T DEFARTWENT OF AGRNGULTURE
AML AND PLANT HEALTH NSPRETON SERVE
OWNERISHIPPER CERTIFICATE
FITNESS TO TRAVEL TO A SLAUGHTER FACILITY
(Please type or pit nak)
"BSE LOADED ON CONVEYANCE
CCONS(GNOR (OWNERISHIPPER) Nae
Bar S Feed Lot
P.O. Box a67
Shelby, MT 59474
(408}-434-7482 ——
STREET ADDRESS
cmry, STaTE, 21° coOE
‘AREA CODE & TELEPHONE NO.
"GHEGK JHE BOX THAT INDICATES THE FOLLOWING IS TRUE FOR AIL THE Hi
Pregnant mars are tayo foal (ive birt deg to tp.
E Heit clstin eshsonotae| appacve
Fequred to complete tis ilormaior calecton Is estmaiad io] APP! 2
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aig nae, an comeing and rove |
fraaring i
alocton & ntrmaton
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MARKET
‘CONSIGNEE (RECEIVER/OESTINATION) NAME
STREET ADONESS BOUVRY EXPORTS ~~
| P.O. Box 2024
|i. staré be 656 For MacLeod, AB
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‘EA CODE 8 TELEPHONE NO, yc an
ee
‘BRANDS
ON THIS CERTIFICATE
ores aro ato boar weight onal ibs
oa unos
semanas irene
oe soem
7s “Sorrel
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THORSES HAVE HAD AGCESS TO FOOD, VIATER, AND REST FOR A MINIMUM OF 6 CONSEGUTIVE
HOURS nAJEOITELY BEFORE LOADING INTO CONVEYANCE.
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THEREBY AUTHORIZE THE Cr
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‘COMPLETED BY THE CFIA OR DGIF TO THE USDA. FALSIPCATION OF THIS FORM OA KNOWINGLY
DDFORN |S A CHIVINAL OFFENSE AND MAY RESULT ILA FINE OF NOT NORE THAN
Pretrtith ties ecteten itt
PART 4-INSF
THIS DOCUMENT AND THE INFORWATION INT AS
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‘CANADIAN FOOD INSPEPTION AGENCY (CFIA)
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DIRECCION GENERAL DE INSPECCION EN
SPECTORnwa iA PLANT PEA ASPESTON SERVE
OWNERISHIPPER CERTIFICATE
FITNESS TO TRAVEL TO A SLAUGHTER FACILITY
(CONTINUATION SHEET)
(Pace pe or pent init)
‘COLOR DESCRIPTION
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THEREBY AUTHORIZE THE GFA TO DSCLOSE THIS DOCUMENT AND THE FORWATION INIT AS COMPLETED BY THE CFIA TO THE USDA. FALSIFICATION
(OF THis ZORM O8 KNOWINGLY USING A FALSIFIED FORM IS-A CRIMINAL OFFENSE AND MAY RESULT INA FINE OF HOT MORE THAN 619,000 OR
IMPRIGNMENT FOR NOT MORE THAN 8 VEARSOR BOTH (18 USC. SECTION 70D).
al information cotanedin tis erie ie ard coven he Des ony owe)
aetna tnt‘Us DEPIVENT OF AGTIOULTORE
sana ik LAT HEAL RSPRCTON SCE a ed Scat tet aaa Sse
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OWNERISHIPPER CERTIFICATE cairo fo cerpete ti raion colton esta 1
FITNESS TO TRAVEL TO A SLAUGHTER FACILITY |uinifin ateis!omeig'ova sells uiorn
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| CONSIGNEE (RECEIVERIDESTINATION) NAME
Smee Abriess Bars FeediLot "STREET aooress BOUVRY EXPORTS
wc aeesae = P.O: Box 887 oka PO, ox 2024
STATE ZPCOOE Shelby, MAT SUATA Jervive zr cone Few Miac.cog, AB
‘ana Cove a TexerHoneno, (408) 434-7182
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ant mares ar tot fain bith) eurng te ip. “| Hones ae etie 0 bear waght onal ibs
fe Soe B net ln in both eyes. _Z ora ar ale o wate unassisted.
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PART 1- INSPECTOR