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Home My WebLink AboutStable Registration - 2022 .4 .r -_ TOWN OF YARMOUTH Board of Health %-4.07 1146 ROUTE 28, SOUTH YARMOUTH,MASSACHUSETTS 02664-24451 Health Telephone(508)398-2231, ext. 1241 Fax(508) 760-3472 Division APPLICATION FOR OPERATION -2022 /� STABLE car / 4a`d7ft( 7 #-/ PLEASE COMPLETE ALL QUESTIONS' E-MAIL' 1/#(/%/jowl � NAME (40,M/ p/ yQ/jj lct HOME TEL.NO.77 d' / 9.O'' STABLE ADDRESS 7/'9/e,i. C.4 Cz�/!GP(,/ d MAILING ADDRESS(IF DIFFERENT) EMERGENCY CONTACT(NAME/PHONE#)Var.-Sea'?" / fC 1 , / 6 �l .� VETERINARIAN(NAME/PHONE#) /�l�i/r//L 2 da-S> TOTAL NUMBER OF HORSES/PONIES j TOTAL NUMBER OF STALLS PLEASE NOTE: PLEASE DO NOT INCREASE THE NUMBER OF ANIM tEIVED WITHOUT PRIOR PERMISSION OF THE HEALTH DEPARTMENT. PLEASE LIST EACH HORSE/PONY/DONKEY/COW SEPARATELY: MAR I 0 2022 ANIMAL NAME(IF APPLICABLE) ��/LQ / / £7 TH DEPT. BREED s/6,- L �/A te YEAR ACQUIRED yji Pi (i'COLOR /fj / , SEX Q.a/ 17/.. / DATE OF RABIES VACCINATION /F y DATE OF EEE VACCINATION DATE OF OTHER VACCINATIONS- � ' - At�. TYPE OF STABLE/SHELTER ate SIZE OF CORRAL AREA c_09 vV (WOOD,CONCRETE,ETC.) NUMBER OF HOSE BIB WATER OUTLETS 01....... DRAINS -- W TER TROUGHS /4.. c TYPE OF STORAGE FACILITY USED FOR FEED/GRAIN / d W TYPE OF FACILITY USED FOR MANURE STORAGE �� S 542: METHOD OF MANURE DISPOSAL J/Gt'� 4/.. /C4a// /'�.II// CORRAL/PEN AREA ENCLOSED BY WHAT TYPE OF FENCING? ©Ci� .# G(p0 OTHER FARM ANIMALS MAINTAINED AT PREMISES? YES NO 7/___ (PLEASE NOTE: POULTRY, SWINE, SHEEP, CATTLE, GOATS REQUIRE SEPARATE LICENSURE.) SNE WAL V NEW APPLICATION- IF NEW APPLICATION, PLEASE ATTACH A COPY OF PLOT PLAN SHOWING LOT LINES AND LOCATION OF STABLE, PEN, ETC.,AND ALL ENCLOSURES. ALSO, A WRITTEN LETTER OR STATEMENT,SIGNED BY ALL ABUTTERS TO PROPERTY. Town of Yarmouth taxes and liens must be paidjrior to renewal or issuance of your permits. Please check appropriately if paid: Yes V No SIGNATU0 _� DATE '- /d • FEES: ST LE& 1 HORSE $30.00(+$5.00 each additional horse/animal) TOTAL DUE:$ .. -- 12/30/19 FORM SERIAL NUMBER -° GVom EIA-17467915 GVL-EQUINE INFECTIOUS ANEMIA LABORATORY TEST 1.LAB/ACCESSION NUMBER 2.DATE BLOOD DRAWN 3.TEST REQUESTED BY VET 4.REASON FOR TESTING NYCH02817261 080521 2021-08-02 AGID Within state use/annual 5.CURRENT HOME PREMISES QF EQUINE:RANCH/FARM/ ,:'.,,,, 7.NAME&ADDRESS OF OWNER 8.NAME&ADDRESS OP VETERINARIAN STABLE/MARKET3- Jen Garbitt f Marina W.Cesar DVM Jen Garbitt 414 Route 6A Marina W.Cesar DVM 414 Route 