VS 1-27A Continuation Sheet for Permit for Movement of Restricted

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 numbers for this information collection are 0579-0047, 0579-0065, 0579-0101, 0579-0127, 0579-0146, 0579-0338, and 0579-0393.
The time required to complete this information collection is estimated to average between 10 minutes and 2 hours, including 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
0579-0047, 0065, 0101,
0127, 0146, 0338, and 0393

PERMIT FOR MOVEMENT OF ANIMALS
CONTINUATION SHEET

PAGE
OF

USE A SEPARATE FORM FOR EACH SPECIES

1. NAME AND ADDRESS OF SHIPPER OR COSIGNOR (include Zip Code)

OF VS Form 1-27

No.

3. MOVED FROM (Name and location of premise if other than item 1)
2. CONSIGNEE (Destination Name and Address include Zip Code)

4. NAME AND ADDRESS OF OWNER AT TIME CONDITION DIAGNOSED

VALID ONLY FOR ABOVE DESTINATION
EAR TAG NO.

BREED

SEX

A

B

C

VS Form 1-27A
SEP 1991

DISEASE
BRAND
D

ANIMALS TO BE MOVED

OTHER IDENTIFICATION
(Complete No.)
E

EAR TAG NO.

BREED

SEX

A

B

C

DISEASE
BRAND
D

OTHER IDENTIFICATION
(Complete No.)
E