❖ CERTIFICATE OF SANITARY PURITY ❖
AR’S STATION
PHYSICIAN’S MANDATE: This establishment/lot has been inspected for the presence of rot, contagion, and filth.
I. SUBJECT: ____________________ (Kennel / Tavern / Estate) II. FINDINGS: [ ] PURE [ ] CONTAMINATED III. ACTION: [ ] Continue Operations [ ] Immediate Quarantine [ ] Destruction of Property
PHYSICIAN: ____________________ SEAL: [ ]
CHIEF SCRIBE: ____________________ DATE: _________ SEAL: [ ]
❖ ARCHIVAL FILING (STANDARD) ❖
COPIES OF ALL DOCUMENTS MUST BE GIVEN TO THE AR'S STATIONS GRAND MUNICIPAL ARCHIVE.
FILING PARTY SIGNATURE: ____________________ DATE: ____________________ SEAL: [ ]
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