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RABIES VACCINATION CERTIFICATE

 

 

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NASPHV FORM 51 (revised 2007)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

RABIES TAG #

 

 

 

 

 

 

 

 

Owner's Name & Address

Print Clearly

MICROCHIP #

 

 

 

 

 

LAST

FIRST

M.I.

TELEPHONE #

 

NO.STREET

CITY

STATE

ZIP

SPECIES

AGE

 

 

 

 

 

 

 

 

SIZE

PREDOMINANT BREED

PREDOMINANT

Dog

 

 

 

 

 

 

 

 

 

 

Months

Under 20 lbs.

 

 

 

 

 

 

 

 

COLORS/MARKINGS

Cat

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Years

 

 

20 - 50 lbs.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Ferret

 

 

 

 

SEX

 

 

Male

Over 50 lbs.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Other:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Female

 

 

 

 

 

 

 

 

 

 

ANIMAL NAME

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Neutered

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(specify)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Animal Control License

 

 

 

 

 

1 Yr

 

 

 

3 Yr

 

 

Other

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DATE VACCINATED

Product Name:

 

 

 

 

 

 

 

 

 

 

Veterinarian's Name:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Manufacturer:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Month / Day / Year

 

 

 

 

 

 

 

 

 

 

 

 

 

 

License Number:

 

 

 

 

 

 

 

 

 

 

 

 

 

(First 3 letters)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1 Yr USDA Licensed Vaccine

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NEXT VACCINATION

 

 

 

 

 

3 Yr USDA Licensed Vaccine

 

 

 

Veterinarian's Signature

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DUE BY:

 

 

 

 

 

4 Yr USDA Licensed Vaccine

Address:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Initial dose

 

 

Booster dose

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Month / Day / Year

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Vaccine Serial (lot) Number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Document Information

Fact Name Details
Form Purpose The Rabies Certificate form is used to document the vaccination status of pets, ensuring compliance with state and local laws regarding rabies vaccinations.
Governing Law In many states, rabies vaccination is mandated by law, with specific requirements outlined in state public health codes. For example, California Health and Safety Code Section 121690 governs rabies vaccinations for pets.
Certificate Validity The certificate typically indicates the duration of the vaccination's effectiveness, commonly one year or three years, depending on the vaccine used and local regulations.
Veterinarian Requirement A licensed veterinarian must complete and sign the Rabies Certificate, confirming that the animal has received the rabies vaccination and is in good health.

Rabies Certificate - Usage Guidelines

Completing the Rabies Certificate form is an important step in ensuring that your pet is properly documented after receiving a rabies vaccination. This certificate serves as proof of vaccination and may be required for various purposes, including licensing your pet or traveling with them. Below are the steps to fill out the form accurately.

  1. Begin by locating the Rabies Vaccination Certificate form. Ensure you have a clear copy to work with.
  2. In the section labeled Owner's Name & Address, print your name clearly. Include your first name, middle initial, and last name. Then, provide your complete address, including street number, city, state, and zip code.
  3. Fill in your telephone number for contact purposes.
  4. Indicate the species of your pet (Dog, Cat, Ferret, or Other) and provide their age in months or years, depending on the species.
  5. Specify the size of your pet: Under 20 lbs., 20 - 50 lbs., or Over 50 lbs.
  6. Identify the predominant breed of your pet and describe any colors or markings that may help identify them.
  7. Indicate the sex of your pet by checking either Male or Female. If your pet is neutered, please specify.
  8. Enter your pet's name in the designated field.
  9. If applicable, provide the Animal Control License number.
  10. In the DATE VACCINATED section, write the date when your pet received the rabies vaccination.
  11. List the product name of the vaccine used, along with the veterinarian's name and license number.
  12. Record the manufacturer of the vaccine and the vaccine serial (lot) number.
  13. Indicate the next vaccination due date for your pet.
  14. Finally, ensure that the veterinarian's signature is present on the form, confirming the vaccination.

Once the form is completed, make sure to keep a copy for your records. You may need to present this certificate for pet licensing or other requirements, so having it readily available is beneficial.

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Annual Summary and Transmittal of U.S. Information Returns - This form is used to report annual information returns to the IRS.

Dos and Don'ts

When filling out the Rabies Certificate form, it is essential to ensure accuracy and clarity. Below are nine important dos and don’ts to consider.

  • Do print clearly to avoid any misunderstandings.
  • Do provide complete information, including the owner's name and address.
  • Do include the animal's microchip number if applicable.
  • Do specify the predominant breed of the animal.
  • Do record the date of vaccination accurately.
  • Don't leave any sections blank; fill in all required fields.
  • Don't use abbreviations that may confuse the reader.
  • Don't forget to sign the form where indicated.
  • Don't submit the form without double-checking for errors.

By following these guidelines, you can help ensure that the Rabies Certificate is completed correctly and efficiently.

Common mistakes

  1. Illegible handwriting: Filling out the form with unclear handwriting can lead to misinterpretation of important details. Always print clearly to avoid confusion.

  2. Missing owner information: Owners often forget to include their full name, address, and contact number. This information is crucial for identification and follow-up purposes.

  3. Incorrect species or breed: Selecting the wrong species or breed can cause issues with records and compliance. Double-check that the species and predominant breed are accurately indicated.

  4. Omitting vaccination details: Failing to provide the date of vaccination, product name, or veterinarian's information can render the certificate invalid. Ensure all fields are completed.

  5. Wrong vaccination duration: Choosing the incorrect vaccination duration (1 year, 3 years, etc.) can lead to legal repercussions. Verify the vaccination history before making a selection.

  6. Neglecting to sign the form: A signature from the veterinarian is often required. Without it, the form may not be accepted, so always ensure it is signed.

  7. Failure to update information: If any details about the animal or owner change, such as a new address or a change in ownership, it is important to update the certificate promptly.

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