VS 1-27 Permit for Movement of Restricted Animals

Scrapie Flock Certification, Animal Identification, and Indemnification Procedures

vs1-27

Private Sector

OMB: 0579-0101

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us, DEPARTlIlENl Of AGRICUL1\IfI£

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PERMIT FOR MOVEMENT OF RESTRICTED ANIMALS

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ANIMALAHD Pl..AHT H£AI.1M IHSP£C1lOH S£RVa
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, . STATE WHtliE ISSUED

USE A SEPA RA,T£ fOR M FOR EM:H SPECIES

1. NAME AN D ADOfl£S.S Of SHIPPER OR CONSIGNOR (It>c _

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7 . MOVEIIENT FOR

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QUARANTINE

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1. MOVED FROM IN..... • nd loe./1On '" Pr....." .. "

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NO. ANIMALS 1"1 nils

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V'EHIC1.E REQUIRED TO BE a..u.NED AND
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I/AUO OHlY fOR ABOVE OEsnMATIOH

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17 , ANIIIlAl.S TO BE MOIlED

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n , SIGNATURE OF ()WtiIER Of S HIPPER

25. DAft SIGNED

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