO NUMBER OR OTHER IDENTIFICATION
BREED —COMMON OR SCIENTIFIC
NAME AGE SEX
COLOR OR DISTINCTIVE MARKS OR
RABIES VACCINATION
1 YEAR 2 YEARS 3 YEARS
OTHER VACCINATIONS, TREATMENT, AND/OR TESTS AND RESULTS
MICROCHIP Vaccination Date Product Dale Product Type and/or Results
Leonard Mix 7w M 981020021493319 Not Old Enough 8/6/2017 DHPP
8/6/2017 Bordetella
8/24/2017 DHPP
9. REMARKS OR ADDITIONAL CERTIFICATION STATEMENTS (WHEN REQUIRED) VETERINARY CERTIFICATION: I certify that the animals described in box 7 have been examined by me this date, that the information provided in box 8 is true and accurate to the best of my knowledge, and that the following findings have been made ("X" applicable statements).
,/I
i appear animal
1
have verified the presence of the microchip, if a microchip is listed in box 7.
I certify that the animal(s) deathbed above and on continuation sheet(s), if applicable, have been inspected by me on this date and to be free of any infectious or contagious diseases and to the best of my knowledge, exposure thereto, which would endanger the or other animals or would endanger public hearth.
To my knowledge, the animal(s) described above and on continuation sheet(s) if applicable, originated from an area not quarantined for rabies and has/have not been expthed to rabies. • H. ,•1.•Tharldii•'• • ,,
ENDORSEMENT FOR INTERNATIONAL EXPORT (IF NEEDED) NAME, ADDRESS, AND TELEPHONE NUMBEICOP'ISSUINGVETERINARIAN LICENSE NUMBER AND STATE
7691 GA PRINTED NAME OF USDA VETERINARIAN
Jaime Terry 1087 E Franklin Street Suite K Hartwell, GA 3 643
I SEP 1 9 2017 I k
Accredited If yes, please
i complete
Yes No below
NATIONAL ACCREDITATION NUMBER
010467 NOTE: Intern o a shipments may re uir certification by.an,accredi
,1a. con- .)i)..—_ 'l ad veterinarian.
SIGNATURE OF USDA VETERINARIAN Apply USDA Seal or Stamp here DATE SIGNATU ISSUING VETERIN IAN "r4,-• ‘•., • ,
— DATE
8/31/2017
APHIS Form 7001 (NOV 2010)
This certificate is valid for 30 days r issuance
Acc
Print Name
(Signature)
ja-6 /14 Can
State Veterinarian's Office Agriculture Building Capitol Square Atlanta, Georgia 30334
GEORGIA DEPARTMENT OF AGRICULTURE CERTIFICATE OF VETERINARY INSPECTION No. CG- 03192
CERTIFICATE VOID 30 DAYS FROM INSPECTION DATE
CONSIGNOR OR SHIPPER
.3; c ctn_ i-7,..4 RA-ce C011yIGNr REC I ER
t i 4-- 264ebte__ DATE ANIMALS INSPECTED. CONSIGNOR'S NAIS PREMISES ID.
1 Q -12 ki f-A .....,
6 - go- S9:1-- 6 c---c.) DATE CERTIFICATE ISSUED
—7 — ) se— )
An-ekiNe\ GA— 7al D 9
•
0 OVA., ,c.okk, „ily Na.ANIMALS IN SHIPMENT
I ENTRY PERMIT NUMBER
X Species X Species X Purpose of Movement X Area Status Herd or Flock Status Cattle Ratite Breeding Accredited Free TB Accredited Herd No. Horses . Cervidae Feeding Modified Accredited TB Certified Herd No. Swine ><Thogs Show Free - Brucellosis Validated Herd No. Goats Cats Slaughter Class A - Brucellosis Qualified Herd No.
—1 Sheep Other )( Other —outi,e ,4th.‘ Class B Brucellosis Monitored Feeder Pig Herd No. Poultry
Individual ID: Official Eartag, Breed Registration Ear Tattoo or Breed
Registration Firebrand
Description of Animal or Registry Name and Number
A g e
S e x
B r e e d
Bruc. Vac.
Tattoo
Brucellosis Test Date
TB Test Inj.
EIA Test Date
PRV Test Date
Other Test / Immunization Date
).1 K-1-PP t (2414--
Other Test / Immunization Date
44 Lab Obs. Results Include Lab & Accession No. Results Results Results Results 72 Hr. Results
(---- 7-14" - 11 ---- 2
3
4
5
6
7
8
9 \
10 r-- ' — Ile I I 1 I 12 AUG ' 2017 I I
I
I
13 I I 14
JrVrznp, ul .,"._ 15
WNER/AGENT shipment are those certified and listed on this certificate
CERTIFICATE OF ISSUING VETERINARIAN I certify as an accredited veterinarian tha the described animals have been inspected by me and that they are not showing signs of infectious contagious and/or communicable ase The vaccination and results of tests are as indicated on the certificate. To the best of my knowledge, the animals listed on this certificate meet the sta es/ation pederal interstate requirements. No further warranty is made or implied.
ta-q q 4-1A er•-c gl sit/ Ad ress
Gt a it•Sr tZ City, State, Zip — Ga. License No.
CERTIFI TE , The ani es.01
,0 WI
ignature)
Original and Blue copies to be forwarded to State Veterinarian's Office. Retain Pink. Yellow copy to accompany shipment.
According tot he Paperwork Reduction Act of 1995, an agency may not cond uct or sponsor, and a p erson is not required to respond to, a collection of information unless it displays a valid OMB control number. The valid OMB control numbers for this information collection are 0579-0036 and 0579-0333.
.. The time required to complete this information collection is estimated to average .25 hours per response including th ti me tor nev iewing instructions, searching existing data sources; gathering and maintaining the data needed and completing and reviewing the collection of information:
No dog, cat nonhuman primate, or additional Inds or classes of animals designated by USDA r egulation sh all be del ivered to a y i ntermediate handler or car der tor transportation in commerce, unless accompanied by a health certificate executed and issued by a licensed veterinarian (7 U.S.C. 21.43.9: CFR, Subchapter A. Part 2).
OMB APPROVED 0579-0036 0579-0333
,. WARNING: UNITED STATES DEPARTMENT OF AGRICULTURE
' ANIMAL AND PLANT'HEALTH INSPECTION SERVICE
UNITED STATES INTERSTATE AND INTERNATIONAL . CERTIFICATE OF HEALTH EXAMINATION
FOR SMALL ANIMALS
Anyone who makes a false, fictitious, or fraudulent' statement on this document, or uses such document knowing it to be false, fictitious, or fraudulent may be subject to a fine of not more than $10,000 or imprisonment of not more thafi ?,. years or both (18 U S C 16013-‘
1. TYPE
X
OF ANIMAL SHIPPED (select one only)
Dog . Cat Other .
2. CERTIFICATE NUMBER - OFFICIAL USE ONLY
CJ Nonhuman Primate Ferret Rodent
.3...TOTAL NUMBER OF ANIMALS . y.
.
4. PAGE
1 of 1
6. NAME, ADDRESS; AND TELEPHONE NUMBER OF OWNER (CONSIGNOR)
Shelter Dog Rescue/Charles Ware , . ' 362 B Aerodrome Way .. • s . ' . • Griffin, GA 30224 •
404 857-2672 • .
USDA License/or Registration Number (if applicable)
-6:1rNAME„ABDRESS, AND TELEPHONE NUMBER OF RECIPIENT AT DESTINATION (CONSIGNEE) .7... 1,. %if- ••.. 4 uff HoUse'Rescue .13;Mme .ard ercato I o- fl( - „.• • 0,ceansidedNY 11572 :038) 5234520
7. ANIMAL IDENTIFICATION 8. PERTINENT VACCINATION TREATMENT AND TESTING HISTORY
NAME, AND/OR TATTOO NUMBER OR OTHER IDENTIFICATION
BREED -COMMON OR SCIENTIFIC
NAME AGE SEX
COLOR OR DISTINCTIVE MARKS OR MICROCHIP
X
RABIES VACCINATION
1 YEAR 2 YEARS 3 YEARS
OTHER VACCINATIONS, TREATMENT, AND/OR TESTS AND RESULTS
Vaccination Date Product Date Product Type and/or Results
9463 Freckles Chihuahua X 3y F Blk Dapple 8/2/17 De ensor 3 8/2/17 Pyrantel, DHLPP-CV, Bordetella, HWT( )
9. REMARKS OR ADDMONAL CERTIFICATION STATEMENTS (WHEN REQUIRED) ..
.,• , i, ,
i
VETERINARY CERTIFICATION: I certify that the animals described in box 7 have been examined by me this date, that the information provided in box 8 is true and accurate to the best of my knowledge, and that the following findings have been made ('X" applicable statements).
X appear animal
X for rabies
I have verified the presence of the microchip, if a micruchip is listed in box 7.
I certify that the animal(s) described above and on continuation sheet(s), if applicable, have been inspected by me on this date and to be free of any infectious or contagious diseases and to the best at my knowledge, exposure thereto, which would endanger the or other animals or would endanger public health.
To my knowledge, the animal(s) described above and on continuation sheet(s) if applicable, originated from an area not quarantined and has/have not been exposed to rabies.
ENDORSEMENT FOR INTERNATIONAL EXPORT (IF NEEDED) NAME, ADDRESS, AND TELEPHONE NUMBER OF ISSUING VETERINARIAN
Christi Ware, D.V.M. Pike County Mobile Pet Care P.O. Box 5 Williamson, GA 30292 404-857-2672
NOTE: International shipments may require certification by an accredited veterinarian
LICENSE NUMBER AND STATE
GA 005889 PRINTED NAME OF USDA VETERINARIAN - i
•
Accredited If yes, please
NATIONAL
064167
X complete
ACCREDITATION
Yes No below
NUMBER
SIGNATURE OF USDA VETERINARIAN Apply USDA Seal or Stamp here DATE SIGNATURE OF ISSUING VETERINARIAN
at-kill: • Art, a / hiM
DATE
8/4/17
APHIS Form 7001 (NOV 2010)
This certificate is valid for 30 days after issuance
According to the Paperwork Reduction Act of 1995, an agency may not gond uc or sponsor, and a p erson is not required to respond to. a collection of information unless it displays a valid OMB control number The valid OMB control numbers for this information apnea° are 0579-0036 and 0579-0333. The time required to complete this information collection is estimated to average .251 ours per response, including th lime for reviewing instructions, searching mdsting data sources, qathehng and maintaining the data needed, and completing and reviewing the collection of information
No dog, cat, nonhuman primate, or additional kinds or classes of animals designated by USDA r egulation sh all be del ivered to any i ntermediate handler or car der for transportation in commerce, unless accompanied by a heal th collimate executed and issued by a licensed veterinarian (7 U.S.C. 21.43.9: CFR, Subchapter A, Part 2).
