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RABIES VACCINATION CERTIFICATE

Type or Print (use ball point pen) Owner's Name and Address: PRINT Last No. SPECIES: Dog 1 Cat 1 Street First City SIZE: Under 20 Lb 1 20-50 lb 1 Over 50 lb 1 Predominent Breed Name: RABIES TAG NUMBER Middle Initial Phone Zip Colors:

Canine

1 Distemper 1 Hepatitis (CAV-1) 1 Adenovirus (CAV-2) 1 Leptospirosis 1Parainfluenza 1 Parvovirus 1 Coronavirus 1 ___________

SEX: AGE: Male 1 3 mo-12 Mo 1 Female 1 12 Mo or older 1 Neutered 1 Microchip 1 Tattoo 1 Number: DATE VACCINATED

Veterinarian's #: Producer: (first 3 letters) ___________________________ Veterinarian's Signature: ROUTE 1M 1 1 yr Lic/Vacc. 1SQ 1 3 yr Lic/Vacc. ___ ________________________ Vacc. Serial (lot) No.

These vaccines are not required for 4-H State Fair

_______________ 20______ Month Day VACCINATION EXPIRES _______________ 20______ Month Day

___________________________ Address:

RABIES VACCINATION CERTIFICATE

Type or Print (use ball point pen) Owner's Name and Address: PRINT Last No. SPECIES: Dog 1 Cat 1 Street First City SIZE: Under 20 Lb 1 20-50 lb 1 Over 50 lb 1 Predominent Breed Name: RABIES TAG NUMBER Middle Initial Phone Zip Colors:

Canine

SEX: AGE: Male 1 3 mo-12 Mo 1 Female 1 12 Mo or older 1 Neutered 1 Microchip 1 Tattoo 1 Number: DATE VACCINATED

1 Distemper 1 Hepatitis (CAV-1) 1 Adenovirus (CAV-2) 1 Leptospirosis 1Parainfluenza 1 Parvovirus 1 Coronavirus 1 Canine Rabies 1 ___________

Veterinarian's #: Producer: (first 3 letters) ___________________________ Veterinarian's Signature: ROUTE 1M 1 1 yr Lic/Vacc. 1SQ 1 3 yr Lic/Vacc. ___ ________________________ Vacc. Serial (lot) No.

These vaccines are not required for 4-H State Fair

_______________ 20______ Month Day VACCINATION EXPIRES _______________ 20______ Month Day

___________________________ Address:

Information

RABIES VACCINATION CERTIFICATE

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