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T DEFARTWENT OF AGRNGULTURE AML AND PLANT HEALTH NSPRETON SERVE OWNERISHIPPER CERTIFICATE FITNESS TO TRAVEL TO A SLAUGHTER FACILITY (Please type or pit nak) "BSE LOADED ON CONVEYANCE CCONS(GNOR (OWNERISHIPPER) Nae Bar S Feed Lot P.O. Box a67 Shelby, MT 59474 (408}-434-7482 —— STREET ADDRESS cmry, STaTE, 21° coOE ‘AREA CODE & TELEPHONE NO. "GHEGK JHE BOX THAT INDICATES THE FOLLOWING IS TRUE FOR AIL THE Hi Pregnant mars are tayo foal (ive birt deg to tp. E Heit clstin eshsonotae| appacve Fequred to complete tis ilormaior calecton Is estmaiad io] APP! 2 Ravine sling titi lastal abate tll gar. aig nae, an comeing and rove | fraaring i alocton & ntrmaton eS ae MARKET ‘CONSIGNEE (RECEIVER/OESTINATION) NAME STREET ADONESS BOUVRY EXPORTS ~~ | P.O. Box 2024 |i. staré be 656 For MacLeod, AB TOLO? ‘EA CODE 8 TELEPHONE NO, yc an ee ‘BRANDS ON THIS CERTIFICATE ores aro ato boar weight onal ibs oa unos semanas irene oe soem 7s “Sorrel =) THORSES HAVE HAD AGCESS TO FOOD, VIATER, AND REST FOR A MINIMUM OF 6 CONSEGUTIVE HOURS nAJEOITELY BEFORE LOADING INTO CONVEYANCE. seonat THEREBY AUTHORIZE THE Cr ‘T0 o1so.0" ‘COMPLETED BY THE CFIA OR DGIF TO THE USDA. FALSIPCATION OF THIS FORM OA KNOWINGLY DDFORN |S A CHIVINAL OFFENSE AND MAY RESULT ILA FINE OF NOT NORE THAN Pretrtith ties ecteten itt PART 4-INSF THIS DOCUMENT AND THE INFORWATION INT AS Tha he formato conanedn We omnis Wow ara earoc> Tian ei we chaae ‘CANADIAN FOOD INSPEPTION AGENCY (CFIA) st rae \ DIRECCION GENERAL DE INSPECCION EN SPECTOR nwa iA PLANT PEA ASPESTON SERVE OWNERISHIPPER CERTIFICATE FITNESS TO TRAVEL TO A SLAUGHTER FACILITY (CONTINUATION SHEET) (Pace pe or pent init) ‘COLOR DESCRIPTION ‘Bey Gey) Bk Prt [Grea Cher TB THEREBY AUTHORIZE THE GFA TO DSCLOSE THIS DOCUMENT AND THE FORWATION INIT AS COMPLETED BY THE CFIA TO THE USDA. FALSIFICATION (OF THis ZORM O8 KNOWINGLY USING A FALSIFIED FORM IS-A CRIMINAL OFFENSE AND MAY RESULT INA FINE OF HOT MORE THAN 619,000 OR IMPRIGNMENT FOR NOT MORE THAN 8 VEARSOR BOTH (18 USC. SECTION 70D). al information cotanedin tis erie ie ard coven he Des ony owe) aetna tnt ‘Us DEPIVENT OF AGTIOULTORE sana ik LAT HEAL RSPRCTON SCE a ed Scat tet aaa Sse ar a Ch corse, isan he OWNERISHIPPER CERTIFICATE cairo fo cerpete ti raion colton esta 1 FITNESS TO TRAVEL TO A SLAUGHTER FACILITY |uinifin ateis!omeig'ova sells uiorn (Pease type or print in ink) catty Pa alae “ypane Bi ioo8 PR re i Eee | CONSIGNEE (RECEIVERIDESTINATION) NAME Smee Abriess Bars FeediLot "STREET aooress BOUVRY EXPORTS wc aeesae = P.O: Box 887 oka PO, ox 2024 STATE ZPCOOE Shelby, MAT SUATA Jervive zr cone Few Miac.cog, AB ‘ana Cove a TexerHoneno, (408) 434-7182 os Sa ee rea ane aan ant mares ar tot fain bith) eurng te ip. “| Hones ae etie 0 bear waght onal ibs fe Soe B net ln in both eyes. _Z ora ar ale o wate unassisted. COLOR OESCRIPTION BREEDITYPE rans ns nan O12 Bay [Grey | | Pe | omen] Or ‘ot | oat | Pony aig Tete, | eerste sR ARAAAAANAIN 71 | | | | [4 2 reams n oF] CaRAD FOOD RAPER AsoneY PTD Farge eae z= Nas tases Ca “aoe eet anet ToL 07s Tw Faia one nae PRGENOF PART 1- INSPECTOR