DEPARTMENT OF AGRICULTURE, GOVERNMENT OF GUAM                                          192 Dairy Road Mangilao, Guam 96913...
Animal permit
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Animal permit

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Animal permit

  1. 1. DEPARTMENT OF AGRICULTURE, GOVERNMENT OF GUAM 192 Dairy Road Mangilao, Guam 96913 APPLICATION for ENTRY PERMIT THIS DOCUMENT IS NOT AN ENTRY PERMIT AND MAY NOT BE USED AS SUCH TELEPHONE NUMBERS OWNER’S NAME: , <(Last) <(First) <( Middle) OFF ISLAND ADDRESS OFF ISLAND: HOME ( )– POINT OF ORIGIN: WORK ( )– ADDRESS IN GUAM: DATE OF ARRIVAL: (mm/dd/yyyy) DATE APPLIED (mm/dd/yyyy) ON ISLAND CARRIER (AIRLINE) NAME & FLIGHT NUMBER (Example. Continental 001) HOME ( )- - WORK ( )- - NAME OF QUARANTINE FACILITY(IES) SELECTED 1. 2. Note: you must attach a letter from the quarantine facility(ies) you have selected verifying your reservation. FOR DEPT. OF AGRICULTURE DESCRIPTION OF EACH ANIMAL TO BE IMPORTED DO NOT WRITE BELOW DOG/CA MARKINGS SEX FACILITY TYPE OF BREED T AGE WEIGHT COLOR PET NAME (IF ANY) TATTOOS, TAG NO, KENNEL M/F WHERE OTHER ID, ETC NO. LOCATED > > >Having the intention of importing the above described animal(s) into the Territory of Guam, the undersignedhereby agrees to pay to the Treasurer of Guam the prescribed sum of U.S. $60 per animal, and to comply withall quarantine rules and regulations of the Department of Agriculture, Government of Guam.DATE PAID: (mm/dd/yyyy) AMOUNT U.S. $ CHECK OR MONEY ORDER NO.SIGNATURE OF APPLICANT: FOR DE PA RTMENT OF AGRICULTURE USE ONLY. DO NOT WRITE BELOW 1. Health and other documents current and valid: YES NO 2. Quarantine exempted: YES NO If no, quarantine required for ______ days. 3. Entry fee: Total Amount U.S. $______.00 Date Paid: ____/____/____; Field Receipt No:_________ 4. Date to be quarantined: ____/____/____, Scheduled date of release: ____/____/____. Entry permit status: Approved Disapproved STEVEN NUSBAUM, Territorial Veterinarian Date

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