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pdfAccording 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.
OWNER/SHIPPER CERTIFICATE
FITNESS TO TRAVEL TO A SLAUGHTER FACILITY
(Please type or print in ink)
UNITED STATES DEPARTMENT OF AGRICULTURE
ANIMAL AND PLANT HEALTH INSPECTION SERVICE
VETERINARY SERVICES
TIME HORSES LOADED ON CONVEYANCE
OMB APPROVED
0579-0332
Exp. Date XX/XXXX
DATE
CITY AND STATE WHERE HORSES WERE LOADED ON CONVEYANCE
VEHICLE LICENSE NUMBER AND DRIVER NAME
NAME OF AUCTION/MARKET
CONSIGNOR (OWNER/SHIPPER) NAME
CONSIGNEE (RECEIVER/DESTINATION) NAME
STREET ADDRESS
STREET ADDRESS
CITY, STATE, AND ZIP CODE
CITY, STATE, AND ZIP CODE
AREA CODE AND TELEPHONE NUMBER
AREA CODE AND TELEPHONE NUMBER
CHECK THE BOX THAT INDICATES THE FOLLOWING IS TRUE FOR ALL THE HORSES ON THIS CERTIFICATE
□ Pregnant mares are not likely to foal (give birth) during the trip.
□ Horses are able to bear weight on all 4 limbs.
□
□
Foals are older than 6 months of age.
TAG
PREFIX
TAG
NO.
Bay
Grey
Blk.
Pinto
Chest
-nut
Other
□
Horses are not blind in both eyes.
COLOR DESCRIPTION
TB
Horses are able to walk unassisted.
BREED/TYPE
SEX
Draft
Stall
ion
QT
Pony
Other
Mare
Gelding
BRANDS
Tattoos,
etc
REMARKS
include
existing
conditions
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
HORSES HAVE HAD ACCESS TO FOOD, WATER, AND REST FOR A MINIMUM OF 6 CONSECUTIVE HOURS
IMMEDIATELY BEFORE LOADING INTO CONVEYANCE.
CANADIAN FOOD INSPECTION AGENCY (CFIA)
EST.
SIGNATURE
DATE
TIME
I HEREBY AUTHORIZE THE CFIA TO DISCLOSE THIS DOCUMENT AND THE INFORMATION IN IT AS COMPLETED BY
THE CFIA OR DGIF 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 (16 U.S.C. SECTION 1001).
DIRECCION GENERAL DE INSPECCION EN
SIGNATURE OF OWNER/SHIPPER (I certify that the information contained in this form is true and correct
to the best of my knowledge.)
EST.
FRONTERAS (DGIF)
DATE
TIME
VS FORM 10-13
FEB 2018
Previous editions are obsolete
PAGE 1 OF ________
File Type | application/pdf |
File Title | VS Form 10-13 Owner/Shipper Certificate Fitness to Travel to a Slaughter Facility |
Author | Khbrown (APHIS-IMB) |
File Modified | 2023-12-22 |
File Created | 2018-02-20 |