VS 10-13A Owner/Shipper Certificate Fitness to Travel to a Slaught

U.S. DEPARTMENT OF AGRICULTURE
ANIMAL AND PLANT HEALTH INSPECTION SERVICE

OWNER/SHIPPER CERTIFICATE
FITNESS TO TRAVEL TO A SLAUGHTER FACILITY
(CONTINUATION SHEET)
(Please type or print in ink)
TAG
PREFIX

Tag
NO.

COLOR DESCRIPTION
Bay

Grey

Blk.

Pinto Chestn Other

According to the Paperwork Reduction Act of 1995, no persons
are required to respond to a collection of information unless it
displays a valid OMB control number. The valid OMB control
number for this information collection is 0579-0160. The time
required to complete this information collection is estimated to
average 1 hour per response, including the time for reviewing
instructions, searching existing data sources, gathering and
maintaining the data needed, and completing and reviewing the
collection of information.
BREED/TYPE

TB

QT

Draft

Pony

SEX
Other

Mare

Stal

Geld

BRANDS
Tattoos, etc.

FORM
APPROVED
OMB NO.
0579-0160 and
0579-0320

REMARKS
Include
precondition

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I HEREBY AUTHORIZE THE CFIA TO DISCLOSE THIS DOCUMENT AND THE INFORMATION IN IT AS COMPLETED BY THE CFIA TO THE USDA. FALSIFICATION
OF THIS FORM OR KNOWINGLY USING A FALSIFIED FORM IS A CRIMINAL OFFENSE AND MAY RESULT IN A FINE OF NOT MORE THAN $10,000 OR
IMPRISONMENT FOR NOT MORE THAN 5 YEARS OR BOTH (18 U.S.C. SECTION 1001).
SIGNATURE OF OWNER/SHIPPER(I certify that the information contained in this form is true and correct to the best of my knowledge.)

VS FORM 10-13A
(SEP 2002)

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