North Dakota Beef Quality Assurance Program Records Transfer Form Please Print

North Dakota Beef Quality Assurance Program Records Transfer Form
Please print Four (4) Copies of this form

TRANSFERRED FROM (SELLER'S INFORMATION)

Date Transferred:_____________; Total Head Transferred:______________; Tag Number Range:_____________
If individual tag numbers of cattle transferred are known, please attach a list of those numbers to this form
Cattle Description

Group Treatment Information (Individual treatment records are available upon request)

M=Intramuscular SC=Subcutaneous
IN=Intranasal
T=Topical
Implant=Implant

three cows black and white image

1=Animal's right neck
2=Animal's left neck
3=Animal's right ear
4=Animal's left ear

Date Example	No. of Head	Sex	Product	Lot#	Company	Dose	Route of Administration	Initials of Processor
5-22-00	55	Heifers	Cowbiotic	0001003	ND Animal Health	5cc	SC-2	LML

I certify that the cattle listed above will qualify for the North Dakota Beef Quality Assurance (NDBQA) Program. The above cattle have been managed and produced according to the guidelines of the NDBQA Program and all records are available to the next operator/owner and NDBQA program staff upon request.
Signature_______________________________________________Date___________________________

TRANSFERRED TO (BUYERS INFORMATION)
Operation/Owner Name____________________________________________________________________
Address_______________________________________________________________________________
City________________________________________________ State____________Zip_______________
Manager Name____________________________ State & Certification Number or Brand_________________
Phone Number_______________________________County______________________________________

AUCTION MARKET INFORMATION	Marketed at___________________________________
Lot Number Number of Head	Lot Number Number of Head

1 copy goes to next owner, 1 copy to auction market, 1 copy for your records and 1 copy sent to Lisa Pederson, NDSU Extension Service, 2718 Gateway Ave., #104, Bismarck ND 58503

BQA Home Page

Breed Type	Color	Sex	Date of Birth	Approximate Weight	Weaning Status