1. TYPE OF ANIMAL SHIPPED (select 2. CERTIFICATE · PDF fileAccording to the Paperwork Reduction Act of 1995, an agency may not conduc or sponsor, and a person is not requ red to respond

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



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


1


3. TOTAL NUMBER OF ANIMALS .1

4. PAGE

1


Northeast Georgia Animal Shelter 870 Bear Creek Rd Lavonia, GA 30553 706-356-5383 •



IAThispeting Pines 1640 Lewis Road Waterville, NY 13480 570-350-2642

7. ANIMAL IDENTIFICATION B. PERTINENT VACCINATION, TREATMENT, AND TESTING HISTORY


BREED -COMMON OR SCIENTIFIC

NAME AGE SD(


X

RABIES VACCINATION

2 3 EARS 1 YEAR YEARS YEARS



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 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


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


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



No. CF- 00201 GEORGIA DEPARTMENT OF AGRICULTURE CERTIFICATE OF VETERINARY INSPECTION

OF OWNER/AGENT CERTIFICA The animal

Owner/Agit (Sig


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


Horses Cervidae Feeding Modified Accredited TB Certified Herd No.

Swine Ni Dogs Show Free - Brucellosis Validated 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



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--


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




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


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


_ 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




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


39(-Scita


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


°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.


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


PRV Test Date

TB Test Inj.

EIA Test Date

Brucellos's Test Dale

A Bruc. Vac.

Tattoo



Description of Animal or Registry Name and Number Tovcia,u9.- Results

Include Lab & Accession No.

Lab Ohs.

Results Results Results

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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




CONSIGNOR 0 IPPER 5 CONSIGHWECEIVE__,

Litto )24-,

j

1

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Ho lith 1DATE

DATE ANIMALS INSPUTED

CERTIFICATLISSUED

0 AY 1 7


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





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




A g e

S e x

,

B r e e d

Bruc. Vac.

Tattoo


TB Test Inj.

r fr te

(2-CFWAV

PRV t

ta. '


.•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

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— Print Name City, State, Zip U Ga. License No.

WV 01:31 L00?-VZ-NVI

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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

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UNITED CERTIFICATE Of HEALTH SUMMATION

FOR SIAALL ANIMALS

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J. TOT. AL MEMBER OF AMENS

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4. PAGE

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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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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).

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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

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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


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



No. CO- 08220 GEORGIA DEPARTMENT OF AGRICULTURE CERTIFICATE OF VETERINARY INSPECTION


(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


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




Swine ---gs Show Free - Brucellosis Validated Herd No.


Sheep Other ----CIF& /4, cc...4_ Class B Brucellosis Monitored Feeder Pig Herd No.

Poultry




A g e

S e x

CO

i- 0 0 p

Bruc. Vac

Tattoo


TB Test Int.

EIA Test Date

PRV Test Date


SA in


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 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


,„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.' •



BREED — COMMON OR SCIENTIFIC

NAME AGE SEX


RABIES VACCINATION

1 YEAR fJ 2 YEARS 3 YEARS



") 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 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`'


i Dog flcat DOther



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



' BREED - COMMON

OR SCIENTIFIC NAME

AGE SEX


RABIES VACCINATION

i 1 YEAR 2 YEARS 3 YEARS



(I) India Pit bull - X 3Y F 985112009400055 6/27/2017 Pfizer 6/27/2017 DHPP

(21


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.



Jaime Terry 1087 E Franklin Street Suite K HartweIl4GA 30643

NOTE- n emational shipments ma equire certification by an accredited veterinarian.


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



FOR SMALL ANIMALS

WARNING: Anyone who makes a false, fictitious, or fraudulent

this document, statement on or


i Dog Cat Other


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


Lake Hartwell Veterinary Clinic 1087 E. Franklin Street e- e- Suite K Hartwell, GA 30643


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




NAME AGE SEX

COLOR OR DISTINCTIVE MARKS OR

RABIES VACCINATION

1 YEAR 2 YEARS 3 YEARS


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 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



ENDORSEMENT FOR INTERNATIONAL EXPORT (IF NEEDED) NAME, ADDRESS, AND TELEPHONE NUMBER OF ISSUING VETERINARIAN LICENSE NUMBER AND STATE


Jaime Terry 1087 E Franklin Street Suite K Hartwell, G 0643

NOTE: Into ational shipments may requi certification by an accredited veterinarian.


