

STATE 



ALL I A CCI\A TIONS MUST BE PROMPTL Y REPOR TED 



_ COOPERATIVE STATE FEDERAL BRUCELLOSIS ERADICATION PROGRAM W 

 BRUCELLOSIS VACCINATION RECORD 





COUNTY 'code 

 1 

 1 



hEBD NUM8E n 



H&RD0VVN6R LAST FIRST INITIAL 



VACCINE USED 



E KPiRAl ION DATE 



owmen number 



ROUTE STREET ROAD 



SERIAL NUMBER DOSAGE 

 a Full 



a R«ducM 



VACC TATTOO 



KIND OF HERD 

 Q OAIRV Q BEEF [~1 MIXED 



POST OFFICE STATE ZiFCODE 



CERTIFICATION FOR PAYMENT 



r— 1 1 I^^EE r— 1 1 |''n'«*TE 



FEDERAL BASIS STATE lOwner i 

 I IemplOYEeI \lFrJenh COUNTY txpemcl 



REMARKS WBBS 



CV AV 



ROE 



TWI" 



SEC 



DISTRICT 



FARM UNIT 



1 CERTIFY THAT (1) 1 have vaccinated with Strain 

 19, tattooed and eartagged or otherwise properly iden- 

 3 hereon as prescribed by the Brucellosis UM & R, and 

 on as prescribed by State regulations, (2) when pay- 







z 



IDENTIFICATION 

 NUMBER 



AC 



Yr (si 



.E 



Mo (s) 



BREED 



SEX 



P/B 

 GRADE 



* 



TATTOO 



tified all animals liste 

 recorded all informat 

 ment is claimed at pre 



1 

















below no payment has been or will be received from any other source. 



Signature 



□ate o( Vacci 

 nation 



Agree Code 



2 





















CERTIFICATION OF OWNER OR WITNESS 



1 CERTIFY THAT the animals listed hereon were vaccinated and identified 

 for the above named owner. 



3 

















4 

















Signature 



Date 



5 

















CERTIFICATION FOR REESTABLISHING VACCINATION STATUS 



* 



[~| indicate tattoo of animals previously vaccinated in appropriate column. 



6 

















1 CERTIFY THAT 1 have personally examined the animal(s) noted hereon, 

 and have read the official tattoo(s) and have retagged them as shown. 



7 

















signature 



Date 



8 

















b 



Z 



IDENTIFICATION 

 NUMBER 



AC 



Yr.(s) 



5E 



Mo. Is 



BREED 



SEX 



P/B 

 GRADE 



* 

 TATTOO 



9 

















23 

















10 

















24 

















11 

















25 

















12 

















26 

















13 

















27 

















14 

















28 

















16 

















29 

















16 

















30 

















17 

















31 

















18 

















32 

















19 

















33 

















20 

















34 

















21 

















35 

















22 

















36 

















VS FORM 4-26 

 (JUL 83) 



Previous edition may be used. 



PART 1-OFFICE 



16-9 



