Illinois Department of Agriculture Division of Meat, Poultry and Livestock Inspection CERTIFICATE OF EXAMINATION OF POULTRY OWNER OR EXHIBITOR CAT CERTIFICATE OF VACCINATION/EXAMINATION Date: _____________ Owner: __________________ ____ JR (13 & under as of 9/1) ____ SR (14 & older as of 9/1) Address: ____________________________________________ City: ___________________________ State: ______ Phone: ________________________ ____________________________________________________ Name and Location of Show ____________________________________________________ Number Entered Breed Species Band No. of each bird: _________________________________ ____________________________________________________ If more space is needed, use reverse side These birds were tested by______________________________ Name Cat Name: _________________________ Breed: ____________________________ Sex: ___Intact Male Address Date ___Intact Female ___Neutered Male ___Spayed Female Birds came from the Pullorum-Typhoid Clean flock of: Age of Cat: ___________ ____ Longhair ____________________________________________________ ____Shorthair Color: _________________ ____________________________________________________ Name of Flock Owner ____________________________________________________ Address This certifies vaccination of cat against: _____ Panleukopenia _____ Rhinotracheitis _____ Chlamydia _____ FeLV _____ Calici _____ Rabies _____ ______________ On _________________ 20 ___, I inspected the listed poultry entries and source of flock or flocks and to the best of my knowledge found them free from any evidence of, and not recently exposed to, Newcaste disease or any other infectious or transmissible disease. ____________________________________________________ Name of Flock Owner or Exhibitor ____________________________________________________ Address The inspection date must be within 5 days of admission to the above show. DVM: _______________________________________________