Faith Livestock Commission Company, Inc

P O Box 397 – Faith, SD  57626

Phone-605-967-2200      Fax-605/967-2203



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 _____________________________.                      



Details: ________________________________________________________________




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