vs 17-65D Agreement for the Transfer of Certain Wild Animals

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control number. The valid OMB control number for this information collection is 0579-0040. The time required to complete this information
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U.S. Department of Agriculture
Animal and Plant Health Inspection Service
Veterinary Service

Form Approved
OMB No.0579-0040

AGREEMENT FOR THE TRANSFER OF CERTAIN WILD ANIMALS

The operators of the two zoological parts shown below request the consent of Veterinary Services to move the animals(s) identified herein from the
first zoological park to the second zoological park for exhibition purposes, said animal(s) having originated in a country where foot-and-mouth disease
or rinderpest exists and subject to 1 year post-entry control under regulations contained in Part 93, Title 9, Code of Federal Regulations.
1. ANIMAL(S) TO BE TRANSFERRED

2. FIRST ZOOLOGICAL PARK (Name and location of park now in possession of animal(s))

In making this request it is understood that the animal(s) will be moved without undue delay and under conditions approved by the Area Veterinarian in
Charge, Veterinary Services. The animal(s) will be accompanied by the pink copy of VS Form 17-65C, "Post Entry Quarantine Record and Periodic
Health Inspection", which has been kept current by appropriate notations of a responsible zoo official and the zoo veterinarian.

6. SECOND ZOOLOGICAL PARK (Name and location of park where animal(s) will be sent)

Upon arrival at the zoological park, identified in item 6, the designated animal(s) will not be sold, exchanged, or moved from the premises without prior
consent of Veterinary Services. The proper VS Form 17-65C, "Permanent Quarantine Record and Periodic Health Inspection", for each of the
designated animals will be kept current by appropriate notations of a responsible zoo official and the zoo veterinarian.

VS FORM 17-65D (SEP 2005)