OMB APPROVED 0579-0036 0579-0333
UNITED STATES DEPARTMENT OF AGRICULTURE ANIMAL AND PLANT HEALTH INSPECTION SERVICE
UNITED STATES INTERSTATE AND INTERNATIONAL CERTIFICATE OF HEALTH EXAMINATION
FOR SMALL ANIMALS
WARNING: Anyone who makes a false, fictitious, or fraudulent statement on this document, or uses such document knowing it to be false, fictitious, or fraudulent may be subject to a fine of not more than $10,000 or . imprisonment of not more thaii.'hl years or both (18 U.S.C.:71.003Ri i_.
X
1. TYPE OF ANIMAL SHIPPED (select one only)
Dog Cat Other
2. CERTIFICATE NUMBER - OFFICIAL USE ONLY
Nonhuman Primate Ferret Rodent
51, - .3. TOTAL NUMBER OF ANIMALS
- -,.,.... 4. PAGE
1 of 1 •
5. NAME, ADDRESS, AND TELEPHONE NUMBER OF OWNER (CONSIGNOR)
Shelter Dog Rescue/Charles Ware 362 B Aerodrome Way Griffin, Ga 30224 404 857-2672
USDA License/or Registration Number (if applicable)
ttRuff -,Pro.
“16NAME;ADDRE5S, ;.:,,.
t/OC,:
CEinside;ENY —5:101731W6
AND TELEPHONE NUMBER OF RECIPIENT AT DESTINATION (CONSIGNEE)
HdttsegResoue ao Diane Indelicato BR Set; . In- ". I 11572
:.,-, - 7. ANIMAL IDENTIFICATION 8. PERTINENT VACCINATION, TREATMENT, AND TESTING HISTORY
NAME, AND/OR TATTOO NUMBER OR OTHER IDENTIFICATION
BREED -COMMON OR SCIENTIFIC
NAME AGE SEX
COLOR OR DISTINCTIVE MARKS OR MICROCHIP
X
RABIES VACCINATION
1 YEAR 2 YEARS 3 YEARS
OTHER VACCINATIONS, TREATMENT, AND/OR TESTS AND RESULTS
Vaccination Date Product Date Product Type and/or Results
Buddy2 Poodle 1y M Black 7/20/17 Def3 7/20/17 DHPP, HVVT(+)Treated
171704 Pit X 12w F Brn/VVht 8/11/17 Def3 7/23/17 Pyrantel
(5) 171705 PitX 12w F Brn/VVht 8/11/17 Def3 7/23/17 Pyrantel
(4) 171840 Blue Boxer X 4y m Black 8/9/17 Def3 8/9/17 HMI-)
(5/
(5/
9. REMARKS OR ADDITIONAL CERTIFICATION STATEMENTS (WHEN REQUIRED)
('X"
VETERINARY information
CERTIFICATION: I certify that the animals described in box 7 have been examined by me this date, that the provided in box 8 is true and accurate to the best of my knowledge, and that the following findings have been made
applicable statements).
IJ X
appear animal
X for rabies
I have verified the presence of the microchip, if a microchip is listed in box 7.
I certify that the animal(s) described above and on continuation sheet(s), if applicable, have been inspected by neon this date and to be free of any infectious or contagious diseases and to the best of my knowledge, exposure thereto, which would endanger the or other animals or would endanger public health.
To my knowledge, the animal(s) described above and on continuation sheet(s) if applicable, originated from an area not quarantined and has/have not been exposed to rabies. —
ENDORSEMENT FOR INTERNATIONAL EXPORT (IF NEEDED) . NAME, ADDRESS, AND TELEPHONE NUMBER-OF ISSUING 'VETERINARIAN;
Christi Ware, D.V.M. . 1 Pike County Mobile Pet Care P.O. Box 5 Williamson, GA 30292 SEP 1 4 2017 404-857-2672
LICENSE NUMBER AND STATE I
GA7005889 I I
PRINTED NAME OF USDA VETERINARIAN
I I Accredrted H yes, please
NATION L
064 67
X complete
ACCREDITATION
Yes No heiow
NUMBER
NOTE- International shipments may require certifi tic arraccreditediveteffilifian, SIGNATURE OF USDA VETERINARIAN Apply USDA Seal or Stamp here DATE SIGNATURE OF ISSUING VETERINARIAN 1771;71 i.4. <Am.)? evm
' ' DATE
8/11/17 fiLefitil: cunimItiL
orm 7001 (NOV 2010)
This certificate is valid for 30 days after issuance
According to the Paperwodt Reduction Act of 1995, an agency may not conduc or sponsor, and a person is not required to respond to. a collection of information unless it displays a valid OMB control number. The valid OMB control numbers for this information collectio are 0579-0036 and 0579-0333. The time required to complete this information collection is estimated to average .25 hours per response. including th time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information
No dog, cat, nonhuman primate, or additional inds or classes of animals designated by USDA r egulation sh all be del ivered to any i ntermediate handler or car her for transportation in commerce, unless accompa led bye health certificate executed and issued by a licensed veterinarian (7 U.S.C. 21,43.9: CFR, Subchapter A, Part 2).
OMB APPROVED 0579-0035 0579-0333
UNITED STATES DEPARTMENT OF AGRICULTURE ANIMAL AND PLANT HEALTH INSPECTION SERVICE
UNITED STATES INTERSTATE AND INTERNATIONAL CERTIFICATE OF HEALTH EXAMINATION
FOR SMALL ANIMALS
WARNING: Anyone who makes a false, fictitious, or fraudulent statement on this document, or uses such document knowing it lobe false, fictitious, or fraudulent may be subject to a fine of not more than $10 000 or imprisonment of not more theiht5:0 years or both (18 U.S.C. :COW-,
X
1. TYPE OF ANIMAL SHIPPED (select one only)
Dog FE Cat Other
2. CERTIFICATE NUMBER - OFFICIAL USE ONLY
Nonhuman Primate Ferret FERodent
3. TOTAL NUMBER OF ANIMALS 4. PAGE
1 of 1
5. NAME, ADDRESS, AND TELEPHONE NUMBER OF OWNER (CONSIGNOR)
Shelter Dog Rescue/Charles Ware 'Ruff 362 B Aerodrome Way r' ik Griffin, Ga 30224 404 857-2672
USDA License/or Registration Number (if applicable)
gSANAME;ADDRESS, AND TELEPHONE NUMBER OF RECIPIENT AT DESTINATION (CONSIGNEE) ,tl^,
HbuserRescue do Diane Indelicato iFiEdrEtti 155 -I rLscik --- rd 0 dffiaNY 11572 ....e, ,,-.--, 51. 2376520
7. ANIMAL IDENTIFICATION ' 8. PERTINENT VACCINATION, TREATMENT, AND TESTING HISTORY
NAME, AND/OR TATTOO NUMBER OR OTHER IDENTIFICATION
BREED -COMMON OR SCIENTIFIC
NAME
, AGE SEX
COLOR OR DISTINCTIVE MARKS OR MICROCHIP
X
RABIES VACCINATION
1 YEAR FE2 YEARS 3 YEARS
OTHER VACCINATIONS, TREATMENT, AND/OR TESTS AND RESULTS
Vaccination Date Product Date Product Type and/or Results (I) 23363 Pup A Lab X 7w F TanAMK 8/9/17 DHLPP-CV, Pyrantel
23364 Pup B Lab X 7w F BrnANht 8/9/17 DHLPP-CV, Pyrantel
23385 Pup C Lab X M Tan/VVht 8/9/17 DHLPP-CV, Pyrantel
23366 Pup D Lab X 7w M TanNVht 8/9/17 OHLPP-CV, Pyrantel (5) 23367 Pup E Lab X 7w M Brn/VVht 8/9/17 DHLPP-CV, Pyrantel (6) 23368 Pup F Lab X 7w M Brn/VVht 8/9/17 DHLPP-CV, Pyrantel 9. REMARKS OR ADDITIONAL CERTIFICATION STATEMENTS (WHEN REQUIRED)
VETERINARY CERTIFICATION: I certify that the aninisIs described in box 7 have been examined by me this date, that the information provided in box 8 is true and accurate to the best of my knowledge, and that the following findings have been made ('X" applicable statements).
X appear animal
X
I have verified the presence of the microchip, if a microchip is listed in box 7.
I certify that the animal(s) descdbed above and on continuation sheet(s), if applicable, have been inspected by me on this date and to be free of any infectious or contagious diseases and to the best of my knowledge, exposure thereto, which would endanger the or other animals or would endanger public health.
To my knowledge, the animal(s) described above and on.continuation sheet(s) if applicable, originated from an area not quarantined for rabies and has/have not been exposeddoiraffies. ri,. • .,,,,,,,,,,siii., , • . .1. I
ENDORSEMENT FOR INTERNATIONAL EXPORT (IF NEEDED) NAME, ADDRESS, AND TELEPHONE NUMBER OPISSUING! yETERINAIAN .I
EICENSE NUMBER AND STATE
GA 005889 1
PRINTED NAME OF USDA VETERINARIAN Christi Ware, D.V.M. Pike County Mobile Pet Care
1 P.O. Box 5 SEP 1 4 2017 Williamson, GA 30292 404-857-2672
•
I Accredited nil/es, please
NATIONAL i
064167 I
X complete
ACCREDITATION
Yes FENo below
NUMBER
NOTE: International shipments may require certification bile') adErkireVireienriiiiirian. SIGNATURE OF USDA VETERINARIAN Apply USDA Seal or Stamp here
- -• ••- -
DATE SIGNATURE OF ISSUING VETERINARIAN DATE
8/18/17 04444.4., Arete46" 4ts Va.
