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. • Y <br />N <br />ANiI SlL. DESCRIPTION : Breed <br />( Color <br />t!� <br />�:. -� Short Ha.zr <br />nursing fesna.�e <br />� VAOCINATION INFORMATION: <br />Height <br />L1U�71-� V ll il �� L 11V�•1� �LJ <br />Q�Nrinr� ro� <br />City License# <br />Veterinarian`s name <br />Sex <br />Weight <br />� Yr <br />Ac�dress Telephone N�r <br />Vaccination Date Vaccination Cextificate N�r <br />Fr�ng iiair <br />Is animal a <br />VIGTIM OF BIT�: ,'; Name Age Address <br />5 • <br />" � I�cation of bite <br />� <br />� Any further infozmation _. ; � ' - <br />.�: , � � ,'� , Fx, � - . r- �'' k�a,� .�x � � � ;: <br />. �, . , . � . �_:;�.»;'- <br />O'GtiTI�R �F ANTM�L: Narne '. - • Address <br />. . <br />,. <br />� A9e _ . <br />ANINL�L II�iPOiJNDID AT: _ <br />{ ,. � <br />IN ACCORDAIVCE WzZH IAW, this animal rnrill be i��ounded at the location specified above, at �hF <br />expense of the owner, for a minim� �ripd of terx days frcdn the tiune af the bi.te. If, durinc <br />the initi.ai �en day quarantine period, the animal shaws any signs or sy�tams of rabies, the <br />quarantine will be inde�initely ext�ded. The animal will not be disposed of during the <br />qu�arantine . <br />. QLIARAN�INE AGR�M�]T <br />��� I�understand �he above orde.r' and I agx�e to impo�nd my animal, at my expense, in hom� �� � <br />a l.ic�nsed veterinazy hospital. If the animai dies or b�cor►�s sick during the tenydays of ec <br />fin�i�, z will personally notify the RosevilZe Police Departn�nt ��;ately. I will not r <br />' move the an;n,.-�L from quarantine until it i�as�been inspected by a representative of the City_ <br />I will nc�t r�ve the animal from the City withoti� per�nission from the Chi�f of Police. I <br />understarid that any vioZation of thes� a�ndi�ions may cause my animal to be in�ouncled at a <br />palice facility at my �xpe�zse and may subject me to criminal penalties. <br />Ani�Z Owner <br />� I cons�n� to the quarantine as provided herein. <br />Bit� Victun <br />� Hos ztal <br />4 - P Irrq�ound vexi£y <br />Ofticer <br />nn�r.n. <br />