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 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)



GEORGIA DEPARTMENT OF AGRICULTURE CERTIFICATE OF VETERINARY INSPECTION No. CH- 00958


CONSIGNOR OR SHIPPER CONSIGNEE OR RECEIVER

Toven, 1/2-\eksvic le5a. DATE ANIMALS

317.9,1ti DATeRTIFICITE

INSPECTED

ISSUED


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



Swine X Dogs Show Free - Brucellosis Validated Herd No.


Sheep Other Other Class B Brucellosis Monitored Feeder Pig Herd No.

Poultry




A g e

S e x

B r e e d

Bruc. Vac.

Tattoo


TB Test IN.

EIA Test Dale

PRV Test 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



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


Dog Cat Other


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


.


.. ,

c6:tNAME;;ADDRES5, AND TELEPHONE NUMBER OF RECIPIENT AT DESTINATION (CONSIGNEE)

. Sttc4,18ilverstein 744,9th Street

eF.t..1fAl ewAl - brk NY 10075


NAME, AND/OR TATTOO BREED NUMBER OR OTHER IDENTIFICATION

- COMMON

OR SCIENTIFIC NAME

AGE SEX


RABIES VACCINATION




Ezra Terrier-X 10w N 981020021416705 Not Old Enough 8/11/2017 DAP

8/11/2017 Bordetelia 8/27/2017 DAP


i

i appear animal

i for rabies


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


'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



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).



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 Dog Cat Other



-3. TOTAL NUMBER OF ANIMALS

_ 49/4?-6,. 1

4. PAGE

1 of 1

5. NAME, ADDRESS AND TELEPHONE NUMBER OF OWNER (CONSIGNOR)


i,


6. NAME ADDRESS, AND TELEPHONE NUMBER OF RECIPIENT AT DESTINATION (CONSIGNEE)

Stakcey,Silverstein

7p: 79th Street —i, l

t 121/ aw:Thrk, NY 10075

_




NAME AGE SEX


RABIES VACCINATION




(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 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.


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


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


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



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,


i Dog Cat Other

2. CERTIFICATE NUMBER -OFFICIAL USE ONLY


3. TOTAL NUMBER OF ANIMALS

1

4. PAGE

1 of 1



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


BREED-COMMON OR SCIENTIFIC

NAME AGE SEX


RABIES VACCINATION




(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 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



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


Dog El Cat Cother

2. CERTIFICATE NUMBER -OFFICIAL USE ONLY


-.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


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 AGE SEX


RABIES VACCINATION




(I) Emily Terrier-X 10w S 981020021831819 Not Old Enough 8/11/2017 DAP


8/27/2017 DAP


,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



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



3 TOTAL NUMBER OF ANIMALS 7-.-..— - at .._L...-"Pti 1

4. PAGE

1 of 1


Lake Hartwell Veterinary Clinic 1087 E. Franklin Street '

Suite K Hartwell, GA 30643


SNAME' ADDRESS, AND TELEPHONE NUMBER OF RECIPIENT AT DESTINATION (CONSIGNEE) htS0A,

' Staceyiailverstein -74-7:61 Street

r Dt 121i Nev7:York, NY 10075 -..-- - .




NAME AGE SEX


RABIES VACCINATION

illl 1 YEAR 2 YEARS 3 YEARS



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)


/ _....- 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


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


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



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


i Dog Cat Other



-3. TOTAL NUMBER OF ANIMALS

— 1 •-11 .0-1‘)/ 1

PAGE

1 of 1




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

'




NAME AGE SEX


RABIES VACCINATION

I.1 YEAR 2 YEARS 3 YEARS



Farrah Mix 7w F 981020021494095 Not Old Enough 8/6/2017 DHPP

8/6/2017 Bordetella

8/24/2017 DHPP


1

V appear animator

i for rabies


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, _



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


i complete

Yes No below


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



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 '"


.4 Dog Cat COther



_1 TOTAL NUMBER OF ANIMALS ism

1

4. PAGE


Lake Hartwell Veterinary Clinic 1087 E. Franklin Street Suite K Ha GA 30643


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,




NAME AGE SEX


RABIES VACCINATION

,t 1 YEAR 2 YEARS 3 YEARS



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 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


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


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



FOR SMALL ANIMALS

WARNING: Anyone who makes a false, fictitious, or fraudulent statement on this or


if Dog flCat COther


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


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


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 AGE SEX


RABIES VACCINATION

1 YEAR 2 YEARS III 3 YEARS


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


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


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


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



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 Dag fl Cat COther



_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


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

.


