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Premises Identification Application Form for Livestock and Poultry Premises

Fields marked with a red star (*) are mandatory.

Pupose of Application?:
New
Updated
Do you presently have livestock and/or poultry at this location?:
Yes
No
Premises Location


Property Parcel Number of premises (on property tax bill):
Civic Adrress:
County:
1. If you have other locations used solely for pasturing animals, please list the parcel numbers


Parcel 1:
Parcel 2:
Parcel 3:
Parcel 4:
Parcel 5:
Parcel 6:
Parcel 7:
Parcel 8:
Parcel 9:
2. If you have other land parcels that house animals, please fillout a separate form for each location


Land Owner Information


First Name:
Middle Name:
Last Name:
Business/Farm Name:
Street #/Road/RTE #:
RR#:
Community/City:
Post Office:
Postal Code:
Primary Phone:
Secondary Phone:
Other Phone:
Fax:
Email:
Emergency Contact Information (individual responsible for the day to day operation of premises)


Contact information same as the Land Owner information::
If No, please fill out the section below.
Yes
No
First Name:
Middle Name:
Last Name:
Street #/Road/RTE #:
RR#:
Community/City:
Post Office:
Postal Code:
Business/Farm Name:
Primary Phone:
Secondary Phone:
Other Phone:
Fax:
Email:
Type of Premises::
Check all that apply.
Farm
Hobby Farm/Small Acreage
Stable
Pasture
Feedlot
Community Pasture
Vet Hospital/Vet Clinic/Vet Lab
Carcass/Deadstock Disposal site
Assembly Yard
Auction/Salesbarn
Racetrack
Exhibition/Fairground
Competition Facility
Provincial Abattoir
Federal Abattoir
Insemination Unit
Research Facility
Egg Grading Station
Poutlry Sales Site
Petting Farm/Zoo
Other
If other, please specify:
Please enter the maximum number of animals for each species that is typically or may be kept on your premises.


Beef:
Dairy:
Sheep:
Swine:
Wild Boar:
Bees:
Bison:
Horses:
Donkey, Mule:
Deer, Red Deer:
Elk:
Llama, Vicuna, Alpaca:
Goats:
Mink:
Fox:
Farmed Rabbits:
Turkeys:
Farmed chinchillas:
Waterfowl (Ducks/Geese):
Purebred Fancier Flock:
Poultry-Meat:


Broilers:
Roasters:
Poultry-Eggs


Laying Hens:
Pullets:
Other Poultry- Please specify:


Other Poultry:
Other Poultry Max Capacity:
Statement of Certification


I certify that: 1. The information provided in this application is complete and correct. 2. I will provide the necessary updates as required by law to ensure that the information related to any premises that I own or operate is complete and correct. 3. I have the authority to provide the information for this premises.
Name of person filling out form.:
Date:
(MM/DD/YYYY)
Information collected


Personal information on this form is collected under the authority of the Animal Health and Protection Act, as it relates directly to and is necessary for purposes outlined in this Act. If you have any questions about this collection of personal information, you may contact The Registrar, Department of Agriculture and Forestry, P.O. Box 2000, Charlottetown, PE, Canada C1A 7N8 Tel: (902)368-4880.

Do you want a copy of the form?


Please send me a simple text-only version of the information I submitted.
Please send me an Acrobat version of the form, with the information I've entered above filled in, that I can print and save.
Please send me both the text-only version and the PDF.
Important Note: Email is not, by its very nature, a secure medium; if you choose to have your form emailed to you, the information you entered will be transmitted over the public Internet to your email box.

Email to address:

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When you click here, the information you've entered above will be sent to the public servant responsible for receiving and processing this form. If you've opted to receive an Acrobat version of the form by email, you will receive this file shortly.
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