Vs 10-13a Owner/shipper Certificate Fitness To Travel To A Slaught

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 0579-0332. 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.

UNITED STATES DEPARTMENT OF AGRICULTURE
ANIMAL AND PLANT HEALTH INSPECTION SERVICE
VETERINARY SERVICES
TAG
PREFIX

TAG
NO.

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

COLOR DESCRIPTION
Bay

Grey

Black

Pinto

Chestnut

OMB APPROVED
0579-0332
Exp. Date XX/XXXX

Other

TB

QT

BREED/TYPE

SEX

Draft

Stall
ion

Pony

Other

Mare

Geld
-ing

BRANDS
Tattoos,
etc.

REMARKS
Include
precondition

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
FEB 2018

Page __________of____________