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\IN.,041 Oyu RABIES VACCINATION CERTIFICATE Tag fee S: ADAPTED NASPHV FORM 5/ Tag #: Cert. Serial #: POINT - use ball point pen or type Owner's Name 8 Addre'Ss FIRST MI TELEPHONE PRINT LAST 7 NO. STREET CITY -- STATE ZIP Si-lo N-t, 1(-)no-c-c4.in S ' SPECIES: SEX: AGE: SIZE: PREDOMNANT BREED: COLORS: Dog rviale 3 Mo. to 12 Mo. E Under 20 lbs. El b ( 0 Li3v-t husctv Cat 17 Female 7 12 Mo. or °Icier )K.20 - 50 lbs LI '... Other Li Altered I..71 Over 50 lbs NAME: (Specify) DATE VACCINATED: PRODUCER: Vn eterinaria's # '2_ is 1111 License No. 1 Month Day Year (First 3 Letters) Veterinarian's (1 - , : 1 yr. Lb./Vac°. ID Signature . --- VACCINATION EXPIRES: i 3 yr. Lie./Vacc. Address i_i_ H t,..ii.iiiii i !It 7.-- litci / 24 S Lipq 4 44,Z 'iliii, n • iiii -ii '''`i P3I6 Moran Day Yea r 7. , ,, Vacc. Serial (Lot) No. VAO0410001 RABIES VACCINATION CERTIFICATE ADAPTED NASPHV FORM 51 Owner's Name & Address PRINT - use ball point pen or type TELEPHONE a___caavG SPE AGE: Dog SIZE: D 3 Mo. to 12 Mo. El PREDOMINANT RREED: Cat Under 20 lbs. D Other El 12 Mo. or older N-1 20 - 50 Ibs S k. (Specify) Over 50 lbs. NAME: LL uu Veterinarian's Signature *— Aficire 71342AWY. Indian School