VS Form 10-13: Owner/Shipper Certificate: Fitness to Travel to a 

 Slaughter Facility 



TIME HORSES LOADED ON CONVEYANCE 



Enter the exact time horse(s) was/were loaded onto a 

 truck, tractor, trailer, or semitrailers or any combination 

 of these, propelled or drawn by mechanical power. Indi- 

 cate time as AM, PM, or Military time. 



DATE 



The date you are completing this form 

 (day, month, year). 



VEHICLE LICENSE NO. AND DRIVER'S NAME 



The vehicle license number is the tag number of the 

 conveyance. Enter the name of the person who is 

 actually driving the conveyance. 



CONSIGNOR (OWNER/SHIPPER) NAME 



Enter the name of any individual, partnership, 

 corporation, or cooperative association that engages in 

 commercial transportation of more than 20 equines per 

 year to slaughtering facilities. 



The three blocks immediately below refer to the street 

 address, city/State/ZlP code, and phone number of the 

 owner/shipper. 



CITY AND STATE WHERE HORSES WERE LOADED 

 ON CONVEYANCE 



Enter the complete city and State where the horse(s) 

 were loaded onto a truck, tractor, trailer, or semitrailer 

 or any combination of these, propelled or drawn b)' 

 mechanical power. 



NAME OF AUCTION/MARKET 



If the owner/shipper purchased any horse(s) from 

 an auction or livestock market, provide the name of 

 the facility. 



CONSIGNOR (RECEIVER/DESTINATION) NAME 



Enter the name of the person and/or slaughter plant 

 that is taking receipt of the Horse(s) at its/their final 

 destination. 



The three blocks immediately below refer to the street 

 address, city/State/ZIP code, and phone number of the 

 person and/or slaughter plant receiving the animal(s). 



CHECK THE BOX THAT INDICATES . . . 



Check all the boxes beside statements that are true for 

 all the horses traveling on this certificate. 



Identification Section 



Hill out as complclcl}' a.s possible. I'hc description 

 MUST match each horse exactly; therefore, be precise 

 when recording information. 



TAG PREFIX 



This inloinialion is located on the top ol the green 

 equine backtag. The alpha prefix is USAA through ZZ. 

 This prefix MUST be recorded as it is part of the back- 

 tag number. 



Tag NO. 



This information is located on the green equine backtag 

 and is a 3- or 4-digit number. This number MUST be 

 recorded. 



COLOR DESCRIPTION 



Ol the six possible boxes, check the one thai best de- 

 scribes each individual horse. 



BREED/TYPE 



Check the appropriate box. TB = thoroughbred; 

 QT = quarter horse. 



SEX 



Check the appropriate box. 



BRANDS Tattoos, etc. 



Indicate any brands, tattoos, markings, or stars that 

 would aid in identih'ing the indi\idual horse(s). 



REMARKS Include existing conditions 



Fill in this section as compleleh as possible for 

 each animal. 



SIGNATURE 



The driver of the conveyance signs here, certif)'ing 

 that the horses have been offered food and water and 

 been allowed to rest as rc(.]iiircd under all applicable 

 Federal laws. 



SIGNATURE OF OWNER/SHIPPER 



The owner/shipper signs here, certifying that all infor- 

 mation on the form is true and correct. 



CANADIAN FOOD INSPECTION AGENCY (CFIA) 



Leave blank. 



16-32 



