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%,i. 1 Rao:es Tag Numcer <br /> "I 5YH310TiCS%;'! i <br /> Rabies Vaccination <br /> . �l Certificate <br /> a <br /> I i Certs 1 icafe Please print-Use ball point pen ).1 6 <br /> Owners Last Name First Middle Initial Telephone <br /> (,' r rss/e 1,A t 1ta iia n ;r. , 2e6- S/ '7/7 <br /> Numoer Street City State Zip <br /> ( -t/S 119(' 1 ( /c r,. rnCI LS0 r; r ) y'),1 - S-/J 2 <br /> Species: Sex: Age: Size: Name: PredominantQQBreed:`. Colors: <br /> ( . 'Dog - Male 3 montns to 12 months Under 20 lbs. I L-.I n d C-4oz,)(2,a r e_, <br /> _ Cat .•Female X.12 months or older 20 to 50 lbs. 7 <br /> � Vetennanan's�itense Number: � r, <br /> Other <br /> /'a Neutered _Over 50 lbs. i G�"7^ L4.c PJ <br /> (SPecify) I / <br /> Producer. Veterinarian's Signature: <br /> }(� ^, .:Telyear License Vaccination /.;t_ -c- ..` <br /> Date Vacccmatea: /�4 f I L' � =3 year License Vaccination Address: <br /> month / ° - Day .-27 ts7.J 'First 3 Letters) <br /> Vaccination Expires: Vaccination Serial(Lot)Numoer i <br /> Month____Z.A_____ f 7_19 i1 // 9.3V / .'Y I . <br /> r <br /> xr <br /> S <br /> 0 <br />