7006A Continuation Sheet for Record of Disposition of Dogs and

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 collection is 0579-0036. The time required to complete this information collection is estimated to average 2 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.

OMB APPROVED 0579-0036 Exp. XX/XXXX

This record is required by law (7 U.S.C. 2131-2156). (9 CFR, Subchapter A, Parts 1, 2 and 3). Failure to maintain this record can result in a suspension or revocation of license and/or imprisonment for not more than 1 y ear, or a fine of not more than $1,000, or both.

UNITED STATES DEPARTMENT OF AGRICULTURE ANIMAL AND PLANT HEALTH INSPECTION SERVICE Continuation sheet for Record of disposition of dogs and cats sale Exchange or Transfer Donation

1. Sell’s invoice number

2. Page

3. Date of disposition

4. Dealer’s License number or research facility registration number

5. seller or Donor (Name and Address)

6. Buyer or receiver (Name)

7. identification of the animals being delivered

research facility use

description of breed, type or mongrel

a. Tattoo or USDA Tag Number

b. Dog

c. Cat

D. Age “X”

E. Weight

F. Distinctive Marks

G. Breed, Type or Mongrel

h. Mongrel – describe (Hair, Tail, Ears, Color, etc.)

i. Number Assigned by Facility

J.

Young

Adult

M

F

M

F

M

F

M

F

M

F

M

F

M

F

M

F

M

F

M

F

M

F

M

F

M

F

M

F

M

F

M

F

M

F

M

F

M

F

M

F

M

F

M

F

M

F

M

F

M

F

M

F

M

F

M

F

M

F

M

F

M

F

M

F

M

F

M

F

M

F

M

F

M

F

M

F

M

F

M

F

M

F

M

F

APHIS 7006A

JUN 2009