This record is required by law (7 USC 2131-2156). (9 CFR, Subchapter A, Parts 1, 2 and 3). Failure to maintain this record can result in
a suspension or revocation of license and/or imprisonment for not more than 1 y ear, or a fine of not more than $1,000, or both.
See reverse side for
additional information.
FORM APPROVED
OMB NO. 0579-0036
1. SELL'S INVOICE NO.
2. PAGE
U.S. DEPARTMENT OF AGRICULTURE
ANIMAL AND PLANT HEALTH INSPECTION SERVICE
3. DATE OF DISPOSITION
CONTINUATION SHEET FOR
RECORD OF DISPOSITION OF DOGS AND CATS
4. DEALER'S LICENSE NO. OR RESEARCH FACILITY
REGISTRATION NO.
SALE
EXCHANGE OR TRANSFER
DONATION
5. SELLER OR DONOR (Name)
6. BUYER OR RECEIVER (Name)
7. IDENTIFICATION OF ANIMALS BEING DELIVERED
RESEARCH
FACILITY USE
DESCRIPTION OF BREED, TYPE OR MONGREL
AGE "X"
IF TYPE OR
MONGREL - DESCRIBE
(Hair, Tail, Ears, Color, etc)
NO.
ASSIGNED
BY
TATTOO
OR USDA
DISTIN-
CITIVE
MARKS
BREED,
TYPE OR
MONGREL
DOG CAT
WT.
TAG NO.
FACILITY
I
E
J
G
H
F
B
C
D
A
F
M
M
F
F
M
M
F
F
M
M
F
F
M
M
F
F
M
M
F
F
M
M
F
F
M
M
F
F
M
M
F
F
M
M
F
F
M
M
F
F
M
M
F
F
M
M
F
F
M
M
F
F
M
M
F
F
M
M
F
F
M
M
F
F
M
M
F
F
M
M
F
F
M
M
F
F
M
M
F
F
M
M
F
F
M
M
F
F
M
M
F
F
M
M
F
Replaces VS Form 18-6A which may be used.
APHIS FORM 7006A (JAN 1990)
YOUNGADULT
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The
valid OMB control number for this information collection is 0579-0036.The time required to complete this information collection is estimated to average 1 hour per response,
including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the co llection of
information.
APHIS FORM 7006A (Reverse)