Form VS 17-33 VS 17-33 Animals Imported for Immediate Slaughter

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 0579-0234. 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.

UNITED STATES DEPARTMENT OF AGRICULTURE
ANIMAL AND PLANT HEALTH INSPECTION SERVICE

OMB Approved
0579-0234
Exp. Date: XX/XXXX

1. PORT OF ENTRY

ANIMALS IMPORTED FOR IMMEDIATE SLAUGHTER
Port Veterinarian – Complete items 1 through 12. Distribute copies as indicated below.
Veterinarian at Destination – Return Part 3 to Port Veterinarian after completion of items 18 through 22.

2. ENTRY DATE

The animals identified below were imported in accordance with Department regulations for shipment to an establishment under your supervision. These
animals must be slaughtered as soon as possible after arrival at destination but not later than two weeks from the “Entry Date” shown below. Slaughter of
these animals must be reported by forwarding a copy of this completed form to the port veterinarian shown in item 12 below.
3. TO: (Veterinarian at destination, include ZIP Code)

←

Mail original to

(Use window envelope)

4. NUMBER

5. SPECIES OF ANIMALS

7. RAILROAD CAR NUMBER

6. TRUCK (Trailer) LICENSE NUMBER

8. SEAL NUMBERS

9. NAME AND ADDRESS OF CONSIGNOR (Include ZIP Code)

10. NAME AND ADDRESS OF CONSIGNEE (Include ZIP Code)

11. SIGNATURE OF PORT VETERINARIAN
12. PORT VETERINARIAN (Include ZIP Code)

←

Return one completed copy to

(Use window envelope)

REPORT OF SLAUGHTER
This is to certify that, except as noted below, all animals identified above were received and held in pens until slaughter was completed, so as to prevent
contact with animals not scheduled for immediate slaughter.
13. DATE SLAUGHTERED
14. REMARKS
15. NAME AND ADDRESS OF ESTABLISHMENT (ZIP Code)

16. SIGNATURE OF ESTABLISHMENT OFFICIAL

18. TAG NUMBER

17. TITLE

ENDORSEMENT AND POST MORTEM REPORT
19. DESCRIPTION OF ANIMAL

20. TUBERCULOSIS LESIONS

Insofar as can be determined, the above certification with respect to slaughter is true and accurate. Except as noted above, post mortem examination of
these animals did not show lesions suggestive of tuberculosis.
21. SIGNATURE OF VETERINARIAN AT DESTINATION
22. DATE SIGNED
VS FORM 17-33
AUG 2009

Previous edition may be used.