I hereby certify that, while in my custody, from ________ to ________ (time period of custody), the above-listed calf or calves have not been treated with drugs, or have been treated with one or more drugs in accordance with FDA approved label directions and have been withheld from slaughter for the period(s) of time specified by those label directions. I certify that, to the best of my knowledge and belief, all information contained herein is true, that the information may be relied upon at the official establishment, and that I understand that any willful falsification of this certification is a felony and may result in a fine of up to $250,000 for an individual or up to $500,000 for an organization, or imprisonment for not more than 5 years, or both (21 U.S.C. 677 , 18 U.S.C. 1001 and 3571 ).
Executed on _______________________________
(date of certification)
_______________________________
(signature of certifier)
_______________________________
(typed or printed name and address of certifier)
_______________________________
(business of certifier)
9 C.F.R. §309.16
Recordkeeping requirements approved by the Office of Management and Budget under control number 0583-0053