Animal Health Certificate - For New Jersey Animals Only

ANIMAL HEALTH CERTIFICATE - FOR NEW JERSEY ANIMALS ONLY

HEALTH CERTIFICATE VOID

30

60

90

DAYS FROM EXAM DATE

PLEASE CIRCLE ONE ABOVE

NEW JERSEY FAIRS AND SHOWS ONLY

Name & Address of Owner

Name & Address of Animal Destination

Date of Inspection

SPECIES

TEST(S)

Cattle

Goat

Horses

Poultry

TESTED FOR:

Bison

Swine

Sheep

Other

DATE:

LAB:

ANIMAL IDENTIFICATION

ANIMAL

PERMANENT

OFFICIAL RABIES

TEST(S)

COLOR

NAME

ANIMAL IDENTIFICATION

AGE

SEX

BREED

VACCINATION

RESULTS

DATE

Veterinary certification: “I certify as an Accredited Veterinarian, that the above described animal has been inspected by me and that it is not showing any

signs of infectious, contagious, and/or communicable disease.

Accredited Veterinarian’s Name (PLEASE PRINT)

Address (PLEASE PRINT)

Accredited Veterinarian(SIGNATURE)

Date Signed:

Owner Certification: "I certify to the best of my knowledge that this animal(s) originates from a herd or flock that does not show any signs of illness. I agree to notify my

veterinarian if this animal(s) or any of its herdmates or flockmates become ill after the time this examination has been made, or before this Health Certificate expires."

Owner Name(PLEASE PRINT)

Address(PLEASE PRINT)

Owner Signature

Date Signed:

Parent/Guardian Name(PLEASE PRINT)

Parent/Guardian Signature (If the above owner is under 18 years of age)