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: _______________________________________________