6A Yarmouth,MA 02673 48 Lombard Ave Yarmouth,MA 02673 Phone:774-268-1987 West Bamstable,MA 02668 Phone:774-268-1987 PIN/LID:/ Phone:508-362-3646 PIN/LID:I 6.COUNTY OF CURRENT HOME PREMISES OF EQUINE VETERINARIAN NATIONAL ACCREDITATION NUMBER Barnstable 050438 CERTIFICATION OF FEDERALLY ACCREDITED VETERINARIAN I certify I am a category II federally accredited veterinarian,authorized,in the state where the sample was obtained,by me,from the animal described below. SIGNATURE OF FEDERALLY,,*.CCREDITED VETERINARIAN t r ' Marina W.Cesar DVM � '_ J(J i z vL 2021-08-03 10:29:15-05:00 HORSE 9.TUBE NUMBER 10.TAG/TATTOO/BRAND 11.REGISTERED NAME 12.COLOR/COAT OR HAIR COLOR(S) 103888077-0 NUMBER Sunny Palomino None 13.BREED OR SPECIES 14.AGE OR DOB 15.GENDER 16.MICROCHIP,BREED,OR REGISTRATION Quarter Horse 2014-01-01 Gelding NUMBER None v. ,i,,,,,,, . ` Agay � -- i � �, � _- ._ „iii 1) 1 s .Gb ` _ - *,..., - -,Y.1.... . , „ ,.....„.,. :„;44,isait,„r,„. :„..„.. .....„. , ,, 441.- ,,. - ...,„...re 1,, ,..„. .....„ ..e. ,:....,...„_,..40-....,.. 4 :„..,, ..,,,,4. W,„... ., NARRATIVE DESCRIPTION: OTHER MARKS AND BRANDS: No marking- 17.HEAD: Star,stripe 18.NECK AND BODY: No marking 19.LEFT FORELIMB: No marking 20.RIGHT FORELIMB: No marking 21.LEFT HINDLIMB: No marking 22.RIGHT HINDLIMB: No marking RABIES VACCINATION TYPE VACCINATION DATE PRODUCT SERIAL NUMBER EXPIRATION DATE ADMINISTERED BY booster 2021-08-02 Core EQ Innovator 489210A 2022-08-02 Marina W.Cesar DVM FOR LABTORY USE ONLY 23.LABORATORY 24.DATE SAMPLE RECEIVED 25.DATE RESULTS-:u 26.OFFICIAL RESUJ T 27.TEST TYPE USED Antech Diagnostics,Inc.-New York 2021-08-03 REPORTED : '°', Negative AGID 1111 Marcus Avenue 2021-08-05 Lake Success,NY 11042 Phone:516-326-3934 28.LABORATORY REMARKS 29.SIGNATURE OF N SL APPROVED EIA TECHNICIAN 30.INTERIM RESULT REFERRED FOR CONFIRMATION / No � Abu Saleh Mohammad Abdullah / `' -$2021-08-05 09:: 22-05:00 ` ' , , °f 0 i 'al EIA Test Form,Appro`�red by USDA Veterinary Services March-2020,GVL ` ' T b, _ FORM SERIAL NUMBER EIA-17467878 ",.. G V L GVL-EQUINE INFECTIOUS ANEMIA LABORATORY TEST 1.LAB/ACCESSION NUMBER 2,DATE BLOOD DRAWN 3.TEST REQUESTED BY VET 4.REASON FOR TESTING NYCH02817271 080521 2021-08-02 AGID Within state use/annual 5.CURRENT HOME PREMISES-OF EQUINE:RANCH/FARM/ 7.NAME&ADDRESS OF OWNER 8.NAME&ADDRESS OF VETERINARIAN STABLE/MARKET Jen Garbitt Marina W.Cesar DVM Jen Garbitt 414 Route 6A Marina W.Cesar DVM 414 Route 6A Yarmouth,MA 02673 48 Lombard Ave Yarmouth,MA 02673 