Preview
FILED: NASSAU COUNTY CLERK 04/19/2022 03:12 PM INDEX NO. 615766/2021
NYSCEF DOC. NO. 305 RECEIVED NYSCEF: 04/19/2022
TYPE OF ANIMAL CAT DOG BREED Date
FILE # MICROCHIP ID ID2 SEX COLOR
PET# LITTER # BREEDER/BROKER
BIRTH DATE ARRIVAL DATE ADDRESS
SIRE NAME REG #
DAM NAME REG# AKC
PURCHASER'S NAME PHONE #
PURCHASER ADDRESS
PURCHASE PRICE + TAX = TOTAL
DATE PURCHASER RECEIVED REG. PAPERS
PURCHASERS SIGNATURE
Conditions - See Purchaser Information Statement Pursuant to GBL Section 753-B (following):
IMPORTANT STATEMENTS
* Other than as set forth in the "Sale of Dogs and Cats Notice," provided herewith, all puppy
sales are final and not returnable. Purchaser agrees that the animal may not be returned for
reasons of landlord disapproval, family disagreement, allergies, other pet problems, etc.
* The puppy that you have purchased is sold to you as a pet. Shake A Paw does not guarantee
the puppy for breeding or showing. Adult mature weights, sizes and temperaments may vary
and cannot be guaranteed.
* All pet sales in New York apply only to the original owner and are non-transferrable
* Consumer agrees that Shake A Paw has made no oral representations. The terms and
conditions of this sale are set forth in this agreement, and accompanying documents.
* Shake A Paw assumes no liability whatsoever, including for vet expenses incurred. In the even
your other pets contract illness from the puppy/kitten described above. Again, we recommend
keeping new puppies/kittens separate from you other pets until veterinary exam and approval
are given.
PURCHASER'S SIGNATURE DATE
SELLER'S SIGNATURE DATE
FILED: NASSAU COUNTY CLERK 04/19/2022 03:12 PM INDEX NO. 615766/2021
NYSCEF DOC. NO. 305 RECEIVED NYSCEF: 04/19/2022
DISCLOSURE OF ANIMAL PEDIGREE REGISTRATION
AND
NYS RECEIPT OF REQUIRED DOCUMENTS
Breed: Sex: File#: Collar #:
The animal vour are nurchasine isresistered/registrable with
Registration means that maintains information the parentage and identy of thisanimal.
regarding
NOTE:
AKC = American KennelClub ACHC = AmericanCanine HybridClub
APR = America's
Pet Registry UKCI = Universal
Kennel Club
ACA = AmericanCanine Association UABR = UnitedAll Breed Registry
CKC = Continental
Kennel Club MIX =No or Pedigree
Registry
ICA = laternational
Kennel Club CP = American Kennel Club Canine Panners
Persons buying animals represented by a petdealer as being registrableare entitledto the papers necessary to
effectsuch registrationwithin 120 days of purchase. Failure to provide such papers entitle the purchaser to
remedies under law. However, ifthe purchaser notifiedthe petdealer within 120-day period that he or she has not
received such papers, the dealer shallhave an additional 60 days commencing at the end of the 120-day period in
which to provide such documents.
I acknowledge receipt of a copy the following: (PlaceX eitherY or N andsignbelow)
1) INFORMATION STATEMENT Y N
2) DISCLOSURE OF ANIMAL PEDIOREE Y N
3) PEDIGREE REGISTRATION DOCUMENTS Y _ N _
4) INFORMATION OF THE VALUE OF SPAYING AND NEUTERING Y N
5) THE SALE OF DOGS AND CATS NOTICE Y N
6) RABIES INFORMATION SHEET Y N
7) RABIES VACCINATION CERTIFICATE (IFREQUIRED) Y N N/A
8) RECEIFT OF PURCHASE Y N
9) DOG LICENSING SHEET Y N
Date Customer Signature
Fuppffracker DisclosuseRegisty2.rpt #18/2022 5:58:59PM Page1of I
FILED: NASSAU COUNTY CLERK 04/19/2022 03:12 PM INDEX NO. 615766/2021
NYSCEF DOC. NO. 305 NEW YORK STATE DEPARTMENT OF AGRICULTURE AND MARKETS RECEIVED NYSCEF: 04/19/2022
DIVISION OF ANIMAL INDUSTRY
1 WINNERS CIRCLE, ALBANY, NY 12235
80.5 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
(a) TYPE OF ANIMAL: CAT DOG
(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:
Breeder Name: Breeder Address:
Broker Name: Broker Address:
(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:
(d) For dogs only:
(i) The breed, sex, color and identifying marks at the time of sale. Identifying Marks:
Breed: Sex: Color:
(ii) If the dog is from a United States Department of Agriculture licensed source, set forth the individual identifying tag, tatoo
or collar number for that animal:
Pet Number:
(iii) If the breed is unknown or mixed, indicate that fact:
(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:
(e) The record of immunizations 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:
See Attached
(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:
(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:
The dog or cat has no known congenital hereditary condition, and the dog or cat has no known congenital or
herediatory condition that adversely affects the health of the animal at the time of sale; or
The dog or cat has an existing condition, that of which is indicated above but has been confirmed by a licensed
veterinarian, that it should not adversly affect the health of the animal at the time of sale; or
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.
