Ïðèëîæåíèå ¹4
ÐÎÑÑÈÉÑÊÀß ÔÅÄÅÐÀÖÈß
ÂÅÒÅÐÈÍÀÐÍÀß ÑËÓÆÁÀ Ôîðìà
¹4
__________________________ Âûäàåòñÿ âåòåðèíàðíûìè
ñïåöèàëèñòàìè ãîñóäàðñòâåííûõ
Ñóáúåêò Ðîññèéñêîé Ôåäåðàöèè è ïðîèçâîäñòâåííûõ ñëóæá
íà âñå âèäû ïîäêîíòðîëüíûõ _____________________________ ãðóçîâ,ïåðåâîçèìûõ
òîëüêî íà òåððèòîðèè ðàéîíà (ãîðîäà).
(ðàéîí, ãîðîä)
_____________________________
(íàèìåíîâàíèå ó÷ðåæäåíèÿ)
ÂÅÒÅÐÈÍÀÐÍÀß
ÑÏÐÀÂÊÀ ¹ 000000
îò "___"___________199 ã.
ß, íèæåïîäïèñàâøèéñÿ âåòåðèíàðíûé âðà÷, âûäàë íàñòîÿùóþ âåòåðèíàðíóþ ñïðàâêó
â òîì, ÷òî ïðèíàäëåæàùàÿ åìó __________________________________________________
(êîìó-íàèìåíîâàíèå
þðèäè÷åñêîãî ëèöà èëè Ô.È.Î.ôèçè÷åñêîãî ëèöà)
_________________________________________________________________________________________
(íàèìåíîâàíèå ïðîäóêöèè ïî ÃÎÑÒ,ÎÑÒ,ÒÓ;
_________________________________________________________________________________________
âèä, âîçðàñò, ïîë æèâîòíûõ, ïòèö (ðûá)
â êîëè÷åñòâå____________________ _________ ___________________________________________
(êã, ìåñò, øòóê,ãîëîâ) (óïàêîâêà) (ìàðêèðîâêà,
¹ è ôîðìà êëåéìà)
ïîäâåðãíóòà(û)_________________________________________________________________
èññëåäîâàíèÿì, âàêöèíàöèè,îáðàáîòêàì,äåçèíôåêöèè,êîíñåðâàöèè,ïàñòåðèçàöèè
(ñòåðèëèçàöèè) è äð.)
íàïðàâëÿå(þ)òñÿ__________________ ___________________________________________
(âèä òðàíñïîðòà) (ìàðøðóò
ñëåäîâàíèÿ)
â______________________________________________________________________________
(íàèìåíîâàíèå è àäðåñ ïîëó÷àòåëÿ)
äëÿ____________________________________________________________________________
(äîðàùèâàíèÿ, îòêîðìà, óáîÿ, ðåàëèçàöèè, õðàíåíèÿ,
ïåðåðàáîòêè è äð.)
ÎÑÎÁÛÅ ÎÒÌÅÒÊÈ___________________________________________________________
(óêàçûâàþòñÿ: ¹¹ âåòåðèíàðíûõ
êëåéì, ¹¹ è êëè÷êè æèâîòíûõ)
_________________________________________________________________________________________
(çàïîëíÿåòñÿ ïðè îòïðàâêå
íà îñîáûõ óñëîâèÿõ)
_________________________________________________________________________________________
Âåòåðèíàðíàÿ ñïðàâêà äåéñòâèòåëüíà òîëüêî â îðèãèíàëå è íà
òåððèòîðèè ðàéîíà (ãîðîäà)
_________________________
Ô.È.Î.
Ì.Ï. _________________________
äîëæíîñòü
_________________________
ïîäïèñü