VS 8-18 Statement of Services Performed

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-XXXX. The time
required to complete this information collection is estimated to average .10 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.
UNITED STATES DEPARTMENT OF AGRICULTURE
ANIMAL AND PLANT HEALTH INSPECTION SERVICE
VETERINARY SERVICES

OMB Approved
0579-XXXX
Exp.: XX/XXXX

1. ACCOUNTING CLASSIFICATION

STATEMENT OF SERVICES PERFORMED
2. NAME AND ADDRESS OF PAYEE (Include Street Address and ZIP Code)

3. PERIOD ENDING

4. CONTRACT OR AGREEMENT NUMBER

5. LOCATION OF VETERINARY SERVICES OFFICE

6. DATE OF
SERVICE

7. NAME AND ADDRESS OF HERD OWNER

8. TYPE OF SERVICE

9. NUMBER OF
UNITS

10. RATE PER
UNIT

$

11. AMOUNT

$

12. CERTIFICATION
I certify that the number of units identified is correct, that the service rendered was in accordance with my contract or agreement and that payment has not been received from any other source.
13. SIGNATURE OF PAYEE
DATE SIGNED

14. SIGNATURE OF APPROVING OFFICIAL

VS Form 8-18
June 2014

Previous editions are obsolete

DATE SIGNED