NAME. AND/OR TATTOO NUMBER OR OTHER IDENTIFICATION

BREED —COMMON OR SCIENTIFIC

NAME AGE SEX


RABIES VACCINATION




(I ) Sheldon Mix 7w M 981020021838886 Not Old Enough 8/6/2017 DHPP (21 8/6/2017 Bordetella (3) 8/24/2017 DHPP (9)


i

V appear animal


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



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


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



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


i Dog Cat Other


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, ,


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 .-

._. _ --




NAME AGE SEX


RABIES VACCINATION




Penny Mix 7w F 981020021466328 Not Old Enough 8/6/2017 DHPP

8/6/2017 Bordetella P)

8/24/2017 DH PP


i

i appear animal


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



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


i Dog flCat flOther



.&TZTAL NUMBER OF ANIMALS nip,7:7,N5,, 1

4. PAGE




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




NAME AGE SEX


RABIES VACCINATION




(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 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


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.


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



FOR SMALL ANIMALS


1. TYPE

1


Dog flcat COther


statement on this document, or uses such document knowing it to be false, fictitious, or fraudulent be to


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


ew.4:Yterk, NY 10075 —tt• ,,,

7. ANIMAL IDENTIFICATION 8. PERTINENT VACCINATION TREATMENT, AND TESTING HISTORY



NAME AGE SEX


RABIES VACCINATION



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


,/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


Jaime Terry 1087 E Franklin Street Suite K Hartwell, GA 3 643

I SEP 1 9 2017 I k


i complete

Yes No below


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


This certificate is valid for 30 days r issuance

Acc

Print Name

(Signature)

ja-6 /14 Can


GEORGIA DEPARTMENT OF AGRICULTURE CERTIFICATE OF VETERINARY INSPECTION No. CG- 03192



.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




A g e

S e x

B r e e d

Bruc. Vac.

Tattoo


TB Test Inj.

EIA Test Date

PRV Test Date


).1 K-1-PP t (2414--


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)


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


Dog . Cat Other .


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 • .


-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 AGE SEX


X

RABIES VACCINATION




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.



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


GA 005889 PRINTED NAME OF USDA VETERINARIAN - i

•


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



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



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


Dog Cat Other



51, - .3. TOTAL NUMBER OF ANIMALS

- -,.,.... 4. PAGE

1 of 1 •


Shelter Dog Rescue/Charles Ware 362 B Aerodrome Way Griffin, Ga 30224 404 857-2672


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 AGE SEX


X

RABIES VACCINATION




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 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


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)


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



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


Dog FE Cat Other


Nonhuman Primate Ferret FERodent

3. TOTAL NUMBER OF ANIMALS 4. PAGE

1 of 1


Shelter Dog Rescue/Charles Ware 'Ruff 362 B Aerodrome Way r' ik Griffin, Ga 30224 404 857-2672


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

, AGE SEX


X

RABIES VACCINATION

1 YEAR FE2 YEARS 3 YEARS


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 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)


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 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


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 AGE SEX


RABIES VACCINATION

X YEAR 2 YEARS 3 YEARS


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



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 Dog Cat Other



..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


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

, ,.,




NAME AGE SEX


RABIES VACCINATION



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)


i E i appear animal

14 for rabies


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


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



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


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 AGE SEX


X

RABIES VACCINATION




Loki catahoula mix 1 year M mode 8/2/17 Novibac 8/2/17 Heartworm test- NEG

(51


("X"


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,


X appear animal

X for rabies



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


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



FOR SMALL ANIMALS


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 Dog Cat COther



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


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


RABIES VACCINATION


OTHER VACCINATIONS, TREATMENT, AND/OR TESTS AND RESULTS NAME, AND/OR TAT NUMBER

OR OTHER IDENTIFICATION


(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)


Hi I

i appear animal

1 for rabies

have verified the presence of the microchip, if a microchip is listed in box 7.


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


Accreditio if yes, p1 as?

V complete

Yes No below


-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.


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



FOR SMALL ANIMALS

WARNING: Anyone who makes a false, fictitious, or fraudulent statement on or

1. TYPE

i


Dog flCat Other


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




NAME AGE SEX

COLOR OR DISTINCTIVE MARKS OR i

RABIES VACCINATION



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.


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.


i complete

Yes C No below


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




ed on this certificate CERTIFICATE OF OWNER/AGENT The anirr als in this shipment are those certified and I

-


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



Swine ) Dogs Show Free - Brucellosis Validated Herd No.


Sheep Other IL. Other cv-e g cAkc ) Class B Brucellosis Monitored Feeder Pig Herd No.

Poultry



i Description of Animal or Registry Name and Number

A g e

S e x

B r e e d

Bruc.

Tattoo Vac.


