VS 10-13A Owner/Shipper Certificate Fitness to Travel to a Slaught

U.S. DEPARTMENT OF AGRICULTURE
ANIMAL AND PLANT HEALTH INSPECTION SERVICE

OWNER/SHIPPER CERTIFICATE
FITNESS TO TRAVEL TO A SLAUGHTER FACILITY
(CONTINUATION SHEET)
(Please type or print in ink)
TAG
PREFIX

Tag
NO.

Grey

Blk.

Pinto

Chestn Other

SEX

BREED/TYPE

COLOR DESCRIPTION
Bay

According to the Paperwork Reduction Act of 1995, an agency
may not conduct or sponsor and a person is not required to
OMB APPROVED
respond to, a collection of information unless it displays a
valid OMB control number. The valid OMB control number
0579-0160
for this information collection is 0579-0160 and 0579-0332.
0579-0332
The time required to complete this information collection is
estimated to average .5 hours per response, including the time
EXP:
for reviewing instructions, searching existing data sources,
gathering and maintaining the data needed, and completing
10/31/13 & XX/XX/XX
and reviewing the collection of information.

TB

QT

Draft

Pony

Other

Mare

Stal

Geld

BRANDS
Tattoos, etc.

REMARKS
Include
precondition

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I HEREBY AUTHORIZE THE CFIA TO DISCLOSE THIS DOCUMENT AND THE INFORMATION IN IT AS COMPLETED BY THE CFIA TO THE USDA. FALSIFICATION
OF THIS FORM OR KNOWINGLY USING A FALSIFIED FORM IS A CRIMINAL OFFENSE AND MAY RESULT IN A FINE OF NOT MORE THAN $10,000 OR
IMPRISONMENT FOR NOT MORE THAN 5 YEARS OR BOTH (18 U.S.C. SECTION 1001).
SIGNATURE OF OWNER/SHIPPER(I certify that the information contained in this form is true and correct to the best of my knowledge.)

VS FORM 10-13A
(AUG 2011)

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