arm (NOV 2010)
This certificate is valid for 30 days after issuance
According to the Paperwork Reduction Act of 1995, an agency may not cond uc or sponsor, and a p erson is not required to respond to, a collection of information unless it displays a valid OMB control number. The valid OMB control numbers for this information colleen° are 0579-0036 and 0579-0333. The time required to complete this information collection is estimated to average .26 hours per response, incjuding try ti me for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the cdlectron of information,
No dog, cat, nonhuman primate, or additional kinds or dosses of animals designated by -USDA r egulation sh all be del ivered to any i ntermediate handle/ or car der for transponation in commerce, unless accompanied by a health certificate executed and issued by a licensed vetednadin (TU.S.C. 21. 3.9 CFR Subchapter A Pail a i
OMB APPROVED 0579-0036 0579-0333
UNITED STATES DEPARTMENT OF AGRICULTURE ANIMAL AND PLANT HEALTH INSPECTION SERVICE
UNITED STATES INTERSTATE AND INTERNATIONAL CERTIFICATE OF HEALTH EXAMINATION 3,
FOR SMALL ANIMALS
WARNING: Anyone who Makes a false, fictitious, or fraudulent statement on this document, or uses such document knowing it lobe false, fictitious, or fraudulent may be subject to a fine of not more than $10,000 or , — imprisonment of not more thati'hii years or both fil8 L.1 S C 4130/fr
1. TYPE OF ANIMAL SHIPPED (select one only)
X Dog Cat DOther 2. CERTIFICATE NUMBER - OFFICIAL USE ONLY
Nonhuman Primate Ferret flRodent
TOTAL NUMBER OF ANIMALS 'i
4. PAGE
1 of 1
5. NAME, ADDRESS, AND TELEPHONE NUMBER OF OWNER (CONSIGNOR) 5f„p ? •x -
Shelter Dog Rescue/Chades Ware - 362 B Aerodrome Way
Griffin, Ga 30224 404 857-2672
USDA License/or Registration Number cif applicable)
k-67-NANIE,ADDRESS, AND TELEPHONE NUMBER OF RECIPIENT AT DESTINATION (CONSIGNEE) ,h-, 7Rtiff Howse-Rescue do Diane lndeficato ' t--- re ,--. t” -KO.,13ox 365't -rty;,..,x,t) lOgeaffsid.ffitNY 11572 33 4934810
7. ANIMAL IDENTIFICATION 8. PERTINENT VACCINATION TREATMENT, AND TESTING HISTORY
NAME, AND/OR TATTOO NUMBER OR OTHER IDENTIFICATION
BREED — COMMON OR SCIENTIFIC
NAME AGE SEX
COLOR OR DISTINCTIVE MARKS OR MICROCHIP
RABIES VACCINATION
X YEAR 2 YEARS 3 YEARS
OTHER VACCINATIONS, TREATMENT, AND/OR TESTS AND RESULTS
Vaccination Date Product Date Product Type and/or Results 23369 Pup G Lab X 7w M Bm/VVht . , 8/9/17 DHLPP-CV, Pyrantel
23370 Pickle Lab X 7w M Brn 8/9/17 DHLPP-CV, Pyrantel (
9. REMARKS OR ADDITIONAL CERTIFICATION STATEMENTS (WHEN REQUIRED) - - VETERINARY CERTIFICATION: I certify that the animals described in box 7 have been examined by me this date, that the information provided in box 8 is true and accurate to the best of my knowledge, and that the following findings have been made ("X" applicable statements).
I_
ITC appear animal
X
- I have verified the presence of the microchip, if a microchip is listed in box 7.
I certify that the animal(s) described above and on continuation sheet(s), if applicable, have been.inipeitd by neon this date and lobe free of any infectious or contagious diseases and to the best of my knowledge, exposure thereto:which Would endanger the or other animals or would endanger public health.
To my knowledge, the animal(s) descnbed above and on continuation sheet(s) if applicable, originated from an area not quarantined for rabies and has/have not been exposed to rabies. , ...
ENDORSEMENT FOR INTERNATIONAL EXPORT (IF NEEDED) NAME, ADDRESS, AND TELEPHONE NUMBER OF ISSUING VETERINARiA14 LICENSE NUMBER AND STATE PRINTED NAME OF USDA VETERINARIAN
Christi Ware, D.V.M. Pike County Mobile Pet Care
I --1 GA 005889 I I '
P.O. Box 5 Williamson, GA 30292 404-857-2672 I
'
SEP i 4 2017
, ....
I I Accredited Ilya please i ,
NATIONAL 1 I
X complete
ACCREDITATION
Yes No below
NUMBER .064167
dredited NOTE: International ship_ments may require cartifica ion by an ac veierin'aPia7 I SIGNATURE OF USDA VETERINARIAN Apply USDA Seal or Stamp here DATE SIGNATURE OF ISSUING VETERINARIAN DATE
agartsar Artav bV ty,„ 8/18/17
APHIS Form 7001 (NOV 2010) This certificate is valid for 30 days after issuance
According to the Paperwork Reduction Act of 1995, an agency may not cond in or sponsor, and a person is not required to respond to, a collection of information unless it displays a valid OMB control number. The valid OMB control numbers f or this information collection are 0579-0036 and 0579-0333. The time required to complete this information collection is estimated to average .25 h ours per response, including the ti me for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information
No dog, cat, nonhuman primate, or additional kinds or classes of animals designated by USDA r egulaton sh all be del Rered to a y i ntermediate handler or car rier for transportation in commerce, unless accompanied by a heal th certificate executed and issued by a licensed veterinarian (7 U.S.C. 21.43.9; CFR Subchapter A. Part 2).
OMB APPROVED 0579-0036 0579-0333
UNITED STATES DEPARTMENT OF AGRICULTURE ANIMAL AND PLANT HEALTH INSPECTION SERVICE
UNITED STATES INTERSTATE AND INTERNATIONAL CERTIFICATE OF HEALTH EXAMINATION
FOR SMALL ANIMALS
WARNING: Anyone Ma makes a false, fictitious, or fraudulent statement on this document, or uses such document knowing it to be false, fictitious, or fraudulent may be subject to a fine of not more than $10,000 or imprisonment of not more tilak"SNIVAIpk,„?...),‘ years or both (18 U.S.C. -1.00Q _
1. TYPE OF ANIMAL SHIPPED (select one only)
.1 Dog Cat Other
2. CERTIFICATE NUMBER - OFFICIAL USE ONLY
Nonhuman Primate Ferret Rodent
..3. TOTAL NUMBER OF ANIMALS
..._,,Atn.Nt, 2 4. PAGE
1 of 1 S. NAME, ADDRESS, AND TELEPHONE NUMBER OF OWNER (CONSIGNOR)
t.... Hart county Animal Rescue cis
5559 Bethany Bowersyille road Canon, GA 30520
USDA License/or Registration Number (if applicable)
c6XNAME; ADDRESS, AND TELEPHONE NUMBER OF RECIPIENT AT DESTINATION (CONSIGNEE) V., K'V141. .."4.„ HappyMe Animal Rescue
;51k; rin Road P5ifeSO'
g n , NY 12563
, ,.,
7. ANIMAL IDENTIFICATION 8. PERTINENT VACCINATION, TREATMENT, AND TESTING HISTORY
NAME, AND/OR TATTOO NUMBER OR OTHER IDENTIFICATION
BREED —COMMON OR SCIENTIFIC
NAME AGE SEX
COLOR OR DISTINCTIVE MARKS OR MICROCHIP
RABIES VACCINATION
i 1 YEAR 2 YEARS 3 YEARS
OTHER VACCINATIONS, TREATMENT, AND/OR TESTS AND RESULTS
Vacdnation Date Product Date Product Type and/or Results
(I) Rascal Mix 19w M 7/31/2017 Menai Serff 22073
Daffney Mix 19w F 7/31/2017 Merial Serif 22073
(0)
9. REMARKS OR ADDITIONAL CERTIFICATION STATEMENTS (WHEN REQUIRED) VETERINARY CERTIFICATION: I certify that the animals described in box 7 have been examined by me this date, that the information provided in box 8 is true and accurate to the best of my knowledge, and that the following findings have been made ('X" applicable statements).
i E i appear animal
14 for rabies
I have verified the presence of the microchip, if a microchip is listed in box 7.
I certify that the animal(s) described above and on continuation sheet(s), if applicable, have been inspected by me on this date and to be free of any infectious or contagious diseases and to the best of my knowledge, exposure thereto, which would endanger the or other animals or would endanger public health.
To my knovAedge, the anknal(s) described above and on continuation sheet(s) if applicable, originated from an area not quarantined and has/have not been exposed to rabies.
ENDORSEMENT FOR INTERNATIONAL EXPORT (IF NEEDED) NAME, ADDRESS, AND TELEPHONE NUMBER-OF-ISSUINDyET?RINAMMt
Jaime Terry
,Th ,-,..,(1,, sr ,, a:trod .1 rd in the
—LICENSE-NUMBER AND STATE l
7691 GA . I PRINTED NAME OF USDA VETERINARIAN
1087 E. Franklin Street Suite K Hartwell, GA 30643
NOTE: In liana! shipments m require certification bcban.accredited.veterinarian.
SEP 6 2017
__,
Accretlitea 1 Yes No
It yes,IpleSse complete below
NATIONAL ACCREDITATION NUMBER I I
0104-6.7 SIGNATURE OF USDA VETERINARIAN Apply USDA Seal or Stamp hem DATE SIGNA E OF ISSUING V ERINARIAN
- ,4.2.Ar ix. ri-tri A 0-n-- ROI,' r I tr4 C1.11b,Ce PVM
I DATE
8/30/2017 .....---- APHIS Form 7001 (NOV 2010)
This certificate is valid for 30 d y after issuance
According tot he Paperwork Reduction Act of 1995, an agency may not cond tic or sponsor, and a parson is not required to respond to, a collection of information unless it displays a valid OMB control number. The valid OMB control numbers for this information callectio are 0579-0036 and 0579-0333. The time required to complete this information collection is estimated to average .25 hours per response, including the ti me for reviewing instructions.
No dog, cat, nonhuman primate, or additional inds or classes of animals designated by USDA r egulation sh all be del ivered to any i ntermediate handler or car rier for transportation in commerce, unless accompanied by a health certificate ex ecuted and
OMB APPROVED 0579-0036 0579-0333
searcning existing Data sources, gamering ana maintaining me oars neeeea, ana completing
UNITED STATES DEPARTMENT OF AGRICULTURE ANIMAL AND PLANT HEALTH INSPECTION SERVICE
UNITED STATES INTERSTATE AND INTERNATIONAL CERTIFICATE OF HEALTH EXAMINATION
FOR SMALL ANIMALS
ana reviewing me collection WARNING: Anyone who makes a false, fictitious, or fraudulent statement on this document, or uses such document knowing it to be false, fidifious. or fraudulent may be subject to a fine or not more than $10,000 or .. imprisonment of not more than 6,.,1 years or both (18 U.S.C. 10015,1 -•
OT intormation.
X
1. TYPE OF ANIMAL SHIPPED
Dog Cat
(select one only)
al Other
, 2. CERTIFICATE NUMBER - OFFICIAL USE ONLY
Nonhuman Primate Ferret Rodent 0003
.3. TOTAL NUMBER OF ANIMALS
ise 1 ' .
