"Information Statement for Purchaser of Dog or Cat Pursuant to General Business Law Section 753-b" - New York

Information Statement for Purchaser of Dog or Cat Pursuant to General Business Law Section 753-b 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 "Information Statement for Purchaser of Dog or Cat Pursuant to General Business Law Section 753-b" - New York

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PROVIDE TO PURCHASER
INFORMATION STATEMENT FOR PURCHASER OF DOG OR CAT
PURSUANT TO GENERAL BUSINESS LAW SECTION 753-B
(a) TYPE OF ANIMAL:
CAT
DOG
Date Acquired__________________
(b) Breeder’s and Broker’s name and address, if known. If not known, set forth the name and address of the source of the
animal. If the person from whom the dog or cat was obtained is a dealer licensed by the United States Department of
Agriculture, set forth the person’s name, address and federal identification number:
_________________________________________________________________________________________________
_________________________________________________________________________________________________
(c) The date of the dog or cat’s birth, unless unknown because of the source of the animal, in which case set forth the date the
pet dealer received the animal and the location where the animal was received:
_________________________________________________________________________________________________
(d) For dogs only:
(i) The breed, sex, color and identifying marks at the time of sale:
_________________________________________________________________________________________________
(ii) If the dog is from a United States Department of Agriculture licensed source, set forth the individual identifying tag,
tattoo or collar number for that animal.
_________________________________________________________________________________________________
(iii) If the breed is unknown or mixed, indicate that fact:
_________________________________________________________________________________________________
(iv) If the breed is being sold as being capable of registration, set forth the name and registration numbers of the
sire and dam and the litter number, if known:
_________________________________________________________________________________________________
_________________________________________________________________________________________________
(e) The record of immunizations and worming treatments administered, if any, to the dog or cat as of the time of sale, while
the animal was in the possession of the pet dealer, including the dates of administration and the type of vaccines or worming
treatments administered:
________________________________________________________________________________________________
__________________________________________________________________________________________________
______________________________________________________________________________________________
(f)
For cats only: Set forth any known diseases, sickness or congenital condition that adversely affects the health of the cat
at the time of sale:
______________________________________________________________________________________________
_________________________________________________________________________________________________
PROVIDE TO PURCHASER
INFORMATION STATEMENT FOR PURCHASER OF DOG OR CAT
PURSUANT TO GENERAL BUSINESS LAW SECTION 753-B
(a) TYPE OF ANIMAL:
CAT
DOG
Date Acquired__________________
(b) Breeder’s and Broker’s name and address, if known. If not known, set forth the name and address of the source of the
animal. If the person from whom the dog or cat was obtained is a dealer licensed by the United States Department of
Agriculture, set forth the person’s name, address and federal identification number:
_________________________________________________________________________________________________
_________________________________________________________________________________________________
(c) The date of the dog or cat’s birth, unless unknown because of the source of the animal, in which case set forth the date the
pet dealer received the animal and the location where the animal was received:
_________________________________________________________________________________________________
(d) For dogs only:
(i) The breed, sex, color and identifying marks at the time of sale:
_________________________________________________________________________________________________
(ii) If the dog is from a United States Department of Agriculture licensed source, set forth the individual identifying tag,
tattoo or collar number for that animal.
_________________________________________________________________________________________________
(iii) If the breed is unknown or mixed, indicate that fact:
_________________________________________________________________________________________________
(iv) If the breed is being sold as being capable of registration, set forth the name and registration numbers of the
sire and dam and the litter number, if known:
_________________________________________________________________________________________________
_________________________________________________________________________________________________
(e) The record of immunizations and worming treatments administered, if any, to the dog or cat as of the time of sale, while
the animal was in the possession of the pet dealer, including the dates of administration and the type of vaccines or worming
treatments administered:
________________________________________________________________________________________________
__________________________________________________________________________________________________
______________________________________________________________________________________________
(f)
For cats only: Set forth any known diseases, sickness or congenital condition that adversely affects the health of the cat
at the time of sale:
______________________________________________________________________________________________
_________________________________________________________________________________________________
(Information Statement continued)
PROVIDE TO PURCHASER
(g) Set forth any veterinary treatment or medication received by the dog or cat while in the possession of the pet dealer (other
than those set forth in paragraph (e) above):
_________________________________________________________________________________________________
_________________________________________________________________________________________________
Check one:
The dog or cat has no known disease or illness, and the dog or cat has no known congenital or hereditary condition that
adversely affects the health of the animal at the time of sale; or
The dog or cat has an existing condition, that of which is indicated above but has been confirmed by a licensed
veterinarian, that it should not adversely affect the health of the animal at the time of sale; or
Set forth any known congenital or hereditary condition, disease or illness that adversely affects the health of the dog
or cat at the time of sale and attach a statement signed by a licensed veterinarian that authorizes the sale of the dog or cat,
recommends necessary treatment, if any and verifies that the condition, disease or illness does not require hospitalization or
non-elective surgical procedures and is not likely to require hospitalization or non-elective surgical procedures in the future. A
veterinarian statement is not required for intestinal or external parasites unless their presence makes the dog or cat clinically
ill or is likely to do so. The statement shall be valid for fourteen business days following examination of the dog or cat by the
veterinarian.
_________________________________________________________________________________________________
PET DEALER CERTIFICATION
I, ________________________________________ ____________________________________________
PRINT NAME OF PET DEALER
TELEPHONE NUMBER
_______________________________________________________________________________________
STREET ADDRESS
_________________________________________________,______________ _______________________
,
STATE
CITY
TOWN OR VILLAGE
ZIP CODE
HEREBY CERTIFY THE ACCURACY OF THE ABOVE STATEMENT.
___________________________________________
____________________________
SIGNATURE OF PET DEALER
DATE
PURCHASER CERTIFICATION
I, ________________________________________
__________________________________________
PRINT NAME OF PURCHASER
TELEPHONE NUMBER
_______________________________________________________________________________________
STREET ADDRESS
_________________________________________________, ________________ ____________________
,
CITY
TOWN OR VILLAGE
STATE
ZIP CODE
HEREBY ACKNOWLEDGE RECEIPT OF THE ABOVE STATEMENT.
___________________________________________
_________________________
SIGNATURE OF PURCHASER
DATE
Pet dealer keeps a copy of both pages
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