X Male X - Great Pyrenees Rescue Society

RABI ES VACCI NATION CERTI FICATE
NASPHV FORM 5/ (Revrsed 2007)
RABIES TAG NUMBER
000883
MICROCHIP NUMBER
Owner's Name & Address
Print Clearly
LAST
FIRST
Rescue
Great Pyrenees
NO
(713)2s1-0133
STREET
CITY
Houston
695 Reinerman Street
SPECIES
Dog
Cat
Other
(Specify)
SEX
X Male X
AGE
Female
Neuter X
4
Animal Control License
DATE VACCINATED
TELEPHONE
M.l.
Months
Years
SIZE
Under 20 lbs
20 - 50 lbs
Over 50 lbs
X
1Yr
3
Yr
ztP
STATE
TX
77007
PREDOMINANT BREED PREDOMINANT
COLORS/MARKINGS
Great Pyrenees
X
White
NAME
Shawn
Other
Veterinarian: Julie Henson, DVM
PRODUCT NAME
12t03t2010
License
No:
8437
MANUFACTURER
(First3Letters) Me
NEXT VACCINATION
DUE BY:
12t03t2011
X
1
r
yr USDA Licensed Vaccine
lnitial
dose
568
Booster dose
3804091 1
Vacc. Serial (Lot) No.
1
81
1
ilt*^
Signature
Address Ldbtta Animal
3 yr USDA Licensed Vaccine
4 yr USDA Licensed Vaccine
Hospital
Louetta Rd. #150
Spring, fX77379
Services in Progress
LOU ETTA AN I MAL HOSPITAL
Account
Rescue Great Pyrenees
Date:
Page:
Patient SHAWN
Date
Service/ltem
oty
12t03t2010
12t03t2010
12t03t2010
12t03t2010
12t03t2010
12t03t2010
Examination-Rescue
Health Certificate Exam
Rabies vaccine 1 year
Rabies Vaccine
Rabies Tag
Fecal Flotation Test- negative
1.00
1.00
1.00
1.00
1.00
1.00
Tax
Net Total
26688
1210312010
I
1
Amount
-
Louetta Animal Hospital
HEALTH CERTIFICATE
5258 Louetta Rd. #150
Spring, TX77379
(281) 370-0721
Date: 1210312010
Rescue Great Pyrenees
695 Reinerman Street
Houston TX 77007
SHAWN
CANINE
Great Pyrenees
Tag: None
Age: 21w
Sex:
MN
Doctor:
No Vaccinations
..
I certify that I have examined the animal described and to the best of my knowledge and belief attest
to the statements indicated:
Free from infectious, contagious, and/or communicable diseases.
-5 <12. ln good physicalcondition.
'\-/ 13/ Owner states no known exposure
to Rabies or other communicable diseases withitn
number
, manufacturer
t-V-,/The county of residence
is not unOer a rabies quarantine.
--The animal in this shipment appears healthy for transport
---+-)6
a terFperature within the animalls thermoneutral zone.
_,______
q
_-_/
Signed:
[Accredited V
,Lt
S.<C'"-/
with expiration date
r
qvrve
Yuqt
ot
t
but needs to be maintained at
r(L{, _Afi41
--
inarian TXIDVM License No.
"
Terry McCabe
906 SW Skyline Blvd.
Portland, OR 97221
(503) 702-3925
Dec.3,2010 at
End of Health Certificate
Page
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