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

Commercial Transportation of Equines to Slaughter

VS 10-13 Apr 2010

Commercial Transportation of Equines to Slaughter (Business)

OMB: 0579-0160

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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 0579-0160. 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.

OMB APPROVED

0579-0160

Exp. Date xx/xxxx

UNITED STATES DEPARTMENT OF AGRICULTURE

ANIMAL AND PLANT HEALTH INSPECTION SERVICE

VETERINARY SERVICES

OWNER/SHIPPER CERTIFICATE

FITNESS TO TRAVEL TO A SLAUGHTER FACILITY

(Please type or print in ink)

TIME HORSES LOADED ON CONVEYANCE

DATE

CITY AND STATE WHERE HORSES WERE LOADED ON CONVEYANCE

VEHICLE LICENSE NUMBER AND DRIVER NAME

NAME OF AUCTION/MARKET

CONSIGNOR (OWNER/SHIPPER) NAME

CONSIGNEE (RECEIVER/DESTINATION) NAME

STREET ADDRESS


STREET ADDRESS


CITY, STATE, AND ZIP CODE

CITY, STATE, AND ZIP CODE

AREA CODE AND TELEPHONE NUMBER

AREA CODE AND TELEPHONE NUMBER

CHECK THE BOX THAT INDICATES THE FOLLOWING IS TRUE FOR ALL THE HORSES ON THIS CERTIFICATE

Pregnant mares are not likely to foal (give birth) during the trip. Horses are able to bear weight on all 4 limbs.


Foals are older than 6 months of age. Horses are not blind in both eyes. Horses are able to walk unassisted.


TAG PREFIX

TAG NO.

COLOR DESCRIPTION

BREED/TYPE

SEX

BRANDS Tattoos, etc

REMARKS include existing conditions

Bay

Grey

Blk.

Pinto

Chest-nut

Other

TB

QT

Draft

Pony

Other

Mare

Stall

ion

Geld-

ing

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HORSES HAVE HAD ACCESS TO FOOD, WATER, AND REST FOR A MINIMUM OF 6 CONSECUTIVE HOURS IMMEDIATELY BEFORE LOADING INTO CONVEYANCE.



SIGNATURE

CANADIAN FOOD INSPECTION AGENCY (CFIA)

EST.

DATE

TIME

I HEREBY AUTHORIZE THE CFIA TO DISCLOSE THIS DOCUMENT AND THE INFORMATION IN IT AS COMPLETED BY THE CFIA OR DGIF 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 (16 U.S.C. SECTION 1001).

DIRECCION GENERAL DE INSPECCION EN FRONTERAS (DGIF)

SIGNATURE OF OWNER/SHIPPER (I certify that the information contained in this form is true and correct to the best of my knowledge.)

EST.


DATE

TIME

VS FORM 10-13 Previous editions are obsolete

APR 2010 PAGE 1 OF ________

File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
File TitleAccording to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond
AuthorKhbrown
File Modified0000-00-00
File Created2021-01-29

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