Phone:774-268-1987 West Barnstable,MA 02668 Phone:774-268-1987 PIN/LID:/ Phone:508-362-3646 PIN/LID:/ 6.COUNTY OF CURRENT HOME PREMISES OF EQUINE VETERINARIAN NATIONAL ACCREDITATION NUMBER Bamstable 050438 CERTIFICATION OF FEDERALLY ACCREDITED VETERINARIAN I certify I am a category II federally accredited veterinarian,authorized,in the state where the sample was obtained,by me,from the animal described below. SIGNATURE OF FEDERALLY, CCREDITED VETERINARIAN `• Marina W.Cesar DVM '`.-4 5a.5,&4,j(;ti.L Li 2021-08-03 10:23:05-05:00 HORSE 9.TUBE NUMBER 10.TAG/TATTOO/BRAND 11.REGISTERED NAME 12.COLOR/COAT OR HAIR COLOR(S) 1556717-5 NUMBER Mikado Bay None 13.BREED OR SPECIES 14.AGE OR DOB 15.GENDER 16.MICROCHIP,BREED,OR REGISTRATION Thoroughbred Horse 1999-09-02 Gelding NUMBER None t I+.x.51 _ y�, _., .5s+c. = w NARRATIVE DESCRIPTION: OTHER MARKS AND BRANDS. tatoo upper kpR20?420 17.HEAD: Star 18.NECK AND BODY: No marking 19.LEFT FORELIMB: No marking 20.RIGHT FORELIMB: No marking 21.LEFT HINDLIMB: No marking 22.RIGHT HINDLIMB: medial coronet RABIES VACCINATION TYPE VACCINATION DATE PRODUCT SERIAL NUMBER EXPIRATION DATE ADMINISTERED BY booster 2021-08-02 Core EQ Innovator 489210A 2022-08-02 Marina W.Cesar DVM FOR LABORATORY USE ONLY 23.LABORATORY 24.DATE SAMPLE RECEIVED 25.DATE RESULTS 26.OFFICIAL RESULT 27.TEST TYPE USED 2021-08-03 REPORTED Negative AGID Antech Diagnostics,Inc.-New York 2021-08-05 1111 Marcus Avenue Lake Success,NY 11042 28.LABORATORY REMARKS Phone:516-326-3934 29.SIGNATURE OF N SL APPROVED EIA TECHNICIAN 30.INTERIM RESULT REFERRED FOR CONFIRMATION Abu Saleh Mohammad Abdullah No .47 '',"/ k.-1-$2021-08-05 09:01:21-05:00 O : ' I EIA Test Form,Approved by USDA Veterinary Services March'2020,GVL Marina W.Cesar DVM Invoice 068714 PO Box 908/48 Lombard Ave West Barnstable, MA 02668 US dr_mcesar@yahoo.com BILL TO SHIP TOS r ,g� , � Jen Garbitt Jen Garbitt A 34 Lynch Ln. Mikado-OHXTHB-1999 DATE PLEASE PAY €UE N. Harwich, MA 02673 Sunny-OH, 2014, Pal. X212021 $0.00 08/31/2021 DATE PATIENT ACTIVITY OTY RATE AMOUNT Farm Call Farm Call 1 80.00 80.00 Exam: General- Sunny, Healthy horse, excellent General 1 35.00 35.00 weight. Exam: General- Mikado, Healthy horse, excellent General 1 35.00 35.00 weight. E&W Encephalitis,WNV, Rabies,Tetanus <:.) &W 2 80.00 160.00 Vaccine \ Encephalitis, WNV, Rabies, . Tetanus Vaccine Coggins Test-online @ globalvetlink.. •m Coggins 2 55.00 110.00 Banamine Paste Ban Paste 1 30.00 30.00 PAYMENT 450.00 TOTAL DUE $0.00 THANK YOU.