PET DEALER CERTIFICATION
I, SHAKE-A-PAW HICKSVILLE (516) 938-7877
PRINT NAME OF PET DEALER TELEPHONE NUMBER
285-11 SOUTH BROADWAY
STREET ADDRESS
HICKSVILLE NY 11801
CITY, TOWN OR VILLAGE STATE ZIP CODE
HEREBY CERTIFY THE ACCURACY OF THE ABOVE STATEMENT.
SIGNATURE OF PET DEALER DATE
PURCHASER CERTIFICATION
I,
PRINT NAME OF PURCHASER TELEPHONE NUMBER
STREET ADDRESS
CITY, TOWN OR VILLAGE STATE ZIP CODE
HEREBY CERTIFY THE ACCURACY OF THE ABOVE STATEMENT.
DATE
SIGNATURE OF PURCHASER
FILED: NASSAU COUNTY CLERK 04/19/2022 03:12 PM INDEX NO. 615766/2021
NYSCEF DOC. NO. 305 RECEIVED NYSCEF: 04/19/2022
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FILED: NASSAU COUNTY CLERK 04/19/2022 03:12 PM INDEX NO. 615766/2021
NYSCEF DOC. NO. 305 RECEIVED NYSCEF: 04/19/2022
What Pet Owners Need to Know About Rabies Vaccinations in New YorkState
OttreedveNovember20,2002, ddslaibneadea sheetnauthe peevidedby petdeales an==epeapoint
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Where can I act my oet vaccinated? .
.. . . .
Allcounties are sequired
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a freevaccinadonclinicoveryfourmonths. Contactyourcounty healthdepartmentforthe
schedule in your
area. Rabiesvaccinationsare also availaMe
from your If you
veterinarian. have questions
about now vaccines .
developed for cats and for
specifically pets at younger
ages, contact
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. WI eq should my not receive
its first
rablesvaccination?
'thelaw requiredthat y6urpet'sfirst
rabiesvaccinationbe givenno later than four months
afrerits date of birth.
Many rabies
vaccines are licensed
for use at three months,
althoughsome may'be given at youngerbes. .
When should my oct receive
its second rabies
vaccinadon? "'
Your pot shoiÄIreceiveits second
rabies vrei""tianwithin The second rables shot
one year aGer the ficut vaccination. and all
shotsthereafteraro so=est- caned boostershots.
After my pot acts its second
rabiesshot when is the next booster shot duo?
Afterthe second you
rables shot, onlyneed to get addidonal
booster shots overy three years, if the vaccinadon
clinicor your
veterinarianis using
a rabies
vaccinelicensedfor three years.
What proof willIhave that mypet received
its rables shots?
The or a person
voterinarian, underthe veterinarian's will
supervision, provideyou witha certina"*a
as proof
that yourpet has
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that .
may have been e'1===t exposure of a person or another "=1=I
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What ifmy not needs to be taloon to the veterinarian?
Whenever you bringyour pet to a veterinarian
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a nerson.