4. PAGE
1 •
S. NAME, ADDRESS, AND TELEPHONE NUMBER OF OWNER (CONSIGNOR) 'V'- 6.
Douglas County Animal Shelter 1Catahoula ...-. 2171 Mack Rd, Douglasville, GA 30135 .._,
. (770) 942-5961 if
1
USDA License/or Registration Number (if applicable)
NAME, ADDRESS, AND TELEPHONE NUMBER OF RECIPIENT AT DESTINATION (CONSIGNEE) 1 •
Rescue of New England
Colleen-Hard L .. L6p9F,Ait1awn Ave. Peekskill NY 10566
(19)4) 469-1070
7. ANIMAL IDENTIFICATION 8 PERTINENT VACCINATION, TREATMENT, AND TESTING HISTORY
NAME, AND/OR TATTOO NUMBER OR OTHER IDENTIFICATION
BREED — COMMON OR SCIENTIFIC
NAME AGE SEX
COLOR OR DISTINCTIVE MARKS OR MICROCHIP
X
RABIES VACCINATION
1 YEAR 2 YEARS 3 YEARS
OTHER VACCINATIONS, TREATMENT, AND/OR TESTS AND RESULTS
Vaccination Date Product Date Product Type and/or Results
Loki catahoula mix 1 year M mode 8/2/17 Novibac 8/2/17 Heartworm test- NEG
(51
9. REMARKS OR ADDITIONAL CERTIFICATION STATEMENTS (WHEN REQUIRED)
("X"
VETERINARY information
CERTIFICATION: I certify that the animals described in box 7 have been examined by me this date, that the provided in box 8 is true and accurate to the best of my knowledge, and that the following findings have been made,
applicable statements).
X appear animal
X for rabies
I have verified the presence of the microchip, if a microchip is listed in box 7.
I certify that the animal(s) described above and on continuation sheet(s), if applicable, have been inspected by me on this date and to be free of any infectious or contagious diseases and to the best of my knowledge, exposure thereto, which would endanger the or other animals or would endanger public health.
To my knowledge, the animal(s) described above and on continuation sheet(s) if applicable, originated from an area not quarantined and has/have not been exposed to rabies. • . •
ENDORSEMENT FOR INTERNATIONAL EXPORT (IF NEEDED) NAME, ADDRESS, AND TELEPHONE NUMBER OF ISSUING VETERINARIAN _ . _
Tammy Parker DVM
535 East Montgomery Street
Villa Rica, GA 30180 AUG 1 5 2017 678-840-8072
LICENSE NUMBER AND STATE
GA #5138 PRINTED NAME OF USDA VETERINARIAN
Accredited If yes, iplease
NATIONAL __I 1
1
X complete
ACCREDITATION
Yes CNo below
NUMBER
#036805 Pe ,---., 0.. fro-AP,—
NOTE- International ments ma re. kar,e certification by an acceeditedNeterinananm
SIGNATURE OF USDA VETERINARIAN Apply USDA Seal or Stamp here DATE SIGNATU ISSUING V AR I
/
r dr
DATE
8/9/17
1 Pi ‘401.4et' {
APHIS Form 7001
(NOV 2010) This certificate is valid for 30 days after issu n
According to the P apenvork Reduction Act of 1995! an agency may not cond uct or sponsor, and a person is not regu red to respond to, a collection of information unless it displays a valid OMB control number. The valid OMB control numbers f or this information collecti n are 0579-0035 and 0579-0333. The time required to complete this information collection is estimated to average•.25 h ours per response, including th ti me for reviewing instructions, Searching existing data sources, gathering and maintaining the data needed and completing and reviewing the collection of information
No dos cat, nonhuman primate, or additional inds or classes of animals designated by USDA r °octagon sh all be del ivered to a y i nterrnediate handler or car rier for transportation in commerce, unless accompanied by a heath certificate executed and issued by a licensed veterinarian 17 U.S.C. 21.43.9; CFR, Subchapter A, Part 2).
OMB APPROVED 0579-0036 0579-0333
UNITED STATES DEPARTMENT OF AGRICULTURE ANIMAL AND PLANT HEALTH INSPECTION SERVICE
UNITED STATES INTERSTATE AND INTERNATIONAL CERTIFICATE OF HEALTH EXAMINATION
FOR SMALL ANIMALS
WARNING: Anyone who makes a false, fictitious, or fraudulent
i statement on this document, or uses such document knoviing it to be false, fictitious, or fraudulent may be subject to a fine of not more than $10,000 arc, imprisonment of not more thatr4 years or both (18 U.S.C.4boll? -
1. TYPE OF ANIMAL SHIPPED (select one only)
1 Dog Cat COther
2. CERTIFICATE NUMBER - OFFICIAL USE ONLY
Nonhuman Primate Ferret CRodent
3. TOTAL NUMBER OF ANIMALS tp 2
4. PAGE
1 of 1 5. NAME, ADDRESS, AND TELEPHONE NUMBER OF OWNER (CONSIGNOR) tr
Hart county Animal Rescue 5559 Bethany Bowersville road tr. Canon, GA 30520
USDA License/or Registration Number (if applicable)
r6XNAME;ADDRE5S, AND TELEPHONE NUMBER OF RECIPIENT AT DESTINATION (CONSIGNEE) Ok, kt a SaraMHill - 'ID "dariban er . 2. -4. g
9,2 Itip/ Road liet,dfine, NY 13460
— • -
7. ANIMAL IDENTIFICATION B. PERTINENT VACCINATION, TREATMENT, AND TESTING HISTORY
BREED - COMMONTOO
OR SCIENTIFIC NAME
AGE SEX
COLOR OR DISTINCTIVE MARKS OR MICROCHIP
RABIES VACCINATION
i 1 YEAR 2 YEARS 3 YEARS
OTHER VACCINATIONS, TREATMENT, AND/OR TESTS AND RESULTS NAME, AND/OR TAT NUMBER
OR OTHER IDENTIFICATION
Vaccination Date Product Date Product Type and/or Results
(I) Puppy 3 Mix 15w . F red/white 7/31/2017 Medal Ser# 22073 12) ' Puppy 4 Mix
• 15w M red/white 7/31/2017 Merial Seri* 22073
(5)
9. REMARKS OR ADDITIONAL CERTIFICATION STATEMENTS (WHEN REQUIRED) VETERINARY CERTIFICATION: I certify that the animals described in box 7 have been examined by me this date, that the information provided in box 8 is true and accurate to the best of my knowledge, and that the following findings have been made ("X" applicable statements).
Hi I
i appear animal
1 for rabies
have verified the presence of the microchip, if a microchip is listed in box 7.
I certify that the animal(s) described above and on continuation sheet(s), if applicable, have been inspected by me on this date and to be free of any infectious or contagious diseases and to the best of my knowledge, exposure thereto, which would endanger the or other animals or would endanger public health.
To my knowledge, the animal(s) described above,andionsontinuation-sheefistit applicable, originated from an area not quarantined and has/have not been exposed to rabies. I jtif,vt:rtimrtart tt.t.tttittit t ts - —I
ENDORSEMENT FOR INTERNATIONAL EXPORT (IF NEEDED) NAME, ADDRESS, AND TELEPHONE NUMBER OF ISSUINB VETERINAlkIAN ' .;; - --
; l 691 Jaime Terry ; 1087 E. Franklin Street I Suite K IAUG 1 5 20 Hartwell, GA 30643 I , 1
i 1 ,
-LICENSE NUMBER AND STATE i 7 GA I
PRINTED NAME OF USDA VETERINARIAN
Accreditio if yes, p1 as?
V complete
Yes No below
NATIONAL ACCREDITATION NUMBER I I
-0104671 - . NOTE Intemati I shi ments may re 71.- r-tn
-Nr..1 ---
certifica ire tion b an accredited Veterinarian. SIGNATURE OF USDA VETERINARIAN Apply USDA Seal or Stamp here DATE SIGNATUR ISSUI VETE
-
,-•NG ARIAN I DATE
8/9/2017 APHIS Form 7001 (NOV 2010)
This certificate is valid for 30 days a issuance
According to the Paperwork Reduction Act of 1995, an agency may not cond ud or spensor, and a person is not regu information unless it displays a valid OMB control number. The valid OMB control numbers for this information colledi The time required to complete this information collection is estimated to average .26 h ours per response, including the searching existing data sources, gathering and maintaining the data needed, and completing and revreamg the collection
red to respond to, a collection of flare 0579-0036iand 0579-0333.
ti me for reviewing instructions, f information
No dog, cat, nonhuman primate, or additional inds or classes of animals designated by USDA r egulation sh all be del Dered to any i ntermediate handler or car rier for transportation in commerce, unless accompa ied by a health certificate executed and issued by a licensed veterinarian (7 U.S.C. 21.43.9; CFR, Subchapter A, Part 2).
OMB APPROVED 0579-0036 0579-0333
UNITED STATES DEPARTMENT OF AGRICULTURE ANIMAL AND PLANT HEALTH INSPECTION SERVICE
UNITED STATES INTERSTATE AND INTERNATIONAL CERTIFICATE OF HEALTH EXAMINATION
FOR SMALL ANIMALS
WARNING: Anyone who makes a false, fictitious, or fraudulent statement on or
1. TYPE
i
OF ANIMAL SHIPPED (select one only)
Dog flCat Other
2. CERTIFICATE NUMBER - OFFICIAL USE ONLY
this document, uses such document knowing it to be false, fictitious, or fraudulent may be subject to a
Nonhuman Primate Ferret Li Rodent
fine of not more than $10,000 or ,, imprisonment of not more thant years or both (113 U.S.C...1.01)V-
3 TOTAL NUMBER OF ANIMALS .- - 3
4. PAGE
1 of 1 5. NAME, ADDRESS, AND TELEPHONE NUMBER OF OWNER (CONSIGNOR) &'rJ40
county Animal Rescue dc°
5559 Bethany Bowersville road ti ta Canon, GA 30520
USDA License/or Registration Number Of applicable)
e Animal RescueCdHart
n6.xNAME;;ADDRESS, AND TELEPHONE NUMBER OF RECIPIENT AT DESTINATION (CONSIGNEE) f.„ :- -
• Hoa1
k.ppW ynAd,.
