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essen <br />SPECIES <br />SEX AGE SIZE <br />!RABIES TAG NUMBER <br />Dog <br />RABIES VACCINATION CERTIFICATE <br />12147 <br />Cat <br />IV4SPHVFORM 51 <br />El <br />Other <br />❑ Altered 171 Over 50 lbs <br />,MICROCHIP NUMBER <br />Owner's Name <br />Animal Contra[ License ❑ 1 Yr ❑ 3 Yr ❑ Other <br />BUDDY <br />LAST <br />FIRST M.I. <br />TELEPHONE <br />Netherton <br />(541)515-9911 <br />ADDRESS <br />CITY STATE <br />ZIP <br />4706 I n, <br />Eugene OR <br />97402 <br />essen <br />SPECIES <br />SEX AGE SIZE <br />PREDOMINANT BREED <br />Dog <br />Male IK Months LI. Under 201bs <br />El Labrador Retriever <br />Cat <br />❑ Female ❑ 2 yr Years N: 20-50lbs <br />El <br />Other <br />❑ Altered 171 Over 50 lbs <br />0 NAME <br />(Specify) <br />Animal Contra[ License ❑ 1 Yr ❑ 3 Yr ❑ Other <br />BUDDY <br />PREDOMINANT <br />COLORSIMARKINGS <br />Yellow <br />DATE VACCINATED PRODUCT NAME Veterinarian: Mick Helton, DVM <br />314/2013 License No: 1688 <br />MANUFACTURER <br />NEXT VACCINATION I (First 3 Letters) 1MIEIRI � � � °�/ <br />DUE BY: <br />313/2016 El 1 yr USDA Licensed Vaccine Veterinarian's <br />3 yr USDA Licensed Vaccine Signature: -ek <br />❑ 4 yr USDA. Licensed Vaccine <br />❑ Ini'dal dose Z Booster dose Address: The Ark Veterinary Clinic <br />18108B 4965 Barger Dr <br />Eugene, OR 97402 <br />Vacc. Serial (Lot) No, <br />