Vs 17-145 U.s. Origin Health Certificate For The Export Of Horses

According to the Paperwork Reduction Act of 1995, an agency may not conduct 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 number for this information is 0579-0020. The time required to complete this information collection is estimated to average .5 hours 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.

U.S. Department of Agriculture Animal and Plant Health Inspection Service Veterinary Services

U.S. ORIGIN HEALTH CERTIFICATE FOR THE EXPORT OF HORSES FROM THE UNITED STATES TO CANADA

OMB Approved 0579-0020 EXP XX/XX

PERMANENT EXPORT TEMPORARY EXPORT (*NOTE BELOW)

NAME AND ADDRESS OF CONSIGNOR

NAME AND ADDRESS OF PLACE OF ORIGIN

NAME AND ADDRESS OF CONSIGNEE

CERTIFICATION STATEMENTS

1.

The animal was, to the best of my knowledge and belief of the issuing veterinarian, not exposed to any communicable disease within 60 days proceeding the date of inspection.

2.

The animal identified below was inspected within 30 days prior to export and found to be healthy and free from evidence of communicable diseases and exposure thereto;

Either (Check Appropriate Box)

3.

The animal has resided in the United States or Canada since birth;

4.

The animal has met all of the import requirements of the United States and has resided in the United States for the past 60 days;

5.

The horse has resided in the United States for less than 60 days and is accompanied by a health certificate from each country in which the horse has resided during the 60 days prior to entry into Canada;

6.

The animal was tested negative for equine infectious anemia using the agar gel immunodiffusion (Coggins) test or ELISA at:

Name of Laboratory

Date Blood Sample Drawn

Sample Drawn by Me or (Enter Name of Accredited

State Accredited In

Laboratory Accession No.

HEALTH CERTIFICATE NUMBER

Issuing Veterinarian

Endorsing Federal Veterinarian

Signature

Signature and Seal

Name (Type or Print)

Date

Name

Date

** Health Certificate valid for 30 days from the date of issuance

Valid only if the USDA Veterinary Seal appears over the signature of the endorsing Federal Veterinarian and health certificate number.

White Markings and Whorls Must be Shown! Please ensure that diagram and written description agree.

Name

Breed

Age

Color

Sex

Written Description:

HEAD

LIMBS

LF

RF

BODY

ACQUIRED MARKS (scars, tattoos, etc.)

LH

RH

Instructions: Mark the diagram with the exact position of any distinguishing marks, scars or brands. Brands to be drawn in position. Scars to be marked and indicated with an arrow (->). Stars or blazes on the face and any other markings to be drawn in on the diagrams showing position shape as accurately as possible. Whorls should be marked with a (X). If no markings – this fact should be stated.

*NOTE: The original copy of the health certificate must remain with the horse if the horse is being temporarily exported. Any clearance by Customs, such as a stamp, must be affixed on the reverse side of the original health certificate. Horses temporarily exported to Canada must return within 30 days of the date of issuance of the health certificate. Exhibition horses must return 90 days from entry into Canada. **NOTE: The date of issuance must be the date of veterinary inspection. Exporter must furnish four (4) copies for USDA endorsement. The original and two (2) copies accompany the shipment, the fourth copy is for the AVIC's office.

VS FORM 17-145

DEC 2010