-• LrraceForster
orb. d t) 51;eloss Road -t; --.;; ,- atteTSon, NY 12563
7. ANIMAL IDENTIFICATION 8. PERTINENT VACCINATION, TREATMENT, AND TESTING HISTORY
NAME, AND/OR TATTOO NUMBER OR OTHER IDENTIFICATION
BREED - COMMON OR SCIENTIFIC
NAME AGE SEX
COLOR OR DISTINCTIVE MARKS OR i
RABIES VACCINATION
1 YEAR 2 YEARS 3 YEARS
OTHER VACCINATIONS, TREATMENT, AND/OR TESTS AND RESULTS
MICROCHIP Vaccination Date Product Date Product Type and/or Results
(I) Larry Lab-X 4m M Black/White 8/1/2017 Merle! Ser# 22073
Curley Sue Lab-X 4m F Black 8/1/2017 Merial Set* 22073 Moe Lab-X 4m M Black 8/1/2017 Merial Ser# 22073
9. REMARKS OR ADDITIONAL CERTIFICATION STATEMENTS (WHEN REQUIRED) VETERINARY CERTIFICATION: I certify that the animals described-in box? have been examined by me this date, that the information provided in box 8 is true and accurate to the best of my knowledge, and that the following findings have beentmade ("X" applicable statements).
i
/ appear animal
i for rabies
I have verified the presence of the microchip, if a microchip is listed in box 7. •
I certify that the animal(s) described above and on continuation sheet(s), if applicable, have been inspected by me on this date and to be free of any infectious or contagious diseases and to the best of my knowledge, exposure thereto, which would endanger the or other animals or would endanger public heath.
To my knowledge, the animal(s) described above and on continuation sheet(s) if applicable, originated from an area not quarantined and has/have not been exposed to rabies.
ENDORSEMENT FOR INTERNATIONAL EXPORT (IF NEEDED) NAME, ADDRESS, AND TELEPHONE NUMBER OF ISSUING VETERINARIAN LICENSE NUMBER AND STATE
7691 GA • PRINTED NAME OF USDA VETERINARIAN Jaime Terry 1087 E. Franklin Street Suite K Hartwell GA 0643 ,
NOTE: In ational shipments ma equire certification by an accredited veterinarian.
Accredited If yes, please
i complete
Yes C No below
NATIONAL ACCREDITATION NUMBER
010467 SIGNATURE OF USDA VETERINARIAN Apply USDA Seal or Stamp here DATE SIG E OF ISSUING VE RINARIAN
-/-)
DATE . 8/1/2017
API-US Form 7001 (NOV 2010) '
This certificate is valid for 30 dá4s after issuance
CERTIFICATE VOID 30 DAYS FROM INSPECTION DATE
State Veterinarian's Office Agriculture Building Capitol Square Atlanta, Georgia 30334
No. CF- 00241 GEORGIA DEPARTMENT OF AGRICULTURE CERTIFICATE OF VETERINARY INSPECTION
ed on this certificate CERTIFICATE OF OWNER/AGENT The anirr als in this shipment are those certified and I
-
CONSIGNOR OR SHIPPER
L5COL-OS
CONSIGNEE OR RECEIVERcm ri:39kek_Sc. tV1010 kir
DATE ANIMALS INSPECTED
n- 2`c • Li CONSIGNOR'S NAIS PREMISES ID.
go. Bo•r 2.-(0 A-te_. DATE CERTIFICATE LISUED
1 . 2-te• I 7 30L-{ ca...-Fon
\7"1 CLaCe2k 1 5041%---- e-BY00 kli--) n , 0 'I ( 12-1 .t.
No. ANIM PMENT ENTRY PERMIT NUMBER
X Species X \-6pecies X Purpose of Movement X Area Status Herd or Flock Status
Cattle Ratite Breeding Accredited Free TB Accredited Herd No.
Horses Cervidae Feeding Modified Accredited TB Certified Herd No.
Swine ) Dogs Show Free - Brucellosis Validated Herd No.
Goats Cats Slaughter Class A - Brucellosis Qualified Herd No.
Sheep Other IL. Other cv-e g cAkc ) Class B Brucellosis Monitored Feeder Pig Herd No.
Poultry
Individual ID: Official Eartag, Breed Registration Ear Tattoo or Breed
Registration Firebrand
i Description of Animal or Registry Name and Number
A g e
S e x
B r e e d
Bruc.
Tattoo Vac.
Brucellos's Test Date
;rest I.
rabtrotAAe
EIA Test Date
Pr. e
PAL e-.0
Other Test / Immunization Date
04411°1- (.9
Other Test / Immunization Dale
g;ovciefe(t
Results
Lab etr - 4r. R esults Include Lab & Accession No. Results Results Results 72-14r-RES017-4
nri -9 k
birma re) s
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th
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n: 240 inc li Iv Cno5t gtloRn - -IS,n 1 3- -7 1
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6
7
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9
10
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11
12 -................%\,,....s.....„......
13
14
15
CERTIFICATE OF ISSUING VETERINARIAN I certify as an accredited veterinarian tha the described animals have been inspected by me and that they are not showing signs of infectious contagious ancVor commun ble disease. The vaccination and results of tests are as indicated on the certificate. To the best of my knowledge, the animals listed on this certificate
et th ate of destinalon and F de al itrstate requirements o further warrantyLigade or impled.
Accred tAti ' rneilrec u.Dct
Veteripariat (Signature) AddLefis
0 pi b i vtuo., frrsokflq 5-7L01 rint Name City, State, Zip Ga. License No.
tr i bes 01111,r/Ag: t (Signature)
Original and Blue copies to be forwarded to State Veterinarian's Office. Retain Pink. Yellow copy to accompany shipment.
State Veterinarian's Office Agriculture Building Capitol Square Atlanta, Georgia 30334
GEORGIA DEPARTMENT OF AGRICULTURE CERTIFICATE OF VETERINARY INSPECTION No. CF- 00242
CERTIFICATE VOID 30 DAYS FROM INSPECTION DATE
CONSIGNOR OR SHIPPER
SID 1CWS CONSIGNEE OR RECEIVER
1/4tY0Mait- &we, 4 Rtreu3 DATE ANIMALS INSPECTED
1- 25--17 CONSIGNOR'S NAIS PREMISES ID.
c• 0 :&)1 0 2-to LEcteo P1-- g Ivorfi-1 DATE CERTIFICATE ISSUED -7 •2s--- • )7
V i actiU ck 1 act 3 puns COri A-1-11‘ I li j 12-SIT 2 _ No. ANIMALS IN SHIPMENT
5 ENTRY PERMIT NUMBER
X Species X Species X Purpose of Movement X Area Status Herd or Flock Status
Cattle Ratite Breeding Accredited Free TB Accredited Herd No.
Horses Cervidae Feeding Modified Accredited TB Certified Herd No.
Swine N.IC, Dogs Show Free - Brucellosis Validated Herd No.
Goats Cats Slaughter Class A - Brucellosis Qualified Herd No.
Sheep Other /.....J Other C a S(JJ•e_,) Class B Brucellosis Monitored Feeder Pig Herd No.
Poultry
Individual ID: Official Eartag, Breed Registration Ear Tattoo or Breed
Registration Firebrand
Description of Animal or Registry Name and Number
Hot g e
S e x
B r e e d
Bruc. Vac.
Tattoo
Brucellos's Test Date
TB Test Inj.
EIA Test Date
PRV Test Date
Other Test / Immunization Date
Olde-4C11
Other Test! Immunization Date
CAF42V Lab Obs. Results Include Lab & Accession No. Results Results Results Results 72 Hr. Results
1 1) V flA 0 IA-5 VA Chef tfiAn itAVE I " 2-SM 11 1 /V - 17 2 Va•Invt gd• • RAJ DI 47. lack tvikii-li ' mik )
Inttttorlk 14,14 -7- II • 1-1 1 -11 -I-1
3 t 1 t i AI 4 4;5 EMI
Ift AN 1
i j 5 -44- lit ft\
6
7
8
\ N.1
9
10
11
12
13 •••—•
14
15
CERTIFICATE OF ISSUING VETERINARIAN I certify as an accredited veterinarian that the described animals have been inspected by me and that they are not showing signs of infectious contagious and/or comm flicable disease. The vaccination and results of tests are as indicated on the certificate. To the best of my knowledge, the animals fisted on this certificate
eet tPj state otdes • ation an1l Federal interstate requirements. No further warranty is madeo implied. 6) c_co mntrchw
PrintPeer°
Accre d Vte aria Acl 'rasa &&
l q- Print Name City, State, Zip Ga. Licen e Mo.
CERTIFICATE OF OWNER/AGENT h animals in this shipment are those certified and listed on this certificate
Owner/Agent ature)
Original andtlue copies to be forwarded to State Veterinarian's Office. Retain Pink. Yellow copy to accompany shipment.
CERTIFICATE
Original and B ue copies to be forwarded to State Veterinarian's Office. Retain Pink. Yellow copy to accompany shipment.
The an als in this shipment are those certified and listed on this certificate
Signa ) 0
State Veterinarian's Office Agriculture Building Capitol Square Atlanta, Georgia 30334
GEORGIA DEPARTMENT OF AGRICULTURE CERTIFICATE OF VETERINARY INSPECTION No. CF- 00204
CERTIFICATE VOID 30 DAYS FROM INSPECTION DATE
CONSIGNOR 0 IPPER 5 CONSIGHWECEIVE__,
Litto )24-,
j
1
\o/Of 4
Ho lith 1DATE
DATE ANIMALS INSPUTED
CERTIFICATLISSUED
0 AY 1 7
CONSIGNOR'S NAIS PREMISES ID.
P-0. ;0)6 ?to
16daditi ` " o q go in r co .----„,,-f-t_, ND Li , t 20 2-2. No. ANIMALS IN SHIPMENT .3 ENTRY PERMIT NUMBER
X Species X Species X Purpose of Movement X Area Status Herd or Flock Status
Cattle Ratite Breeding Accredited Free TB Accredited Herd No.
Horses Cervidae Feeding Modified Accredited TB Certified Herd No.
Swine Dogs Show Free - Brucellosis Validated Herd No.
Goats 1E
Cats Slaughter Class A - Brucellosis Qualified Herd No.
Sheep Other t Other Crt fa(t) Class B Brucellosis Monitored Feeder Pig Herd No.
Poultry
Individual ID: Official Eartag, Breed Registration Ear Tattoo or Breed
Registration Firebrand
Description of Animal or Registry Name and Number
A g e
S e x
,
B r e e d
Bruc. Vac.
Tattoo
Brucellosis Test Date
TB Test Inj.
r fr te
(2-CFWAV
PRV t
ta. '
Other Test / Immunization Date
.•60.,
Other Test / Immunization Date Dore
Lab Obs. Results Includ ab & Ac ssion No. Results Results Results Results 72 Hr. Results
1 Anirli 4 t. lettctte, ear% Tlipatitnif n lot trio 840.0 6.117 2 Caitt e., —}-yi co to r Pf-..) he p..v.ol . m 'tin in Ick e-2,3.1-7 c) . as 47 E -9. q 3 le—oacu r--
, WILI IC 7.060 In MCA- 1 - 19) - r7 vyta._, 1. (8 - n h (a_...
