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DEPARTMENT OF AGRICULTURAL RESOURCES
BUREAU OF ANIMAL HEALTH
INSPECTOR'S COPY
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(Owner's Name) Farm Name)
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(Ad ress w iere anunals are kept-street number and name)
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(To (Zip code) (P one num�er)T
Dealer: Yes� No�
1. Cattle(Adult = 2 years&over) Adult Young
Dairy
Beef
Steers/Oxen
2. Goats(Adult = 1 year&over) �,
' 3. Sheep(Adult = 1 year&over)
4. Swine: Breeders
Feeders
' S. Ilamas/Alpacas
,' 6. Equines: Horses/Ponies
Donkeys/Mules
' Stable use: Private Boarding_11�aining_Rental Lessons
7. Poultry: Chickens �t�► 'Ilirkeys
Ratites(Ostrich,Emu) Waterfowl Gamebirds
8. Rabbits
9. Other
10. Do animals listed appear to be free from contagious disease?�
' 11. Are accommodations adequate with reference to situation,cleanliness,
light,ventilation and w ter supply?(explain briefly)
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I hereby certify that I have this day inspected these animals and the
conditions under which they are kept.
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Date Inspe r o Animals(sigi ature) �
Fotat 74 p 500 BKS•07Po3•4DB58B1
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