United States Department of Agriculture

Animal and Plant Health Inspection Service

Veterinary Services National Center For Import And Export Import/Export Animals 4700 River Road, Unit 39 Riverdale, MD 20737-1231

Horse:_________________________________________________ Health Certificate Number:__________________________________ Country of Origin/Export:___________________________________ This is to certify, Within the five (5) days immediately prior to export, the horse(s) has not been on any premises or area quarantined or identified to be infected with FMD, nor has the horse(s) been in contact with animals that have been in a FMD quarantine area or on an FMD affected or quarantined premises. The horse was groomed to remove dirt and debris, and subsequently wiped, sprayed and/or sponged down with vinegar or a solution of 6.5 ounces of concentrated glacial acetic acid in 1 gallon of water or another approved disinfectant. These procedures were performed in the exporting country prior to loading for departure. The horses' hooves were cleaned and disinfected with a 4% sodium carbonate solution or another approved disinfectant in a manner to ensure that the hooves are free of dirt, manure, and debris. This was performed in the exporting country prior to loading for departure. Prior to loading the horse all crates and transportation vehicles were cleaned and disinfected with an approved disinfectant. This was performed in the exporting country. Any equipment (tack, blankets, sheets, leg wraps, etc.,) accompanying the horse has been laundered or cleaned to remove dirt and debris and subsequently disinfected with an approved disinfectant. Signature:_________________________________________ Date:________________________                    Official Veterinarian for Ministry of Agriculture                                                                                  or Signature:__________________________________________ Date:_______________________                   A full time Salaried Government Veterinarian                                                    And Signature:__________________________________________ Date:_______________________                   Endorsed by Local Veterinary Inspector Effective April 2001

VS - Safeguarding Animal Health Phone (301) 734-8364, FAX (301) 734-6402

http://www.aphis.usda.gov An Equal Opportunity Employer