4 (1111J7
5 •
6
7
a
9
10
\ N \
_ i
11
----: 12 nro 7
13 I
14 1
15 i
CERTIFICATE OF ISSUING VETERINARIAN I certify as an accredited veterinarian t a the described animals have been inspected by me and that they are not showing signs of infectious contagious and/or corm icable disease. The vaccinatio and results of tests are as indicated on the certificate. To the best of my knowledge, the animals listed on this certificate meet state o de ination a d Feet I interstate requirements. No further warranty is made or im led,
PVInVirefr W
err Ve eri arian (ag2a_ttit ilr:'
I III
Addrersagi
ikiCirk ALtiti Print
— Print Name City, State, Zip U Ga. License No.
CERTIFICATE VOID 30 DAYS FROM INSPECTION DATE
State Veterinarian's Office Agriculture Building Capitol Square Atlanta, Georgia 30334
No. CF- 00240 GEORGIA DEPARTMENT OF AGRICULTURE CERTIFICATE OF VETERINARY INSPECTION
CERTIFIC TE OF OWNER/AGENT
4 CONSIGcc CONSIGNOR OR NPIDER ir
StwAtt OR RECEIVER r.
430Litt, A- ?Jai DATE ANIMALS INSPECTED
i- m • (I CONSIGNOR'S NAIS PREMISES ID.
. (10 ibo 1C 'MO two 0—• q rroyti., DATE CERTIFICATE
1.14.0 ISSUED
V1:104tit1 V SOU-1K Cenerktk . Nil i 7- r 7 2 No. ANIMAflI9 SHIPMENT ENTRY PERMIT NUMBER
X Species X Species X Purpose of Movement X Area Status Herd or Flock Status
Cattle Ratite Breeding Accredited Free TB Accredited Herd No.
Horses Ceividae Feeding Modified Accredited TB Certified Herd No.
Swine 'IP Dag,,s. Show Free - Brucellosis Validated Herd No.
Goats "k-C oats.") Slaughter Class A - Brucellosis Qualified Herd No.
Sheep Other Y.. other viSartli Class B Brucellosis Monitored Feeder Pig Herd No.
Poultry
Individual ID: Official Eartag, Breed Registration Ear Tattoo or Breed
Registration Firebrand
Description of Animal or Registry Name and Number
A g e
S e x
B r e e d
Bruc. Vac.
Tattoo
Brucellos's Test Date
TB Test Inj.
EIA Test Date
PRV Test Date
Other Test / Immunization rearmie, tri out/.
Other Test / Immunization Date
Lab Obs. Results Include Lab & Accession No.
es,,N KAAA to Results Results Results Results 72 Hr. Results
1 ,4 tAbg,\-4q to-biej lui v PW -to no, r tr2.9.- 11 2 li s 3 W
1
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I
5 t4
X
, 6 t4 4/ ,' r 4 V 7
8
--------s...N\ 9
10
11
12
13
14
15
CERTIFICATE OF ISSU NO VETERINARIAN I certify as an accredited veterinarian tha the described animals have been inspected by me and that they are not showing signs of infectious contagious and/or commu able dise e The vaccin,tion and resi4ts of tests are as indicated on the certificate. To the best of my knowledge, the animals listed on this certificate
et th stateolds irwtion
../ Accredlt8d Veteri arian (Signau
men' (V._ ell/Die, Print Name
requirements. No further warranty is made or implied.
ccO 0-ttSV/1 \eint Address.
City, State, Zip Ga. License No
The anim# in this shipment are tho4 certified and listed on this certificate
Owner
Original and Blue copies to be forwarded to State Veterinarian's Office. Retain Pink. Yellow copy to accompany shipment.
CERTIFICATE VOID 30 DAYS FROM INSPECTION DATE
State Veterinarian's Office Agriculture Building Capitol Square Atlanta, Georgia 30334
No. CG- 0 7 4 7 8 GEORGIA DEPARTMENT OF AGRICULTURE CERTIFICATE OF VETERINARY INSPECTION
CONSIGNOR OR SHIPPER
AfrA7fAi446- da04Tto1/4,fitik*pmwak-0.4 CONSIGNEE OR RECEIVER
,..4,.... Rug gestat. DATE ANIMALS INSPECTED
9/L7 i ( -3--
CONSIGNOR'S NAIS PREMISES ID.
11° igerr ClefidC Retair /(040 teuvLA-z U. 513-b-350-24:42_ DATE CERTIFICATE ISSUED
i t 1-avm,frA. 64 30553 7.4-35{,- c3,,,iveverope. , ,._ . wv 13 get
No. ANIMALS IN SHIPMENT
S ENTRY PERMIT NUMBER
X Species ) X I Species X Purpose of Movement X Area Status Herd or Flock Status
Cattle Ratite Breeding )( Accredited Free TB Accredited Herd No.
Horses Cervidae Feeding Modified Accredited TB Certified Herd No.
Swine Dogs Show X. Free - Brucellosis Validated Herd No.
Goats I Cats Slaughter Class A - Brucellosis Qualified Herd No.
Sheep Other X Other ktic,„e, Class B Brucellosis Monitored Feeder Pig Herd No.
Poultry
Individual ID: Official Eartag, Breed Registration Ear Tattoo or Breed
Registration Firebrand
Description of Animal or Registry Name and Number
A g e
S e x
B r e e d
Bruc. Vac.
Tattoo
Brucellos's Test Date
TO Test Inj.
EIA Test Date
PRV Test Date
Other Test / Immunization Date
Other Test / Immunization Date
Lab Obs. Results Include Lab & Accession No. Results Results Results Results 72 Hr. Results
1 frt.-4-X tiAnl 6 4,410I'VYNI AZ49-.. 7,,, ft} fig- gt-lsi 740 m
mirm: 2
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3 thpri"- illfw NI
4 (A)ketk CM rpi "wet. -Adm rAtcx 1 I 5 .6 go„...---te-- eitper shoo tA (Alt
6
7
8
9
10 t
1 i ----. I
12 err I
13 "1 l 0 ZU / I I
14 _ I
15 ,•. ,, •p , I
CERTIFICATE OF ISSUING VETERINARIAN I certify as an accredited veterinarian that the described animals have been inspected by me and that they are not showing si ns of infectious contagious and/or communicable disease. The vaccination and results of tests are as indicated on the certificate. To the best of my knowledge, t e animals listed on this certificate meet the state of d fion and Federal interstate requirements. No further warranty; made or implied.
7 Accredi id Veterinarian (Signatusp) dres eik
(4-t \‘‘k. 1)6 (14— CsA-1 tGzA 4(11(4_ Print me ty, State, Zip Ga. License No.
CERTIFICATE OF OWNER/AGENT •
The animals in this shipment are those certified a
COAAAAA.._ /Agent (Signature)
on this certificate
Original and Blue copies to be forwarded to State Veterinarian's Office. Retain Pink. Yellow copy to accompany shipment.
According to the Paperwork Reduction Act of 199$ an agency may not conduc or sponsor, and a person is not regu red to respond to, a collection of information unless it displays a valid OMB control number. The valid OMB control numbers for this information collection are 0579-0036 and 0579-0333. The time required to completethis Information collection is estimated to average .25 hours per response, including I e time for reWewIng Instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.
No dog, cat, nonhuman primate, or additional kinds or classes of animals designated by USDA regulation shall be delivered to any intermediate handier or carrier for transportation in commerce, unless accompa ied by a health.certificate executed and Issued by a licensed veterinarian (7 U.S.C. 21.43.9; CFR, Subchapter A, Part 2).
. OMB APPROVED 0579-0036 0579-0333
UNITED STATES DEPARTMENT OF AGRICULTURE ANIMAL AND PLANT HEALTH INSPECTION SERVICE
UNITED STATES INTERSTATE AND INTERNATIONAL CERTIFICATE OF HEALTH EXAMINATION
FOR SMALL ANIMALS
WARNING: Anyone who makes a false, fictitious. or fraudulent statement on this document, or uses such document knowing it to be false, fictitious, or fraudulent may be subject to a fine of not more than $10,000 or impdsonment of not more than 5 years or both (18 U.S.C. 1001).
X
1. TYPE OF ANIMAL SHIPPED (select one only)
Dog Cat Other
1. CERTIFICATE NUMBER
1
Nonhuman Primate Ferret Rodent
3. TOTAL NUMBER OF ANIMALS 3
4. PAGE
1
6. NAME, ADDRESS, AND TELEPHONE NUMBER OF OWNER (CONSIGNOR)
Northeast Georgia Animal Shelter 870 Bear Creek Rd Lavonia, GA 30553 706-356-5363
USDA License/or Registration Number (if applicable)
6. NAME, ADDRESS, AND TELEPHONE NUMBER OF RECIPIENT AT DESTINATION (CONSIGNEE)
Whispering Pines 1540 Lewis Road Waterville, NY 13480 570-350-2642
7. ANIMAL IDENTIFICATION 8. PERTINENT VACCINATION, TREATMENT, AND TESTING HISTORY
NAME, AND/OR TATTOO NUMBER OR OTHER IDENTIFICATION
BREED - COMMON OR SCIENTIFIC
NAME AGE SEX
COLOR OR DISTINCTIVE MARKS OR MICROCHIP
X
RABIES VACCINATION
1 YEAR 02 YEARS 3 YEARS
OTHER VACCINATIONS, TREATMENT, AND/OR TESTS AND RESULTS
Vaccination Date Product Date Product Type and/or Results
CU Milo Husky 6y M/N Black/A/hit° 09/13/17 Defensor 1
Pixey Shih Tzu Mix 2Y F/S Chocolate 09/13/17 Defensor 1
Cindy Lou Chihuahua 2y F/S Ten 09/13/17 Defensor 1
9. REMARKS OR ADDITIONAL CERTIFICATION STATEMENTS (WHEN REQUIRED)
Cr
VETERINARY information
CERTIFICATION: I certify that the animals described in box 7 have been examined by me this date, that the provided in box 8 is true and accurate to the best of my knowledge, and that the following findings have been made
applicable statements).
;I
animal
I have verified the presence of the microchip, If a microchip is listed In box 7.
I certify that the animal(s) described above and on continuation sheet(s), if applicable, have been inspected by me on this date end er to be free of any infectious or contagious diseases and to the best of my knowledge, exposure thereto, which would endanger the
or other animals Of would endanger public health.
