Form VPH-20 "Certification of Veterinary Supervision of the Disease Control and Health Care Program at a Licensed Animal Facility" - New Jersey

What Is Form VPH-20?

This is a legal form that was released by the New Jersey Department of Health - a government authority operating within New Jersey. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on May 1, 2016;
  • The latest edition provided by the New Jersey Department of Health;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form VPH-20 by clicking the link below or browse more documents and templates provided by the New Jersey Department of Health.

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Download Form VPH-20 "Certification of Veterinary Supervision of the Disease Control and Health Care Program at a Licensed Animal Facility" - New Jersey

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New Jersey Department of Health
Infectious and Zoonotic Diseases Program
P. O. Box 369
Trenton, NJ 08625-0369
CERTIFICATION OF VETERINARY SUPERVISION
OF THE DISEASE CONTROL AND HEALTH CARE PROGRAM
AT A LICENSED ANIMAL FACILITY
N.J.A.C. 8:23A-1.9(a) requires that this form be updated yearly and posted at the facility in an area clearly
visible to the public.
LICENSED ANIMAL FACILITY INFORMATION
Name of Licensed Animal Facility
License Number
Street Address
City, State, Zip Code
CERTIFICATION BY SUPERVISING VETERINARIAN
This is to certify that I have established and am maintaining a disease control and health care program
at the above licensed animal facility, as specified in N.J.A.C. 8:23A-1.9(a).
Name of Veterinarian (Print)
License Number
Street Address
City, State, Zip Code
Telephone Number (During Business Hours)
Telephone Number (After-Hours Emergencies)
Signature
Date
- THIS FORM TO BE RETAINED AT FACILITY -
VPH-20
MAY 16
New Jersey Department of Health
Infectious and Zoonotic Diseases Program
P. O. Box 369
Trenton, NJ 08625-0369
CERTIFICATION OF VETERINARY SUPERVISION
OF THE DISEASE CONTROL AND HEALTH CARE PROGRAM
AT A LICENSED ANIMAL FACILITY
N.J.A.C. 8:23A-1.9(a) requires that this form be updated yearly and posted at the facility in an area clearly
visible to the public.
LICENSED ANIMAL FACILITY INFORMATION
Name of Licensed Animal Facility
License Number
Street Address
City, State, Zip Code
CERTIFICATION BY SUPERVISING VETERINARIAN
This is to certify that I have established and am maintaining a disease control and health care program
at the above licensed animal facility, as specified in N.J.A.C. 8:23A-1.9(a).
Name of Veterinarian (Print)
License Number
Street Address
City, State, Zip Code
Telephone Number (During Business Hours)
Telephone Number (After-Hours Emergencies)
Signature
Date
- THIS FORM TO BE RETAINED AT FACILITY -
VPH-20
MAY 16