VS Form 4-26: Brucellosis Vaccination Record 



STATE, COUNTY, AND CODE 



Enter the complete State and county name. Use the 

 Federal Information Processing Standards code for 

 the county. 



HERD NUMBER, OWNER NUMBER 



Herd and owner numbers are assigned by the State. 

 You may or may not have them when you complete 

 the form. 



KIND OF HERD 



Mark the appropriate box. 



REMARKS, WBBS 



[Leave blank.] 



HERD OWNER 



Enter the complete name and mailing address of 

 the owner. 



CV, AV 



Mark whether this is a calfhood vaccination or adult 

 vaccination. 



LOCATION 



Use the appropriate codes for these items. Check with 

 your State or Veterinary Services area office. 



VACCINE USED 



Enter the name of the biological supply company 

 producing the vaccine used. 



EXPIRATION DATE 



Enter the expiration date of the vaccine. 



SERIAL NUMBER 



Enter the serial number of the vaccine. 



DOSAGE 



Mark the appropriate box. 



VACC. TATTOO 



Enter the vaccination tattoo used. See "Brucellosis 

 Eradication: Uniform Methods and Rules" to 

 determine the proper tattoo. 



CERTIFICATION FOR PAYMENT 



Mark the appropriate box. 



SIGNATURE 



This is a legal document; be sure to sign it. 



DATE OF VACCINATION 



Enter the date that the vaccination was performed. 



AGREE. CODE 



Enter your agreement code provided by the State. 



CERTIFICATION OF OWNER OR WITNESS 



Have the owner or a witness sign and date the form. 



CERTIFICATION FOR RE-ESTABLISHING 

 VACCINATION STATUS 



Mark this block if caltliood \accinates arc bcintz 

 retagged; sign and date. Retagging is always done at 

 the owner's expense. 



IDENTIFICATION NUMBER 



Enter the calfhood vaccination tag number from the 

 eartag that you are applying. Note any other permanent 

 identification numbers, if present. 



AGE (MO.) 



List the age in months. 



BREED 



Use the breed codes listed in table 3. 



SEX 



Enter F. 



P/B-GRADE 



Mark this block if the animals are purebred (registered) 

 or grade calves. 



TATTOO 



List the present tattoo if retagging. 



16-8 