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periodmust taloo place at the
owner's expense, at an appropriate such as an animal shelter,
facility veterinarian's
office, If veur net is mºto-date
Preview
FILED: NASSAU COUNTY CLERK 04/19/2022 03:12 PM INDEX NO. 615766/2021 NYSCEF DOC. NO. 305 RECEIVED NYSCEF: 04/19/2022 TYPE OF ANIMAL CAT DOG BREED Date FILE # MICROCHIP ID ID2 SEX COLOR PET# LITTER # BREEDER/BROKER BIRTH DATE ARRIVAL DATE ADDRESS SIRE NAME REG # DAM NAME REG# AKC PURCHASER'S NAME PHONE # PURCHASER ADDRESS PURCHASE PRICE + TAX = TOTAL DATE PURCHASER RECEIVED REG. PAPERS PURCHASERS SIGNATURE Conditions - See Purchaser Information Statement Pursuant to GBL Section 753-B (following): IMPORTANT STATEMENTS * Other than as set forth in the "Sale of Dogs and Cats Notice," provided herewith, all puppy sales are final and not returnable. Purchaser agrees that the animal may not be returned for reasons of landlord disapproval, family disagreement, allergies, other pet problems, etc. * The puppy that you have purchased is sold to you as a pet. Shake A Paw does not guarantee the puppy for breeding or showing. Adult mature weights, sizes and temperaments may vary and cannot be guaranteed. * All pet sales in New York apply only to the original owner and are non-transferrable * Consumer agrees that Shake A Paw has made no oral representations. The terms and conditions of this sale are set forth in this agreement, and accompanying documents. * Shake A Paw assumes no liability whatsoever, including for vet expenses incurred. In the even your other pets contract illness from the puppy/kitten described above. Again, we recommend keeping new puppies/kittens separate from you other pets until veterinary exam and approval are given. PURCHASER'S SIGNATURE DATE SELLER'S SIGNATURE DATE FILED: NASSAU COUNTY CLERK 04/19/2022 03:12 PM INDEX NO. 615766/2021 NYSCEF DOC. NO. 305 RECEIVED NYSCEF: 04/19/2022 DISCLOSURE OF ANIMAL PEDIGREE REGISTRATION AND NYS RECEIPT OF REQUIRED DOCUMENTS Breed: Sex: File#: Collar #: The animal vour are nurchasine isresistered/registrable with Registration means that maintains information the parentage and identy of thisanimal. regarding NOTE: AKC = American KennelClub ACHC = AmericanCanine HybridClub APR = America's Pet Registry UKCI = Universal Kennel Club ACA = AmericanCanine Association UABR = UnitedAll Breed Registry CKC = Continental Kennel Club MIX =No or Pedigree Registry ICA = laternational Kennel Club CP = American Kennel Club Canine Panners Persons buying animals represented by a petdealer as being registrableare entitledto the papers necessary to effectsuch registrationwithin 120 days of purchase. Failure to provide such papers entitle the purchaser to remedies under law. However, ifthe purchaser notifiedthe petdealer within 120-day period that he or she has not received such papers, the dealer shallhave an additional 60 days commencing at the end of the 120-day period in which to provide such documents. I acknowledge receipt of a copy the following: (PlaceX eitherY or N andsignbelow) 1) INFORMATION STATEMENT Y N 2) DISCLOSURE OF ANIMAL PEDIOREE Y N 3) PEDIGREE REGISTRATION DOCUMENTS Y _ N _ 4) INFORMATION OF THE VALUE OF SPAYING AND NEUTERING Y N 5) THE SALE OF DOGS AND CATS NOTICE Y N 6) RABIES INFORMATION SHEET Y N 7) RABIES VACCINATION CERTIFICATE (IFREQUIRED) Y N N/A 8) RECEIFT OF PURCHASE Y N 9) DOG LICENSING SHEET Y N Date Customer Signature Fuppffracker DisclosuseRegisty2.rpt #18/2022 5:58:59PM Page1of I FILED: NASSAU COUNTY CLERK 04/19/2022 03:12 PM INDEX NO. 615766/2021 NYSCEF DOC. NO. 305 NEW YORK STATE DEPARTMENT OF AGRICULTURE AND MARKETS RECEIVED NYSCEF: 04/19/2022 DIVISION OF ANIMAL INDUSTRY 1 WINNERS CIRCLE, ALBANY, NY 12235 80.5 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 (a) TYPE OF ANIMAL: CAT DOG (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: Breeder Name: Breeder Address: Broker Name: Broker Address: (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: (d) For dogs only: (i) The breed, sex, color and identifying marks at the time of sale. Identifying Marks: Breed: Sex: Color: (ii) If the dog is from a United States Department of Agriculture licensed source, set forth the individual identifying tag, tatoo or collar number for that animal: Pet Number: (iii) If the breed is unknown or mixed, indicate that fact: (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: (e) The record of immunizations 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: See Attached (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: (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: The dog or cat has no known congenital hereditary condition, and the dog or cat has no known congenital or herediatory condition that adversely affects the health of the animal at the time of sale; or The dog or cat has an existing condition, that of which is indicated above but has been confirmed by a licensed veterinarian, that it should not adversly affect the health of the animal at the time of sale; or 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. PET DEALER CERTIFICATION I, SHAKE-A-PAW HICKSVILLE (516) 938-7877 PRINT NAME OF PET DEALER TELEPHONE NUMBER 285-11 SOUTH BROADWAY STREET ADDRESS HICKSVILLE NY 11801 CITY, TOWN OR VILLAGE STATE ZIP CODE HEREBY CERTIFY THE ACCURACY OF THE ABOVE STATEMENT. SIGNATURE OF PET DEALER DATE PURCHASER CERTIFICATION I, PRINT NAME OF PURCHASER TELEPHONE NUMBER STREET ADDRESS CITY, TOWN OR VILLAGE STATE ZIP CODE HEREBY CERTIFY THE ACCURACY OF THE ABOVE STATEMENT. DATE SIGNATURE OF PURCHASER FILED: NASSAU COUNTY CLERK 04/19/2022 03:12 PM INDEX NO. 615766/2021 NYSCEF DOC. NO. 305 RECEIVED NYSCEF: 04/19/2022 theof 4. 3. in dueA 2-a. theThe of the later days The the The to publie the shall Such (c) (b) (a) section, the notice sale section. be reland animal, written consumer 1Nothing designated such Every than purchase, of tendered to setminary The Law choosing, infeedous co in The reasonable De by such constaner optionsevent summarising heakh pet information the 2.nerefund Such to the veterinarian veterinary three following bythe animal, veterinarian's if the this set taking consumer's pet notice sh may rightcosts right right Customer's sucItthat law, prescribed the provided cure thrther dealer a rabies cornmissioner foan ea==ininnae to to licensed disease, to dealer angor name, in by to Ibrth condition.a receipt by or reimbursement certifies in pet sectioninitiate shall finding tasiness signinganimat an by dealer or by dealer. An who shall direct7 retan a raguired pm retain coag==hia if, possession ofa the cenification choosing, retum veerinarian's shall an days Such addrums "eetian treatment shaD to such shall by provides th have dealer the the state Upca sells that for the in animal consumer and nottheanempting related that se within action an immnalassion ofintestinal signed seven include, regulations regulations examiningthe the to afford animal if any subdivision thereof. reimbursement to section in such daeamem but anioual animal Signature a rightwishes may shall shall value the animal to the one certifies co to foUowing in information shall includecue way one to not not and certification and at of animal be within of telephone mcommended Immdred to and seven court bepeasites veteriney be is the purpose such limit provide required shall the that receipt which of to hundred unfit poi this contest requirements. by it veterinarian squire pascribe similar thereceiveconanner the examination, shall found theanknairequired ifany, to prescribe unfit costs of is a limited a a receiveveterinarian's for fosteen ifthe to flayfour the animal hundred not moberof include, and for of mal="l sa section curing receive cighty to rights the unfitbe be of an form aninsal adanand orcontpetent certification thebut thereofby services er an right refund be or shan is wi for connaner as subdivision &is ror, initial to pmehase for as notinformation contained. of a business within consaner at pmchase not unfit unSt flay-four caleader to grounris one be and ccstification the tencommner herein vaccinated estimate due saloon point of which ==upon rendered reimbasement article.to,infor=arian for choose for of days remedies for consmaer, or the exchange attempting to wr refund, by that days jurisdiction and of this the caceed a sis andlimited the veterinny pasuant toGem one to shall which the witicly theproduce imalaea aceoina salealpinst to the a pinchase of required.theto, be cement other animal pachase pmchase no the a core pa foRowing are of acchange declaring section actual of this of the sticle, days wida animal price following recover dealer or an the a rabies, Such the due congenhal the the costidentifies isthe to or shan anomat examination licensed evaminarian dealer areanimal provided purchase purseent such theof secdon. safe leijury be in unGs for description, for mai=at to following otherwise anianalwrinen ofthe an rees incinding of