Certificate of Veterinary Inspection · issued 2023-06-02
35-252286
Ellie Dickinson → Jacob Dickinson · 1 dogs
Consignor (shipper)
Ellie Dickinson
120 Telemark Pkwy Mt Horeb, WI 53572
Consignee (buyer)
9502 Puffin Circle Eagle River, Alaska 99577-8636
Carrier
Not stated on the certificate.
Issuing Veterinarian
Christin Olson
Petcare Animal Hospital
7530 Mineral Point Rd, 53717
Health declarations
Vaccinations (5)
| Name | Manufacturer / Product | Lot | Administered | Expires | Applies to |
|---|---|---|---|---|---|
| Rabies | Boehringer Ingelheim / Imrab 3 | 2022-04-01 | 2025-04-01 | specific | |
| DAPP | DAPP | 2022-04-01 | specific | ||
| Lepto | Lepto | 2022-10-07 | specific | ||
| Lyme | Lyme | 2022-10-07 | specific | ||
| Bordetella | Bordetella | 2022-10-07 | specific |
Remarks / additional certifications
Veterinarian certifies no signs of infectious, contagious and/or communicable disease. Animal meets state of destination and Federal interstate requirements.
Emails on form: petcareanimalhospitalstaffe@gmail.com
Animals listed on this shipment (1)
| ID | Breed | Sex | Age / DOB | Color | Microchip / tattoo | Other |
|---|---|---|---|---|---|---|
| Ajax | Terrier Mix | M | 5y | White/Brown | 5y |
The CVI form lists each dog individually. Per-animal vaccination and treatment history is on the source PDF.
Primary source
This certificate was published by Wisconsin DATCP and is hosted on cvicentral.com. Click through to see the original PDF with all vaccination dates, treatment records, and any handwritten notes.
Extraction provenance
shrine_id 645794 · doc_class PaperCvi