1. (a) TYPE OF ANIMAL: CAT □ DOG □
2. (b) Breeder's name and address, if known. If not known, set forth the name and address of the source of the animal. If the person from whom the dog or cat was obtained is a dealer licensed by the United States Department of Agriculture, set forth the person's name, address and federal identification number:
3. (c) The date of the dog or cat's birth, unless unknown because of the source of the animal, in which case set forth the date the pet dealer received the animal and the location where the animal was received:
4. (d) For dogs only:
5. (i) The breed, sex, color and identifying marks at the time of sale:
6. (ii) If the dog is from a United States Department of Agriculture licensed source, set forth the individual identifying tag, tattoo or collar number for that animal.
7. (iii) If the breed is unknown or mixed, indicate that fact:
8. (iv) If the breed is being sold as being capable of registration, set forth the name and registration numbers of the sire and dam and the litter number, if known:
9. (e) The record of inoculations and worming treatments administered, if any, to the dog or cat as of the time of sale, while the animal was in the possession of the pet dealer, including the dates of administration and the type of vaccines or worming treatments administered:
10. (f) For cats only: Set forth any known diseases, sickness or congenital condition that adversely affects the health of the cat at the time of sale:

11. (g) Set forth any veterinary treatment or medication received by the dog or cat while in the possession of the pet dealer (other than those set forth in paragraph (e) above):

    Check one:

    □ (i) The dog or cat has no known disease, illness or congenital or hereditary condition that adversely affects the health of the animal at the time of sale; or

    □ (ii) Set forth any known congenital or hereditary condition, disease or illness that adversely affects the health of the dog or cat at the time of sale and attach a statement signed by a licensed veterinarian that authorizes the sale of the dog or cat, recommends necessary treatment, if any and verifies that the condition, disease or illness does not require hospitalization or non-elective surgical procedures and is not likely to require hospitalization or non-elective surgical procedures in the future. A veterinarian statement is not required for intestinal or external parasites unless their presence makes the dog or cat clinically ill or is likely to do so. The statement shall be valid for fourteen business days following examination of the dog or cat by the veterinarian.

    ​​

Pursuant to General Business Law section 753-B, every pet dealer shall deliver to the purchaser of a dog or cat, at the time of sale, a written statement in the following form:

NEW YORK STATE DEPARTMENT OF AGRICULTURE AND MARKETS DIVISION OF ANIMAL INDUSTRY 1 WINNERS CIRCLE, ALBANY, NY 12235

81.5 Information statement. Pursuant to General Business Law section 753-B, every pet dealer shall deliver to the purchaser of a dog or cat, at the time of sale, a written statement in the following form:

INFORMATION STATEMENT FOR PURCHASER OF DOG OR CAT PURSUANT TO GENERAL BUSINESS LAW SECTION 753-B