D. The division may approve self-inspection by movers of livestock and feedlots and dairies pursuant to section 3-1203, subsection D. Movement shall be documented on simple and concise self-inspection forms that are provided by the department and that include only the following information:

1. 1. The certificate number.
2. 2. The department contact information.
3. 3. For out-of-state shipments, official identification.
4. 4. For dairy cattle, back tag numbers.
5. 5. The amount collected pursuant to section 3-1236.
6. 6. The number and description of livestock.
7. 7. The livestock owner's or agent's name, signature and address.
8. 8. The transporter's name.
9. 9. The location of the place and date of shipment.
10. 10. The destination or buyer's name and address.
11. 11. For branded animals, the animal's registered brand, including brand number, location and expiration date.