;rest I.

rabtrotAAe

EIA Test Date

Pr. e

PAL e-.0


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

i Fs b uor, -- 13 - il i • 13 r1

-Y

1. (Oekix ai

th

2 rm it-%

r

a

3

I

-.U

.

n 1 a 211

n: 240 inc li Iv Cno5t gtloRn - -IS,n 1 3- -7 1

- 3 . I 1

-

a

7- e-il _

t (itfe0 Ilis 'ex mAi., " atiltuitAti

6:10001-Hc9re I (0214- 1 -13-11 1 ' 1311 1- 13 -C1

4 .t...We...S VYkt:NY Lx—rveAt."&"*X0 4441 IN kky Kb001-14 Cal teco Th is -fl 113 - 11 -I 13 - n 5

6

7

8 '''.."--...„......„

\\NNNN

9

10

...--------.........,..................

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)






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




Swine N.IC, Dogs Show Free - Brucellosis Validated Herd No.


Sheep Other /.....J Other C a S(JJ•e_,) Class B Brucellosis Monitored Feeder Pig Herd No.

Poultry




Hot g e

S e x

B r e e d

Bruc. Vac.

Tattoo


TB Test Inj.

EIA Test Date

PRV Test 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




CONSIGNOR 0 IPPER 5 CONSIGHWECEIVE__,

Litto )24-,

j

1

\o/Of 4

Ho lith 1DATE

DATE ANIMALS INSPUTED

CERTIFICATLISSUED

0 AY 1 7


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





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




A g e

S e x

,

B r e e d

Bruc. Vac.

Tattoo


TB Test Inj.

r fr te

(2-CFWAV

PRV t

ta. '


.•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.




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



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




A g e

S e x

B r e e d

Bruc. Vac.

Tattoo


TB Test Inj.

EIA Test Date

PRV Test Date

Other Test / Immunization rearmie, tri out/.


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

f 4 1.4 4-

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




No. CG- 0 7 4 7 8 GEORGIA DEPARTMENT OF AGRICULTURE CERTIFICATE OF VETERINARY INSPECTION


AfrA7fAi446- da04Tto1/4,fitik*pmwak-0.4 CONSIGNEE OR RECEIVER

,..4,.... Rug gestat. DATE ANIMALS INSPECTED

9/L7 i ( -3--


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.


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




A g e

S e x

B r e e d

Bruc. Vac.

Tattoo


TO Test Inj.

EIA Test Date

PRV Test 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

J7< pia

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


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



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


Dog Cat Other


1


3. TOTAL NUMBER OF ANIMALS 3

4. PAGE

1


Northeast Georgia Animal Shelter 870 Bear Creek Rd Lavonia, GA 30553 706-356-5363



Whispering Pines 1540 Lewis Road Waterville, NY 13480 570-350-2642




NAME AGE SEX


X

RABIES VACCINATION




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


Cr


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


;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


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)


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.




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



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




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


TorclettlA


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

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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.





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




Swine sk Dogs Show Free - Brucellosis Validated Herd No.


Sheep Other sf, Other ( acad.)) Class B Brucellosis Monitored Feeder Pig Herd No.

Poultry




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 _


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

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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





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



A g e

S e x

B r e e d

Bruc. Vac.

Tattoo


TB Test Inj.

EIA Test Date

PRV Test 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

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10 \se... .................N

3 I I

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1 13 i

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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



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 ..


V Dog fl Cat COther


Nonhuman Primate Ferrel Rodent


1

4. PAGE

1 of 1 -


rn .4

Lake Hartwell Veterinary Clinic r:4 1087 E. Franklin Street

Suite K Hartwell, GA 30643

'e


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


BREED - COMMON ' OR SCIENTIFIC

NAME AGE SEX


RABIES VACCINATION

i 1 YEAR C2 YEARS 3 YEARS



(I) Angelica Chihuahua-X 14w F Brown 8/28/2017 Medal Ser# 22073 8/10/2017 DHLP


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 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 --


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



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 -.


i Dog Cat flOther


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 AGE SEX


j 1 YEAR

RABIES VACCINATION

2 YEARS 3 YEARS



(I) Rosie Catahoula-X 5m F Blue Merle 9/6/2017 Merial Berg 22073

(9)


-

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 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


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


.

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


This certificate is valid for 30 days afterfttuanoe

Documents

1. TYPE OF ANIMAL SHIPPED (select 2. CERTIFICATE · PDF fileAccording to the Paperwork Reduction Act of 1995, an agency may not conduc or sponsor, and a person is not requ red to respond