DAR etd Beiey It is vital that all infor Cente Anima Records ust) Py Lis 22 Fron Bouman, Keyaborsgh VIC 3473 Prone 03) 3708 Sa Focamie C3) 708 3198 1 You wi cae docunanaon fn “te tvornaton promed cant Microchip Subscription tio on this form is completed. thel Registry once dtals have been entered on thf frm 8 used to ensure that the ick retuned tos owner. Ina: lo Gar com su Weta. Rape com as "LEASE PRINT PLEARLY AND ACCURATELY ** eae eee i eee ‘OWNER DETAILS (Owners Name PES RES! Aasdrose loo: DAL RYMmie: “SUNBURY Email { PPrmary Address Where Animal Kept aie reece Te] ‘Aterate Contact Person er ethan yess as arace sweet ames “NONE PRoviiieo ANIMAL DETAILS Implant Date 10. 2012. aina name ... BIS! Date OF th wane nraoraasr, WCE RS. car tog Number EIDE, Tifoe Cremat ' , 1D Number of Oter Permanert ID Device implanted | soknowledge that tha informat has been advised ofthe Privacy} C. Approved impanter Signature soe Author ‘Supenising Vetesnarian Name aan Access ‘unoifation| sex desered Cl ves [oe at pen : specs [cq Cex Loner speaty Pfodveed ater CI ves [1 Ne vrees ... Labor actor....x cate on Black. LUFETIME Subseription Apolies Dangerous Dog Menecing Bog Restictd Brood APPROVED IMPLANTER INFORMATION Name. BRAK on ST MET ooo Code M NER, Address 3.4 BROOK. Sm. - Sou .... SUNBURY. Postcode 3.2... te_prond 0S. F742. 24 AM [Sztepent (628 below) noe. AZISIE. laton turer Important Notice te Owner PRIVACY STATEMENT - Thsinforston eel contin ard ony internation etet Counel pst rgltvasons, wl be supped to autre scereing cates, cop where Gaal al Fi Stats inommaton maybe suppled toner partes br purposes astodated wih arma elave andlor anagem ‘imal Recor wl pee the ormaton ony on assuroe tat he fort wilt be use fo commer Thaw roe, eerste and aecop ace condos of cata use, onchave sought and btaned petmisen om Pe ‘eermaton proves on Ps fr wo and comes nd fhe poten raed aa ere tha egal ovr te an person under ne ape 17 or 12 camot be corse a aga owner of pe &nereore cannot gh Delran) SIGNATURE (over Aon fo Fedby iowa podic ay ct oration foe nts nafinsors Sues of Auta, 2 nme) DATEDr Daniel Mitchell veterinarysurgeon | gi 31 Brook Street, Sunbury, Victoria 3429 T: (03) 9740 2444 a c F: (03) 9740 2666 www.sunburyet.com.au Brook Street Vet _22stcare@sunburwet.com.au CLIENT DETAILS: Name: {Riis Bue Address: L. D iS Age (Date of Bit Sex: F wg VACCINATION CERTIFICATE Today the above animal was vaccinated with a GS . (Batch number/s_ He/she is due for another vaccination on signed_b_ MSM Dr Daniel Mitchell Veterinary Surgeon General Healthcare Medicine Surgery fe Puppy School Behaviour. Export. All Hols S ‘sn 9897 3916075 vice