APHIS 7005 Record of Acquisition of Dogs and Cats on Hand

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 0579-0036. 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.

OMB APPROVED 0579-0036 and 0579-XXXX EXP.: XX/XXXX

UNITED STATES DEPARTMENT OF AGRICULTURE ANIMAL AND PLANT HEALTH INSPECTION SERVICE Record of acquisition of dogs and cats on hand

This record is required by law (7 U.S.C. 2131-2156). (9 CFR, Subchapter A, Parts 1, 2, and 3). Failure to maintain this record can result in a suspension or revocation of license and/or imprisonment for not more than 1 year, or a fine of not more than $1,000, or both.

1. record for (“X”)

Usda License or registration number

2. name and address of licensee, registrant, or holding facility

3. business year

4. PAGE NUMBER

Dealer Other

Holding Facility (Submit copy to Dealer) Exhibitor (Dogs and Cats only)

FROM (Mo., Day, Yr.)

TO (Mo., Day, Yr.)

identification of EACH animal being delivered (See reverse for Breed Abbreviations)

Acquired from

DISPOSITION

a. tattoo or usda tag numbr

b. Dog

C. Cat

d. Age or date of birth

E. Wt.

F. Breed or Type * (If mixed breed, list 2 dominant breeds)

G. description of animal (Color, Distinctive Marks, Hair, Tail, Tattoos, etc.)

h. date acquired

i. name and adDress, usda license or registration number, or driver’s license number and state, vehicle license number and state

J. Date Removed or Sold

K. Date Died or Euthanized (Specify)

“X” M OR F

M

F

M

F

M

F

M

F

M

F

M

F

M

F

M

F

M

F

M

F

M

F

M

F

APHIS 7005 JUL 2009

Inspector use only

Last inspection (Date)

Total Number Animals Entered Since Last Inspection

Count total Number Animals Actually on Premises

Difference (+ or -)

Date

Initials

Previous edition may be used. Replaces VS 18-5 which may be used.

Breed abbreviations – dogs (Column F)

Afghan Hound - AH Dachshund - DH Komondor - KM Shih-tzu - SI

Airedale Terrier - AD Dalmatian - DL Labrador Retriever - LR Silky Terrier - ST

Akita - AK Doberman - DB Lhasa Apso - LA Spitz - SZ

American Bull Terrier - AB Elkhound - EH Malamute - MM Springer Spaniel - SR

Basenji - BS English Bulldog - EB Mastiff - MA Staffordshire Bull - SA

Basset Hound - BH English Setter - ES Maltese - MT Terrier

Beagle - BE Eskimo Dog - ED Miniature Pinscher - MP Walker - WK

Bedlington Terrier - BL Foxhound - FH Newfoundland - NF Weimaraner - WI

Bichon Frise - BF Fox Terrier - FT Old English Sheepdog - OE Welsh Corgi - WC

Black and Tan - BT French Bulldog - FB Pekingese - PK Whippet - WH

Coonhound German Shepherd - GS Pomeranian - PM Yorkshire Terrier - YT

Bluetick - BK German Short Haired - SH Poodle - PO Other (Specify)

Boston Terrier - BO Pointer Pug - PU

Boxer - BX Golden Retriever - GR Redbond Coonhound - RB

Bullmastiff - BM Gordon Setter - GO Rhodesian Ridgeback - RR

Cairn Terrier - CT Great Dane - GD Rottweiler - RW

Catahoula - CU Great Pyrenees - GP Saint Bernard - SB

Chihuahua - CA Greyhound - GH Samoyed - SM

Chinese Crested Dog - CD Husky - HK Schipperkee - SK

Chow-Chow - CC Irish Setter - IS Schnauzer - SN

Cocker Spaniel - CK Jack Russell Terrier - JR Scottish Terrier - SC

Collie - CL Keeshond - KH Shar-pei - SP

Coonhound (Specify) - CH King Charles Spaniel - KC Shetland Sheepdog - SS

BREED ABBREVIATIONS – CATS (Column F)	TYPE (Column F)
Abyssinian - AB Manx - MX Burmese - BU Persian - PR Domestic Long Hair - DL Russian Blue - RB Domestic Short Hair - DS Rex - RE Himalayan - HM Siamese - SI Maine Coon - MC Other (Specify)	Hound Crossbreed - HX Terrier Crossbreed - TX Shepherd Crossbreed - SX Spaniel Crossbreed - PX

APHIS 7005 (REVERSE)

JUL 2009