VS 17-65D Agreement for the Transfer of Certain WIld Animals

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

OMB APPROVED:
0579-0040
EXP. DATE
XX/XXXX

AGREEMENT FOR THE TRANSFER OF CERTAIN WILD ANIMALS

The operators of the two zoological parks shown below request the consent of Veterinary Services to move the animals(s) identified herein from the
first zoological park to the second zoological park for exhibition purposes. Said animal(s) have originated in a country where foot-and-mouth disease
or rinderpest exists and are subject to 1 year post-entry control under regulations contained in Part 93, Title 9, Code of Federal Regulations.
1. ANIMAL(S) TO BE TRANSFERRED
NUMBER

KIND OF ANIMAL(S)

TATTOO NUMBER

2. FIRST ZOOLOGICAL PARK (Name and location of park now in possession of animal(s))

In making this request, it is understood that the animal(s) will be moved without undue delay and under conditions approved by the Area Veterinarian
in Charge, Veterinary Services. The animal(s) will be accompanied by the pink copy of VS Form 17-65C, Post Entry Quarantine Record which
includes a Periodic Health Inspection, which has been kept current by appropriate notations of a responsible zoo official and the zoo veterinarian.
3. SIGNATURE OF OFFICER OF PARK

4. TITLE

5. DATE

6. SECOND ZOOLOGICAL PARK (Name and location of park where animal(s) will be sent)

Upon arrival at the zoological park, identified in item 6, the designated animal(s) will not be sold, exchanged, or moved from the premises without prior
consent of Veterinary Services. The proper VS Form 17-65C, Post Entry Quarantine Record, which includes a Periodic Health Inspection" for
each of the designated animals, will be kept current by appropriate notations of a responsible zoo official and the zoo veterinarian.
7. SIGNATURE OF OFFICER OF PARK

VS FORM 17-65D
DEC 2014

8. TITLE

9. DATE