7019 Record of Animals on Hand

According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not 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 collection of information.

This record is required by law (7 U.S.C. 2131-2156). Failure to maintain this record can result in suspension or revocation of license.

OMB APPROVED 0579-0036 Exp. XX/XXXX

U.S. DEPARTMENT OF AGRICULTURE ANIMAL AND PLANT HEALTH INSPECTION SERVICE Record of Animals on Hand (Other than Dogs and Cats)

1. USDA License Number

2. Name and Address of Dealer

3. Business Year

4. Page Number

From (Mo., Day, Yr.)

TO (Mo., Day, Yr.)

Age - Sex

Arrival at premises

Disposition

Container Tag number crate or pen number

Number animals

Individual Identification tattoos or tag numbers (if applicable)

Species

Number Young

Number Adult

Invoice Number

Date (Mo., Day, Year)

From (Name and Address) Give License Number, if Licensee)

date sold, exchanged or donated

date died (Mo., Day, Yr.)

invoice number

mo., day, year

a

b

C

D

E

F

G

H

I

J

K

APHIS Form 7019 JUN 2009

Inspector’s initials

Date