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 numbers for these information
collections are 0579-0040 and 0579-0324. The time required to
complete this information collection is estimated to average .25
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.
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OMB
Approved
0579-0040
and
0579-0324
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UNITED
STATES DEPARTMENT OF AGRICULTURE
ANIMAL
AND PLANT HEALTH INSPECTION SERVICE
VETERINARY
SERVICES
Application
for Inspection and Dipping
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Port
of Entry
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Proposed
Date of Entry
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Number
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Breed
|
Species
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Purpose
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Inspection
and, when necessary, supervised dipping, are hereby requested
under 92, 9 CAR, for livestock described, when offered for
Importation. The undersigned agrees to waive all claims against
the United States for any loss or damage to livestock occasioned
by or resulting from dipping, or resulting from the fact that they
are later found to be still tick infested, and also for all
subsequent loss or damage to any other animals In the possession
or control of such importer which may come in contact with the
animals so dipped.
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Premises
of Origin
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Municipality
of origin
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State
of Origin
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Record
of last dipping
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Name
and business address of importer
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For
delivery to
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Located
at
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This
is to certify that the Information given above is correct and that
any ruminants or swine covered by this application have originated
In Mexico and that none of the animal have been in any other
country during the time foot-and-mouth disease existed there, or
have been corralled, pastured, or held with such ruminants during
the preceding 60 days, unless accompanied by a valid import permit
issued by Veterinary Services.
Acknowledgement
is hereby made that only certain dips (Listed in 9 CFR Parts 72,
73, and 74) are permitted for treatment against cattle fever ticks
and scabies.
If
I am advised that precautionary dipping Is to be against scabies,
then _____________________________ dip is hereby requested.
This
application may become null and void If the livestock are not
submitted for Inspection on the “Accepted date”
approved by the Port Veterinarian of Veterinary Services.
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Signature
and Title (Imported or Authorized Agent)
|
Date
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TO
BE FILLED OUT WHEN ANIMALS ARE AT PORT OF ENTRY
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This
is to further certify that the above-described livestock while en
route to the port of entry have not been trailed or driven through
fever-tick-infested areas prior to being offered for Importation,
except that for cattle exposed to such infestation In Mexico
offered for importation into the State of Texas, this part of the
certification need not be completed.
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Signature
and Title (Imported or Authorized Agent)
|
Date
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