Dog Birth Certificate Template - Health Guarantee Page 3
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1
2
3Puppy Information:
Birth date
______/______/______
Sex
Male
Female
Color
B
Y
Ch
Micro-chipped
Y
Puppy Registration Number ______________________________________
Shot History
Medicine ___________________
Date _______
Date _______
Worming:
Medicine ___________________
Date _______
Date _______
Date _______
New Owner’s Name and Address
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
Date received
___________________________________
__________________________________ Date _________
New Owner Signature
David Eaton
Mill Pond Retrievers
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