X for rabies
To my knowledge, the animal(s) described above and on continAldraaiakaailiCkible, originetecilfrom an area not quarantined and has/have not been exposed to rabies. I SI-Or of nrorXia I
ENDORSEMENT FOR INTERNATIONAL EXPORT (IF NEEDED) NAME, ADDRESS, AND TELEPHONE NUMBER OF ISSUING
I I Dr. Laura Yetzina Royston Animal Hospital 2888 W Main Street 1 Royston Ga, 30662 I
I
VETERINARIAN
SEP 1 9 201' 7488 GA
LICENSE NUMBER AND STATE I
i 1 PRINTED NAME OF USDA VETERINARIAN
Accredited If yes, please . .
005848
NATIONAL ACCREDITATION
X complete
Yes No below
NUMBER 708-245-6650 Rohr,: NI CIIIO% cf MIA
NOTE: International shipments may require certificationI,by an accreddet4tir 1
SIGNATURE OF USDA VETERINARIAN Apply USDA Seal or Stamp here DATE SIGNA RE OF ISSUING VETERINARIAN DATE
09/13/17 CCUV`0% Nin-g-'
APHIS Form 7001 (APR 2010)
This certificate is valid for 30 days after issuance
PART S - USDA OR STATE VETERINARIAN
The animals in this shi ent are those certified an
Owner/Ag Signature)
ted on thi certificate i
Original and Blue copies to e forwarded to S Retain Pink. Yellow copy to accompany ship
e Veterinarian's Office ent.
State Veterinarian's Office Agriculture Building Capitol Square Atlanta, Georgia 30334
GEORGIA DEPARTMENT OF AGRICULTURE CERTIFICATE OF VETERINARY INSPECTION No. CF- 00211
CERTIFICATE VOID 30 DAYS FROM INSPECTION DATE
CONSIGNOR OR SHIPPE
RDICS(P5
CON GNE OR RE
S
VER
KO Oblar
DATE ANIMALS INSPECTED
,(' q is., 7 CONSIGNOR'S NAIS PREMISES ID,
Q 'p. 'Bch/ IA 0 94 CpLA-on Ave, . DATE CERTIHgTEII, ED
VattkINC . (611 /2DLr15 CB1(0° yy i put 1.--2-tg No. ANI I HIPMENT ENTRY PERMIT NUMBER
X Species X Species X Purpose of Movement) X Area Status Herd or Flock Status
Cattle Ratite Breeding Accredited Free TB Accredited Herd No.
Horses Cervidae Feeding Modified Accredited TB Certified Herd No.
Swine )C Dogs Show Free - Brucellosis Validated Herd No.
Goats Cats Slaughter ________ Class A - Brucellosis Qualified Herd No.
Sheep Other 1, Other Lir) Class B Brucellosis Monitored Feeder Pig Herd No.
Poultry
Individual ID: Official Eartag, Breed Registration Ear Tattoo or Breed
Registration Firebrand
Description of Animal or Registry Name and Number
1
Co
o
S e x
B r e e d
Bruc. Vac.
Tattoo
Bri.er T Date ,
MCCArDikte .t.firtra .±E.
TB Test In].
EIA e
PD:Wries" t•--- e lesti:41_,0
Other Test / Immunization Date
TorclettlA
Other Test / Immunization Date
Potcry Results
Obs. esults Inclurt& A ssion No. Results Results Beewffes 72 Hr. Results
-1-tby-,eu 131cc-kri-tot,i- tr, otn,Nr% kiatety, al • s .1 sirtiP 5-3 -n 2 9.Apo .6 -1-...A., tin, nry,-, los sc __. al-s•liss s -5-1-1 -I- 2-t • 17 43-2-* [7
2 • (1 --hain eirn IV/3 111010&"11 — 9. 6. li- €?? 6.11 1 • g-i . II 3 CA,-It.:St.
4 aleifik 4 blue- -r LikAve i.,_ pir -4 env:to-Ho - .453(.0 es- 5 • (7 (4-2-1• rt Co • ( • ("7 1/45. 11 5 0--VAVIifek tat id +an 2 3/ 5 01 *A0440% Sitk-f 61.S- • 11 62. 13- n 4-22 I1 .°1-5. 11 6 a J- ebta c k- i ink owvoNay cletss000y • ... 21201 3•1-1 1311-il E-3 1-1 9,31 -1
7 Ca —131&Q1C--HeLie-‘ (IA ,micaphef 1- i, 617203044v snsii 12/11 5-317 43 • 12-17 t• 12-1- ui va•ic,..v_ paktstxt_, vw-, 415 kot444).0 ctS2,000 4-0 (i 21 3q c--- ta -3 • ll (2,4 ( • I-1 s 73.11 Z.s..."---/ , 8 Lim;
9 --AD-MA— 0,) U1/4-4-41-, 1.j IIVIJ 11,0€ rifty 462-00o trit) Co 1 I'S I • 1 Cc' 11
10
II bt,' 2 0 2D17 I
12 i
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14 ....ss%*%..„„,...................... ....i
I
15 CERTIFICATE OF ISSUING VETER NARIAN I certify a an accredited vetednarian the the described animals have been inspected by me and that they are not showing signs of infectious contagious and/or communi ble disease. The vaccination and results of tests are as indicated on the certificate. To the best of my knowledge, the animals listed on this certificate
eet the tate of destine on and F deraltt terstate requi ements. No further warranty is made or impli d.
eXYt_
red etenganan (Signature)
MCnr I
Print Name --
,SOD LomP1W D3C1 Addryn AttAildvat470 rin City, State, Zip Ga. License NJ.
CERTIFICATE VOID 30 DAYS FROM INSPECTION DATE
State Veterinarian's Office Agriculture Building Capitol Square Atlanta, Georgia 30334
No. CF- 00210 GEORGIA DEPARTMENT OF AGRICULTURE CERTIFICATE OF VETERINARY INSPECTION
CONSIGNOR OR SHIPPER
SOAPS
CONSIGNEE ATIVER
1 in naaci: awe n Si -ray DATE ANIMALS
f • INSPECTED
fl CONSIGNOR'S NAIS PREMISES ID.
P.o. Box 9,10 LAV60 PT- q /U. DATE4ER IFIC1 ISSUED
V daliaielA 30C-I lg C Orn i t-h 1 09 I at a D o AL IN SHIPMENT
It ENTRY PERMIT NUMBER
X Species X Species X Purpose of Movement X Area Status Herd or Flock Status
Cattle Ratite Breeding Accredited Free TB Accredited Herd No.
Horses Cervidae Feeding Modified Accredited TB Certified Herd No.
Swine sk Dogs Show Free - Brucellosis Validated Herd No.
Goats Cats Slaughter Class A - Brucellosis Qualified Herd No.
Sheep Other sf, Other ( acad.)) Class B Brucellosis Monitored Feeder Pig Herd No.
Poultry
Individual ID: Official Eartag, Breed Registration Ear Tattoo or Breed
Registration Firebrand
Description of Animal or Registry Name and Number
A g e
S e x
B r e e d
Bruc. Vac.
Tattoo
Brucelloss ' Test Date
TB Test Inj.
EIA i
e TOV/ IZC-re
rd.- tab \
1 _
Other Test / Immunization Date
cori-PPv
Other Test / Immunization Dale
)0.41.ede2 Lab Obs. Resul lnctØetab 8, AeCesslon No. Results Results Results Results 72 Hr. Results
i A lune a 41 -T5 va on PIO Put niA 4b0 ea, 1 - I • 17 c?)-is---t .- 2 tA
-frt gesevteN t" V/Ift-a-ti 1110 V IR ''I g 4. ii c? • Cr 1 j 3 ?-6041 ht e7 g-I to lova e f ict) F 4 IA -A2 33 tart+-cui-A-c--Ehttol F
In 5 IA
6 a
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1
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1
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OW Vivac.
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14 _ _
15
CERTIFICATE OF ISSUING VETERINARIAN I certify as an accredited vetednarian tha the described animals have been inspected by me and that they are not showing signs of infectious contagious and/or communicable disease. The vaccination and results of tests are as indicated on the certificate. To the best of my knowledge, the animals listed on this certificate me the st e of destination and Fed I interstate requirements. No further warranty is made or in lied.
Addr 4 Accredited Veterinarian (Sign re)
"Ifinnric (i/YRAiir-DVL Vs
y • 3 MilLi -5S-14 Print Name City, State, Zip Ga. License No.
et vz....-531e31it
The ni als in thi sh. ent are those certified d Isted on this certificate CERTIFICATE OF
Owner/Age (Signature)
Original and Blue copies orward tate Veterinarian's Office. Retain Pink. Yellow copy to accompany s ipment.
CERT FICATE OF OWNER/AGENT The ani Is • this shipment are those certified and listed on this certificate
ner/Age gn
Original and Blue copies to be forwarded to State Veterinarian's Office. Retain Pink. Yellow copy to accompany shipment. Print Name
State Veterinarian's Office Agriculture Building Capitol Square Atlanta, Georgia 30334
GEORGIA DEPARTMENT OF AGRICULTURE CERTIFICATE OF VETERINARY INSPECTION No. CF- 00214
CERTIFICATE VOID 30 DAYS FROM INSPECTION DATE
CONSIGNOR OR SHIPPER
S°V91()S
CONSIGNEE OR RECEIVER .
401 1,4\rav,c401/4.-IC Scwe ICI WeA-4-1 DATE ANIMALS INSPECTED
9 , 3 •ti CONSIGNOR'S NAIS PREMISES ID.
P- 0 ` e CI 1/4P Q41--) (-Kar0 /2+ ' q Oa
DATE CERTIFICATE ISSUED
1 ' IS ' I M
Vga—uCc‘ oliq a"--ns-- t Celn\fc-fizt wL
1-1e22_ k-
2 No. ANI ...... SHIPMENT ENTRY PERMIT NUMBER
X Species X Species X 41 Purpose of Movement X Area Status Herd or Flock Status
Cattle Ratite Breeding Accredited Free TB Accredited Herd No. Horses Cervidae Feeding Modified Accredited TB Certified Herd No. Swine .y-, Dogs Show Free - Brucellosis Validated Herd No. Goats Cats Slaughter Class A - Brucellosis Qualified Herd No. Sheep Other Other (viaScik,C) Class B Brucellosis • Monitored Feeder Pig Herd No. Poultry
Individual ID: Official Earlag, Breed Registration Ear Tattoo or Breed
Registration Firebrand
Description of Animal or Registry Name and Number
A g e
S e x
B r e e d
Bruc. Vac.
Tattoo
Brucellos's Test Date
TB Test Inj.
