Permit To Ship Poultry And/or Hatching Eggs Into Kansas - Department Of Agriculture
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1Permit to Ship Poultry and/or Hatching Eggs into Kansas
Office Use Only
Expires: 9/30/20___ Permit No: ____________
SECTION I (to be completed by shipper)
Facility Name:______________________________________________ NPIP Number:________________
Address:________________________________________________________________________________
City:___________________________________State:____________________Zip:___________________
Phone: __________________Fax: _____________________ E-mail: _______________________________
The above hereby applies for permission to ship the following into Kansas (check the desired boxes):
Chicken hatching eggs
Chickens under 8 weeks of age
Turkey hatching eggs
Pullets under 8 weeks of age
Exhibition hatching eggs
Poults under 8 weeks of age
Exhibition birds under 8 weeks of age
Game birds
Other (please explain ) ______________
Water fowl under 8 weeks of age
I am familiar with the rules and regulations governing the importation of poultry and hatching eggs into the
state of Kansas and agree to comply the with same.
__________________________________________
________________________________
Signature (must be owner or officer)
Date
After completion, forward to your state NPIP Agency. The status of the above checked products must be
indicated below or permit will not be processed.
SECTION II (to be completed by the disease control agency in the state of origin)
U.S. Sanitation Monitored
U.S. Pullorum Typhoid Clean
U.S. Salmonella Monitored
U.S. M. Gallisepticum Clean
U.S. Avian Influenza Clean
U.S. M. Synoviae Clean
U.S. H5/H7 AI Monitored
U.S. M. Meleagridis Clean
U.S. H5/H7 AI Clean
U.S. S. Enteritidis Clean
Other (please explain)__________________________________________________
After completion by the official state agency, please forward to the Manhattan, Kansas KDA office listed
above, by fax at (785)564-6778 or via email to kda.poultry@ks.gov.
_______________________________________________________________________________
Date
Signature-Official State Agency
________________________________________________________________________________
Title-Official State Agency
NOTE: Any permit issued on the basis of this application is valid only for the items checked above. Submit
original and keep a copy for your files. Application must be properly endorsed by state NPIP representative.
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