"Veterinary Certification of Unfitness of Dog or Cat for Purchase" - New York

Veterinary Certification of Unfitness of Dog or Cat for Purchase is a legal document that was released by the New York State Department of Agriculture and Markets - a government authority operating within New York.

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Download "Veterinary Certification of Unfitness of Dog or Cat for Purchase" - New York

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New York State Department of Agriculture and Markets 
 
Veterinary Certification of Unfitness of Dog or Cat For Purchase 
Date of Exam
Date of Exam
: ___________________________ 
___________________________ 
Owner of Dog or Cat
Owner of Dog or Cat
: __________________________________________________________________________________ 
: __________________________________________________________________________________ 
Owner Address
Owner Address
: _________________________________________________________________________________________ 
: _________________________________________________________________________________________ 
Owner Telephone Number
Owner Telephone Number
: (______)___________________________________________________________________ 
: (______)___________________________________________________________________ 
Animal Species
Canine
Feline
:   
___________   
_______________ 
Breed
: ___________________________________________________________ 
Age
Sex
Color
: ______________   
: ________________  
: ________________ 
Diagnosis
Diagnosis
: ________________________________________________________________________________________________ 
: ________________________________________________________________________________________________ 
Recommended Treatment
Recommended Treatment
: __________________________________________________________________________ 
: __________________________________________________________________________ 
______________________________________________________________________________________________________________ 
______________________________________________________________________________________________________________ 
Estimate or Actual Cost of Treatment
Estimate or Actual Cost of Treatment
: ___________________________ 
: ___________________________ 
This is to certify pursuant to Article 35‐D of the General Business Law of the State of 
This is to certify pursuant to Article 35‐D of the General Business Law of the State of 
New York, that I am a veterinarian duly licensed by the State of __________________, 
New York, that I am a veterinarian duly licensed by the State of __________________, 
that I have examined the above animal as set forth herein and that I find that said ani‐
that I have examined the above animal as set forth herein and that I find that said ani‐
mal is unfit for purchase due to: (check one) 
mal is unfit for purchase due to: (check one) 
_______illness 
_______illness 
_______congenital malformation which adversely affects the health of the animal 
_______congenital malformation which adversely affects the health of the animal 
_______the presence of symptoms of a contagious or infectious disease 
_______the presence of symptoms of a contagious or infectious disease 
Signature of Veterinarian 
Signature of Veterinarian 
Date
Date
 
 
______________________________________________________  
______________________________________________________  
: ____________ 
____________ 
Name of Veterinarian (printed): 
Name of Veterinarian (printed): 
Lic #: 
Lic #: 
______________________________________________  
______________________________________________  
____________ 
____________ 
Address of Veterinarian
Address of Veterinarian
: _____________________________________________________________________________ 
_____________________________________________________________________________ 
Phone Number  of Veterinarian: 
Phone Number  of Veterinarian: 
(______)__________________________ 
(______)__________________________ 
New York State Department of Agriculture and Markets 
 
Veterinary Certification of Unfitness of Dog or Cat For Purchase 
Date of Exam
Date of Exam
: ___________________________ 
___________________________ 
Owner of Dog or Cat
Owner of Dog or Cat
: __________________________________________________________________________________ 
: __________________________________________________________________________________ 
Owner Address
Owner Address
: _________________________________________________________________________________________ 
: _________________________________________________________________________________________ 
Owner Telephone Number
Owner Telephone Number
: (______)___________________________________________________________________ 
: (______)___________________________________________________________________ 
Animal Species
Canine
Feline
:   
___________   
_______________ 
Breed
: ___________________________________________________________ 
Age
Sex
Color
: ______________   
: ________________  
: ________________ 
Diagnosis
Diagnosis
: ________________________________________________________________________________________________ 
: ________________________________________________________________________________________________ 
Recommended Treatment
Recommended Treatment
: __________________________________________________________________________ 
: __________________________________________________________________________ 
______________________________________________________________________________________________________________ 
______________________________________________________________________________________________________________ 
Estimate or Actual Cost of Treatment
Estimate or Actual Cost of Treatment
: ___________________________ 
: ___________________________ 
This is to certify pursuant to Article 35‐D of the General Business Law of the State of 
This is to certify pursuant to Article 35‐D of the General Business Law of the State of 
New York, that I am a veterinarian duly licensed by the State of __________________, 
New York, that I am a veterinarian duly licensed by the State of __________________, 
that I have examined the above animal as set forth herein and that I find that said ani‐
that I have examined the above animal as set forth herein and that I find that said ani‐
mal is unfit for purchase due to: (check one) 
mal is unfit for purchase due to: (check one) 
_______illness 
_______illness 
_______congenital malformation which adversely affects the health of the animal 
_______congenital malformation which adversely affects the health of the animal 
_______the presence of symptoms of a contagious or infectious disease 
_______the presence of symptoms of a contagious or infectious disease 
Signature of Veterinarian 
Signature of Veterinarian 
Date
Date
 
 
______________________________________________________  
______________________________________________________  
: ____________ 
____________ 
Name of Veterinarian (printed): 
Name of Veterinarian (printed): 
Lic #: 
Lic #: 
______________________________________________  
______________________________________________  
____________ 
____________ 
Address of Veterinarian
Address of Veterinarian
: _____________________________________________________________________________ 
_____________________________________________________________________________ 
Phone Number  of Veterinarian: 
Phone Number  of Veterinarian: 
(______)__________________________ 
(______)__________________________