Certificate of Veterinary Inspection · issued 2023-05-24
35-257434
Dawn Kundert → Jordyn Allen · 1 dogs
Consignor (shipper)
Dawn Kundert
16141 Sharp Rd Mt Horch WI 53572
Consignee (buyer)
12713 Saddle Brook Place Silver Spring MD 20906
Carrier
Not stated on the certificate.
Issuing Veterinarian
Jeffrey R. Kandert
Mt. Horch Animal Hospital
1300 Springdale St, Mt. Horch, WI
Health declarations
Vaccinations (2)
| Name | Manufacturer / Product | Lot | Administered | Expires | Applies to |
|---|---|---|---|---|---|
| Rabies | specific | ||||
| Dist/Parvo (DA2PPv equivalent) | Nobivac Puppy DPV / Nobivac Puppy DPV | 2023-05-23 | specific |
Remarks / additional certifications
Animals are traveling with owner on vacation. Not returning to WI. Received by WI Fri, 02 Jun 2023 11:59am CDT.
Animal is traveling with owner on vacation. Not returning to WI.
Emails on form: jkurdorte@mthorchanihospital.com
Animals listed on this shipment (1)
| ID | Breed | Sex | Age / DOB | Color | Microchip / tattoo | Other |
|---|---|---|---|---|---|---|
| Bels Tervuren | Belgian Tervuren | M | 8 yrs | Brown & Black/Merle | 956000016749292 | 8 yrs |
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 638105 · doc_class PaperCvi