Faith Livestock Commission Company, Inc
P O Box 397 – Faith, SD 57626
Phone-605-967-2200 Fax-605/967-2203 firstname.lastname@example.org
Owner’s Name: _____________________________ Sale Date: _________________
The following procedures have been done on the following livestock by the owner.
Brand: ________________Location_____________ Number of Head:_____________
Scourguard: YES NO Month given_________________________
Vibrio lepto: YES NO Month given: _______________________
Prg-guard: YES NO Month given:________________________
Cows were poured YES NO Type of pour on: _____________________
_______________________bulls were turned in on ___________________________
for _______ days, cows/heifers to start calving on _____________________________.
As an affidavit is deemed by USDA as an official record of Country of Origin, I attest through first-hand knowledge, normal business records, or producer affidavit(s) that all livestock referenced by this document or other communications specific to the transaction and transferred are of United States origin. Should the origin of my livestock become other than that described above, I agree to notify Faith Livestock when this occurs.
This affidavit/declaration shall remain in effect until revoked in writing by the undersigned and is delivered to Faith Livestock.
I certify that the information provided on this form is correct. I agree to indemnify the above named market against any and all claims, losses, cost and expenses including reasonable attorney’s fees that arise out of or relate to this certification.
____________________________ _________ ____________________________
Signature Date Ranch Name