Form 01.30m '03 Rabies Vaccination Certificate by scz11423

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									                                                                                                                     Canine
                                RABIES VACCINATION CERTIFICATE                                                       o   Distemper
                                                                                                                     o   Hepatitis
                  Type or Print (use ball point pen)                         RABIES TAG NUMBER                               (CAV-1)
                                                                                                                     o   Adenovirus
Owner’s Name & Address:                                                                                                      (CAV-2)
                                                                                                                     o   Leptospirosis
PRINT Last                                    First                Middle Initial     Phone:                         o   Parainfluenza
                                                                                                                     o   Parvovirus
                                                                                                                     o   Coronavirus
No.              Street                                             City                                Zip          o   ____________

                                                                                                                     Vaccines listed in
SPECIES:      SEX:           AGE:                 SIZE:            Predominant Breed:            Colors:             the shaded portion
Dog    o      Male    o      3 mo. - 12 mo. o     Under 20 lb. o                                                     of this Certificate
Cat    o      Female o       12 mo. or older o    20-50 lb.   o                                                      are not required for
              Neutered o                          Over 50 lb. o                                                      participation at the
                                                                   Name:                                             WA State 4-H Fair
Microchip o     Tattoo o      Number:

To be completed by Veterinarian or Clinic:â
DATE VACCINATED                                                             Veterinarian or Clinic Identification:
                                      Producer:
                                                                                                                     Feline
_________________ 20 ____                                                                                            o   Panleukopenia
Month      Day                                        (First 3 Letters)                                              o   Rhinotracheitis
                                      ROUTE                                                                          o   Calcivirus
VACCINATION EXPIRES:                  o IM            o 1 yr. Lic./Vacc.                                             o   Chlamydia
                                                                                                                     o   Feline
                                      o SQ            o 3 yr. Lic./Vacc.                                                 Leukemia
_________________20 ____
Month     Day                                                                                                        o _____________
                                      ________________________
                                                                                                                     WS4HF/1.30m
                                      Vacc. Serial (lot) No.

                                                                                                                     Canine
                                RABIES VACCINATION CERTIFICATE                                                       o   Distemper
                                                                                                                     o   Hepatitis
                  Type or Print (use ball point pen)                         RABIES TAG NUMBER                               (CAV-1)
                                                                                                                     o   Adenovirus
Owner’s Name & Address:                                                                                                      (CAV-2)
                                                                                                                     o   Leptospirosis
PRINT Last                                    First                Middle Initial     Phone:                         o   Parainfluenza
                                                                                                                     o   Parvovirus
                                                                                                                     o   Coronavirus
No.              Street                                             City                                Zip          o   ____________

                                                                                                                     Vaccines listed in
SPECIES:      SEX:           AGE:                 SIZE:            Predominant Breed:            Colors:             the shaded portion
Dog    o      Male    o      3 mo. - 12 mo. o     Under 20 lb. o                                                     of this Certificate
Cat    o      Female o       12 mo. or older o    20-50 lb.   o                                                      are not required for
              Neutered o                          Over 50 lb. o                                                      participation at the
                                                                   Name:                                             WA State 4-H Fair
Microchip o     Tattoo o      Number:

To be completed by Veterinarian or Clinic:â
DATE VACCINATED                                                             Veterinarian or Clinic Identification:
                                      Producer:
                                                                                                                     Feline
_________________ 20 ____                                                                                            o   Panleukopenia
Month      Day                                        (First 3 Letters)                                              o   Rhinotracheitis
                                      ROUTE                                                                          o   Calcivirus
VACCINATION EXPIRES:                  o IM            o 1 yr. Lic./Vacc.                                             o   Chlamydia
                                                                                                                     o   Feline
                                      o SQ            o 3 yr. Lic./Vacc.                                                 Leukemia
_________________20 ____
Month     Day                         ________________________                                                       o _____________
                                                                                                                     WS4HF/1.30m
                                      Vacc. Serial (lot) No.

								
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