following obtain pamuant ofsuch price whichever saleGiness unable type for this an to made or or to unfit certineatian of and of The **aanarwh sales such by writing certification malfounation m reimbasanent sustained nodee, animal veterinarians options: te aceipt for by the veteriany tax available shaR the including that animal occurred of reach or section pmehase. in pmchase section; to examination the treatment choice receipt, sale be pa anânal,an and wirich a reibnd, thean made witish by Thebreed diagnosde of Inst, a by pmvitled pet theis animal reasonable iHness Such services preemee a a petof subject unless by animal passus of dealer fees predmity to im animal the forms is The the the twenty-one presented dealer subject owner, to value 9om to exchange consumer not a whichever adversely reasonable foragreement licensed to dealerto not this to of the shall unfit the thisegsivalent consumercontracted me Inter the value under an&er such animal animal, shall the veterinarian which hundel for alsodate of affectssymptoms is pet the dheetly licensedvaise occurredarticle any department ean ofof ra and treating section; veterinarythea w such veterinarian pursuant ten date or and last,the other subsequent. deala consumer reimhmsable to of include provisions panchase,related costs a coratitutes to clinicalk not ceitlÈsuch health seceipt law. examination, this othealth, upon the of to thein diagnasta services veterinarian of telmbasement. one orge business of contagious thiswhich thevessrinarian. isservices of smaanable dhesdy theHeensed or consumer's tfic FILED: NASSAU COUNTY CLERK 04/19/2022 03:12 PM INDEX NO. 615766/2021 NYSCEF DOC. NO. 305 RECEIVED NYSCEF: 04/19/2022 What Pet Owners Need to Know About Rabies Vaccinations in New YorkState OttreedveNovember20,2002, ddslaibneadea sheetnauthe peevidedby petdeales an==epeapoint staminatee,dess andteamm) Statetaw requires rabiesvaccinations (shots) ferretsf for all cats, dogs and domesticated Where can I act my oet vaccinated? . .. . . . Allcounties are sequired to provide a freevaccinadonclinicoveryfourmonths. Contactyourcounty healthdepartmentforthe schedule in your area. Rabiesvaccinationsare also availaMe from your If you veterinarian. have questions about now vaccines . developed for cats and for specifically pets at younger ages, contact your countyhealthdepartmentor veterinarian. . WI eq should my not receive its first rablesvaccination? 'thelaw requiredthat y6urpet'sfirst rabiesvaccinationbe givenno later than four months afrerits date of birth. Many rabies vaccines are licensed for use at three months, althoughsome may'be given at youngerbes. . When should my oct receive its second rabies vaccinadon? "' Your pot shoiÄIreceiveits second rabies vrei""tianwithin The second rables shot one year aGer the ficut vaccination. and all shotsthereafteraro so=est- caned boostershots. After my pot acts its second rabiesshot when is the next booster shot duo? Afterthe second you rables shot, onlyneed to get addidonal booster shots overy three years, if the vaccinadon clinicor your veterinarianis using a rabies vaccinelicensedfor three years. What proof willIhave that mypet received its rables shots? The or a person voterinarian, underthe veterinarian's will supervision, provideyou witha certina"*a as proof that yourpet has 6een v"eeta"rat The veterinarian's officewin of your pet's v"ee8"""la= also loeep acopy certificate. The law requires the veterinarian the wrei"""ian to provido cortificate to any public health of5cial for any caso involving your dog, cat or ferret that . may have been e'1===t exposure of a person or another "=1=I to cables, or im>any case of possible to rabics. What ifmy not needs to be taloon to the veterinarian? Whenever you bringyour pet to a veterinarian she winverifyif the a"lmat is up-to-date on its raWes shots. (Itheanisualis not up-to-date as stated below, on its rables shots or exempt or if the veterinarian cannot End proof of the ""i=t's rabies v"eera-sion you history, may requestyour pet be v=e3=ratat this time. . Ifgay pet bites does it have to be euthanh5ed (put to sleep)? a nerson. Ifyour petbitesa personand you wishto avoid and testing euthanizing it for cables, it must be conRned and observedforten days. ffvour on its rables thots. net Is not up-to-date the ten-day confi==ear#observation periodmust taloo place at the owner's expense, at an appropriate such as an animal shelter, facility veterinarian's office, If veur net is mºto-date