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i Rabies Tag Number <br /> Rabies Vaccination SYt3�OTICS`; <br /> I Certificate <br /> Please print—Use ball point pen I /31111 <br /> i J <br /> Owners Last Name First Middle Initial Telephone <br /> �: <br /> l:�rc�Sl�in U a n I k� ~yG- y <br /> Number Street ' <br /> City State Zip <br /> - gam( Gal I • 11 Kr) 57 // <br /> Species: Sex: Age: Size: Name: Predominant Breed: it Colors: <br /> _ og =Male 3 months to 12 months _Under 20 lbs. 49 /N Li 3)1Q r 2 <br /> Cat ,Female .:*12 months or older -A.20 to 50 lbs. Veterinarian's Ucense Number: I Le)/Z <br /> Other Neutered _Over 50 lbs. <br /> (Specify) <br /> Producer: Veterinarian's Signature: <br /> 7 <br /> Dateyear License Vaccination <br /> _ r /�I c%�rG E yr F o <br /> Vaccinated: ` 11 _3 year License Vaccination Address: f <br /> • <br /> 'loom_/ Day N 1993 (First 3 Letters) <br /> Vaccinationexpires: Vaccination Serial(Lot)Number <br /> mom __ Day_ G''J Q <br /> 7 19/ / / // 3 li q <br /> V <br /> • <br /> • <br /> S <br />