Certification of US issued Rabies Vaccination

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Certification of U. S.-issued rabies vaccination (for live dog re-entry into the United States)
Veterinary Authority
UNITED STATES DEPARTMENT OF AGRICULTURE

Date Of Issue

Certificate Number

1. Consignor:

2. Consignee:

3. Country Of Origin:

4. State Of Origin:

USA
5. Country Of Destination:

United States

6. Zone Of Destination:

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7. Place Of Origin:

8. Port Of Embarkation / Border Crossing:

9. Estimated Date Of Shipment:

10. Means Of Transport:

11. *******************************************************

12. CITES Permit Number:

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13. Description Of Commodity:

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14. Date Of Inspection:

Dogs
15. Total Quantity:

16. Additional Information:

17. Total Number Of Packages/Containers:
18. Identification / Seal Numbers:

19. Commodities Intended Use:

20. Type Of Admission:

21. Identification Of Commodities:

(See next page)
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Certification of U. S.-issued rabies vaccination (for live dog re-entry into the United States)
Veterinary Authority
UNITED STATES DEPARTMENT OF AGRICULTURE

Date Of Issue

Certificate Number

----------------------------------------------------------------------------------------------------------21. Identification Of Commodities: Continued
Name
ISO Microchip Number
Microchip Implant Date
Breed
Date of Birth (mm/dd/yyyy)
Sex
Color

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Certification of U. S.-issued rabies vaccination (for live dog re-entry into the United States)
Veterinary Authority
UNITED STATES DEPARTMENT OF AGRICULTURE

Date Of Issue

Certificate Number

---------------------------------------------------------------------------------------------------------Certification Statements:

I certify that I have verified the presence of an ISO-compliant microchip and the
microchip listed on this form is true and correct, and matches the information in the
official medical records. The microchip must be administered on or before the date of
the most recent rabies vaccine or the rabies vaccine is considered invalid and
revaccination is required.
I certify for the animal listed above and that age, breed, sex, and description of
the animal is true and correct, and matches the information documented on the rabies
vaccination certificate and in the official medical records.
I certify based on either having personally administered or supervised the
administration of the vaccine or booster, or upon review of medical records maintained
within the veterinary clinic in which I practice medicine, that the animal identified
above was vaccinated against rabies within the United States, using a USDA-licensed
rabies vaccine on the date listed above.
I certify based on either having personally administered or supervised the
administration of the vaccine or booster, or upon review of medical records maintained
within the veterinary clinic in which I practice medicine, that: (1) the initial
rabies vaccine was administered on or after 12 weeks (84 days) of age; or (2) the
rabies booster vaccine was administered on or after 60 weeks (15 months) of age and
the owner had proof of previous rabies vaccination that was administered on or after
12 weeks (84 days) of age.
I certify that I have accurately recorded the animal’s complete rabies vaccination
history for the past 3 years on this form to the best of my knowledge and belief and
based on official medical records.
I certify that I am licensed to practice veterinary medicine in at least one U.S.
state and maintain a valid USDA Category I or II National Veterinary Accreditation.
I certify the animal listed above is expected to travel to these foreign
country(ies), ______ , and then re-enter the United States
I hereby certify to the best of my knowledge and belief that the information
submitted herein is complete and accurate and that any false statement made in
connection with this certification may subject me to criminal penalties under 18
U.S.C. 1001.
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Certification of U. S.-issued rabies vaccination (for live dog re-entry into the United States)
Veterinary Authority
UNITED STATES DEPARTMENT OF AGRICULTURE

Date Of Issue

Certificate Number

----------------------------------------------------------------------------------------------------------RABIES VACCINE INFORMATION
Product Name Manufacturer Lot Number Product Expiration Date Date of Vaccination Date Next Vaccination is Due

Name of Accredited Veterinarian

Name of USDA Veterinarian

Signature of Accredited Veterinarian

Signature of USDA Veterinarian
_INVISIBLE_CERT_SIGNATURE_PAGE_INVISIBLE_

Date

Date
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