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Notice to Owners and Importers of Dogs - PDF

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									                                                DEPARTMENT OF HEALTH AND HUMAN SERVICES
         Retrieve Data                                           PUBLIC HEALTH SERVICE                                                  Reset Form
                                                               CENTERS FOR DISEASE CONTROL
                                                                 ATLANTA, GEORGIA 30333
                                             NOTICE TO OWNERS AND IMPORTERS OF DOGS
(Please print)
POINT OF ENTRY - CITY                                                                                                                        DATE


OWNER'S NAME                                                                       PASSPORT No.


                                                                                   DRIVER'S LICENSE No.                                         STATE ISSUED
OWNER'S COMPLETE ADDRESS &, TELEPHONE No.

                                                                                   ADDRESS WHERE DOG(S) WILL BE CONFINED




          The following dog(s) (number, type, age,and description):



which arrived on
                                               (Kind of conveyance - Name of Ship; Flight No. of Plane; Tag No. of Vehicle)
from                                                                                                                                            , is/are admitted
to the United States, subject to restrictions of section 71.51 of Public Health Service Foreign Quarantine Regulations checked below:

    1.           ''Confinement" for           days, which will complete a 30 day period from the date of the antirabies vaccination
                 (§ 71.51 (c) (2) (i).)
    2.           ''Confinement" until three months of age; then antirabies vaccination to be followed by confinement for 30 days.
                 (§ 71.51 (c) (2) (ii).)
    3.           "Confinement" until antirabies vaccination at destination to be followed by ''confinement'' for 30 days.
                 (§ 71.51 (c) (2) (iii).)

   The above restrictions are imposed under section 71.51 Title 42, Code of Federal Regulations, and compliance is necessary before
legal quarantine control of the animal(s) is relinquished.

   ''Confinement'' as used above means ''restriction of an animal by the owner or his agent to a building or other enclosure in isolation
from other animals and from persons except for contact necessary for its care, or, if it is allowed out of such enclosure, muzzling the
animal and keeping it on leash.''

     NOTICE TO OWNER: You are expected to observe this requirement as a safeguard against the introduction of rabies. A person
                      violating U.S. Foreign Quarantine Regulations which provide for this requirement is a subject to a fine up
                      to $1000 and /or imprisonment up to 1 year.



                     (Signature of Government Officer)                                                           (Name: Please print or type)


                                                                                                                              (Title)

Statement to U.S. Government Officer

       I certify that I am the owner, or authorized representative of the owner, of the above listed dog(s). I further certify that I acknowledge
    and will comply with the restrictions checked above. Also, I will be responsible for complying with any additional measures that may be
    required by health departments or other authority in the State of destination.

Copy sent to:
        State health officer in
        state of destination                                                     (Signature of Owner or Representative)                              (Date)

            U.S. Quarantine Station
            (See reverse side)


CDC 75.37 (E), Rev. 05/2004, CDC Adobe Acrobat 5.0 Electronic Version, 05/2004

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           U.S. QUARANTINE STATIONS AND DIVISION OF QUARANTINE HEADQUARTERS



         MAILING ADDRESS AND TELEPHONE                                                       JURISDICTION

         Los Angeles, CA                                             All ports in Southern California, Arizona, Colorado,
         Tom Bradley International Airport                           New Mexico, Texas, Las Vegas-Nevada, and the U.S.
         380 World Way, Box N19                                      Mexico Border.
         Los Angeles, CA 90045
         (310) 215-2365
         San Francisco, CA                                           All ports in Northern California, Utah, Wyoming and
         San Francisco International Airport                         Nevada (except Las Vegas).
         PO Box 280548 SFIA
         San Francisco, CA 94128-0548
         (650) 876-2872

         Miami, FL                                                   All ports in Florida, Puerto Rico, and the US Virgin Islands.
         Miami International Airport
         PO Box 996488
         Miami, FL 33299-6488
         (305) 526-2910


         Honolulu, HI                                                All ports in Hawaii, Guam, and Pacific Trust Territories.
         Honolulu International Airport
         300 Rodgers Blvd. Terminal Box #67
         Honolulu, HI 96819-1897
         (808) 861-8530

         Chicago, IL                                                 All ports in Illinois, Indiana, Iowa, Kansas, Kentucky,
         O'Hare International Airport                                Michigan, Minnesota, Missouri, Nebraska, North
         AMC O'Hare, POB 66012                                       Dakota, Ohio, South Dakota, and Wisconsin. Canadian
         Chicago, IL 60666-0012                                      pre-clearance port: Toronto.
         (773) 894-2960


         Jamaica, NY                                                 All ports in New York, Connecticut, Delaware, District
         JFK International Airport                                   of Columbia, Maine, Maryland, Massachusetts, New
         Room 219.016 Terminal 4(E)                                  Hampshire, New Jersey, Pennsylvania, Rhode Island,
         Jamaica, NY 11430-1081                                      Vermont, Virginia, and West Virginia. Canadian
         (718) 553-1685                                              pre-clearance port: Montreal. Also, pre-clearance at
                                                                     Shannon and Dublin.

         Seattle, WA                                                 All ports in Washington, Alaska, Idaho, Montana, and
         Seattle-Tacoma International Airport                        Oregon. Canadian pre-clearance ports: Edmonton,
         Room S-2067M                                                Calgary, Vancouver, and Victoria.
         Seattle, WA 98158-1250
         (206) 553-4519


         Atlanta, GA                                                 All ports in Georgia, Alabama, Arkansas, Louisiana,
         Hartsfield-Jackson International Airport                    Mississippi, North Carolina, South Carolina, and
         PO Box 45256                                                Tennessee, Oklahoma
         Atlanta, GA 30320
         (404) 639-1220

                               For Public Health assistance, contact the appropriate office above.


         The Centers for Disease Control and Prevention, an agency of the Department of Health and Human
         Services, is authorized to collect this information under provisions of the Public Health Service Act, Section
         301 (42 U.S.C. 241). Response in this case is voluntary and there is no penalty for non-response. The
         individually identified data may be shared with health departments and other public health authorities used to
         locate animal owners if the address is invalid.


         CDC 75.37 (E), Rev. 05/2004, CDC Adobe Acrobat 5.0 Electronic Version, 05/2004

								
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