EIA Test Date
PRV Test Date
Other Test / Immunization Date
Other Test / Immunization Date
DICIPPV 1- Lab Obs. Results Include Lab & Accession No. Results Results 1-11 Results Results 72 Hr. Results
I eIA/64/15100(00--g I EIYAt\A-1.0 I Lie, c FAW/544 LI e- i ern 2 ti 4k2- PS \Nile (Alikli-ei ..g. 3 I 1 +3,r s \roitt Uhijit/ V 4 it It I Y1 v RNA\--0 C
ii 5 4 tic -1e5)InVOAC-1 WIL1)1' I V V .1 6
7
8 _..
9 — ' r i
10 \se... .................N
3 I I
bilk 11
\
I I 12
1 13 i
s
14
15 CERTIFICATE OF ISSUING VETERINARIAN I certify as an accredited veterinarian that the described animals have been inspected by me and that they are not showing signs of infectious contagious and/or communicable disease. The vaccination and results of tests are as indicated on the certificate. To the best of my knowledge, the animals listed on this certificate m et the tate of destin lion and e te li i nte tate re uirements. No further warranty ' ade or . lied.
A e t Immeyai way
vract-vol Rai-F-14 npa
City, State, Zip J Ga. License No.
According to the Paperwork Reduction Act of 1995! an agency may not ccnd uct or sponsor, and a person is not rabbi red to respond to, a collection of information unless it displays a valid OMB control number. The valid OMB contr I numbers for this information collodion are 0579-0036 and 0579-0333. The time required to complete this information collection is estimated to avera e .25 h ours per response, including th ti me for reviewing instructions, Searching existing data sources, gathering and maintaining the data needed, and completingand reviewing the cottection of information
No dog, cat, nonhuman primate, or addibonal kinds or classes of animals designated by USDA r egulation sh all be del ivered to any i ntennediate handler or car rier for transportation in commerce, unless accompanied by a heal th certificate executed and issued by a licensed veterinarian (7 US.C. 21.43.9 CFR, Subchapter A, Part a
0M8 APPROVED 0579-0036 0579-0333
UNITED STATES DEPARTMENT OF AGRICULTURE ANIMAL AND PLANT HEALTH INSPECTION SERVICE
UNITED STATES INTERSTATE AND INTERNATIONAL CERTIFICATE OF HEALTH EXAMINATION
FOR SMALL ANIMALS
WARNING: Anyone who makes a false, fictitious, or fraudulent statement on this document, or uses such document knoWng it to be false, fictitious, or fraudulent may be subject to afine of not more than $10,000 or.,-/ imprisonment of not more thah-N years or both (18 U.S.C.48131It ..
1. TYPE OF ANIMAL SHIPPED (select one only)
V Dog fl Cat COther
2. CERTIFICATE NUMBER - OFFICIAL USE ONLY
Nonhuman Primate Ferrel Rodent
3. TOTAL NUMBER OF ANIMALS
1
4. PAGE
1 of 1 -
5. NAME, ADDRESS, AND TELEPHONE NUMBER OF OWNER (CONSIGNOR)
rn .4
Lake Hartwell Veterinary Clinic r:4 1087 E. Franklin Street
Suite K Hartwell, GA 30643
'e
USDA License/or Registration Number (if applicable)
Mr-NAME:ADDRESS, AND TELEPHONE NUMBER OF RECIPIENT AT DESTINATION (CONSIGNEE) ()IC 'ciaNi ..,4 Stff
lifewsilverstein
474irE tsth Street
--7 - ork, NY 10075
—
T. ANIMAL IDENTIFICATION 8. PERTINENT VACCINATION, TREATMENT, AND TESTING HISTORY
NAME, AND/OR TATTOO NUMBER OR OTHER IDENTIFICATION
BREED - COMMON ' OR SCIENTIFIC
NAME AGE SEX
COLOR OR DISTINCTIVE MARKS OR MICROCHIP
RABIES VACCINATION
i 1 YEAR C2 YEARS 3 YEARS
OTHER VACCINATIONS, TREATMENT, AND/OR TESTS AND RESULTS
Vaccination Date Product Date Product Type and/or Results
(I) Angelica Chihuahua-X 14w F Brown 8/28/2017 Medal Ser# 22073 8/10/2017 DHLP
8/10/2017 Bordetella
8/26/2017 Dhpp
0)
9. REMARKS OR ADDITIONAL CERTIFICATION STATEMENTS (WHEN REQUIRED) VETERINARY CERTIFICATION: I certify that the animals described in box? have been examined by me this date, that the information provided in box 8 is true and accurate to the best of my knowledge, and that the following findings have been made ('X" applicable statements).
i
1 appear animal
i
I have verified the presence of the microchip, if a microchip is listed in box 7.
I certify that the animal(s) described above and on continuation sheet(s), if applicable, have been inspected by me on this dale and to be free of any infectious or contagious diseases and to the best of my knowledge, exposure thereto, which would endanger the or other animals or would endanger public heath.
To my knowledge, the animal(s) described above and on continuation sheet(s) if applicable, originated from an area not quarantined for rabies and has/have not been exposed to rabies. ---- I
ENDORSEMENT FOR INTERNATIONAL EXPORT (IF NEEDED) NAME, ADDRESS, AND TELEPHONE NUMBER OF ISSUING VETERINARIAN .1.0 '' [LICENSE NUMBER AND STATE I PRINTED NAME OF USDA VETERINARIAN
. 7691 QA
i I Jaime Terry 1087 E Franklin Street Suite K
SEP 1 4 2, i
A If
ccreditel yes, plea i e
vi . complete
Yes U No below
Hartwell, GA 30643 NATIONAL
-0104d7
ACCREDITATION NUMBER
\ NOTE: Int ational shipment ay require certification by
,,, . , an accredited)veterinahani:
,,(1 „
SIGNATURE OF USDA VETERINARIAN Apply USDA Seal or Stamp hem DATE SIGNA E OF ISSUIN TERINARIAN L____ vrti i DATE
9/7/2017 --
APHIS Form 7001 (NOV 2010)
This certificate is valid for 30 daVs after issuance
According to the Paperwork Reduction Act of 1995:an agency may not conduct or sponsor, and a person is not requ'red to respond to, a collection of information unless it displays a valid OMB control number. The valid OMB control numbers for this information collect' n are 0579-0036 and 0579-0333. The time required to complete this information collection is estimated to average .25 hours per response, including the ti me for reviewing instructions, Searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. -
No dog, cat, nonhuman primate, or additional inds or classes of animals designated by USDA r egulation sh all be del ivered to a y i nterrnediate handler or car rier for transportation in commerce, unless accompa ed by a heal th certificate executed and issued by a licensed veterinarian (7 U.S.C. 21.43.9, CFR, Subchapter A, Part 2).
OMB APPROVED 0579-0035 0579-0333
UNITED STATES DEPARTMENT OF AGRICULTURE ANIMAL AND PLANT HEALTH INSPECTION SERVICE
UNITED STATES INTERSTATE AND INTERNATIONAL CERTIFICATE OF HEALTH EXAMINATION
FOR SMALL ANIMALS
WARNING: Anyone who makes a false, fictitious, or fraudulent statement on this document, or uses such document knowing It to be false, fictifious, or .
fraudulent may be subject to a fine of not more than $10,000 or. imprisonment of not more thaiqpir years or both (18 U.S.C.41101V -.
1. TYPE OF ANIMAL SHIPPED (select one only)
i Dog Cat flOther
2. CERTIFICATE NUMBER - OFFICIAL USE ONLY
Nonhuman Primate Ferrel Rodent
-. 3. TOTAL NUMBER OF ANIMALS Sy ,. r...... ”rtn-.
-* .,,, 1
4. PAGE
1 of 1
5. NAME, ADDRESS, AND TELEPHONE NUMBER OF OWNER (CONSIGNOR) M7retati " t— ve ,.;
Hart county Animal Rescue 5559 Bethany Bowersville road w
Canon, GA 30520
•
USDA License/or Registration Number at applicable)
t6:VNAME;ADDRESS, AND TELEPHONE NUMBER OF RECIPIENT AT DESTINATION (CONSIGNEE)
Tr Hik,okife Animal Rescue -5 , rS 1
it Roa a erson, NY 12563
7. ANIMAL IDENTIFICATION S. PERTINENT VACCINATION, TREATMENT, AND TESTING HISTORY
NAME, AND/OR TATTOO NUMBER OR OTHER IDENTIFICATION
BREED —COMMON OR SCIENTIFIC
NAME AGE SEX
COLOR OR DISTINCTIVE MARKS OR MICROCHIP
j 1 YEAR
RABIES VACCINATION
2 YEARS 3 YEARS
OTHER VACCINATIONS, TREATMENT, AND/OR TESTS AND RESULTS
Vaccination Date Product Date Product Type and/or Results
(I) Rosie Catahoula-X 5m F Blue Merle 9/6/2017 Merial Berg 22073
(9)
9. REMARKS OR ADDITIONAL CERTIFICATION STATEMENTS (WHEN REQUIRED)
-
VETERINARY CERTIFICATION: I certify that the animals described in box 7 have been examined by me this date, that the information provided in box 8 is true and accurate to the best of my knowledge, and that the following findings have been made ("X" applicable statements).
/ — 1
app animal
i for rabies
I have verified the presence of the microchip, if a microchip is listed in box 7.
I certify that the animal(s) described above and on continuation sheet(s), if applicable, have been inspected by me on this date and ar to be free of any infectious or contagious diseases and to the best of my knowledge, exposure thereto. which would endanger the
or other animals or would endanger public health.
To my knowledge, the animal(s) described-above-and-on-continuation-sheet(shilapplicable,.originated from an area not quarantined and has/have not been exposed to fables. I
ENDORSEMENT FOR INTERNATIONAL EXPORT (IF NEEDED) NAME, ADDRESS, AND TELEPHONE NOMBER.OF_ISSUINGIVETERINARIAN
Jaime Terry 1087 E. Franklin Street Suite K Hartwell, GA 30643
SEP i 1 4 2017
LICENSE NUMBER AND STATE -I I 17691 GA
I
PRINTED NAME OF USDA VETERINARIAN
.
I Accredited !f yelp, please
i complete
Yes Li No below
J NATIONAL ACCREDITATION NUMBER
,. 7d. tr9«,ri n-,--..
NOTE: Intemat shipments may require cad ion by anWM-edit/a aiiiiiiiiian. 010467 SIGNATURE OF USDA VETERINARIAN Apply USDA Seal or Stamp here DATE
9/6/2017 SIGNATURE F SSUING VETERINARIA
--- DATE
APHIS Form 7001 (NOV 2010)
This certificate is valid for 30 days afterfttuanoe