1196 Franklin Rd, Amboy, IL 61310
(815)857-2603
$5.00 at gate Thursday-Saturday; $2.00 Sunday; kids 12 & under FREE

Certification of Examination of Poultry

Illinois Department of Agriculture Division of Meat, Poultry and Livestock Inspection
CERTIFICATE OF EXAMINATION OF POULTRY
OWNER OR EXHIBITOR


________________________________________________________________________________________________________________
Name and Location of Show


_____________________________________________________________________________________
Number Entered                                                Breed                                       Species

 


Band No. of each bird:______ _______ _______ _______ ________ ________ _______ ______

 

If more space is needed, use reverse side.


These birds were tested by_______________________________________________________________
                                                      Name and Address                                                Date


Birds came from the Pullorum-Typhoid Clean flock of ________________________________________
                                                                                                 Name of Flock Owner


 ________________________________________________________________________________
Address


On_________,20____, I inspected the listed poultry entries and source of flock or flocks and to the best of my knowledge found them free from any evidence of, and not recently exposed to, any other infectious or transmissible disease.

 


_______________________________________________________________________________________________________________
Name and Address of Flock Owner or Exhibitor

 

 


The inspection date must be within 5 days of admission to the above show