Livestock And Fish Movement Report Utah Department Of Agriculture & Food Page 2

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LIVESTOCK AND FISH MOVEMENT REPORT
UTAH DEPARTMENT OF AGRICULTURE & FOOD
350 N. REDWOOD ROAD / PO BOX 146500
Salt Lake City, Utah 84114-6500
801-538-7166
Date:
Time:
A.M.
P.M.
______________________________
VEHICLE OWNER OR DRIVER:
____________________________________________
ADDRESS:
____________________________________________
City
State
Zip
__________________
_____________________
Phone
Vehicle License Number
Shipment Loaded at:
______________________________________________
City
State
Shipment Destination:
_________________________________________________________________
Name
City
State
LIVESTOCK SECTION
NUMBER AND KIND OF LIVESTOCK
Steers/
Other
Heifers
Cows
Horses
Elk
Sheep
Swine
Bulls
________
LIVESTOCK MOVEMENT FOR:
Slaughter
Change of Pasture
Pleasure
Feed Lot
Breeding
Auction Market
Sale
Hunting
HEALTH CERTIFICATE
BRAND OR LIFETIME
NUMBER
CERTIFICATE NUMBER
Certificate No.
State
Certificate No.
State
FISH SECTION
PORT OF ENTRY STAMP
Fish:
Species _________________________
Poundage _______________________
Live
Dead
Entry Permit No. ______________________
Certificate of
Registration No. ______________________
I hereby certify under penalty of perjury, that all information is true and correct.
X _________________________________________________
Signature of Driver

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