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Reptilienvon ReptilienFranken
Auffangstatio Auffangstation
e.V.
Datum: 2015.05.28
n Franken e.V. 15:44:33 +02'00'
REPTILIEN-AUFFANGSTATION FRANKEN E.V.
HOTLINE:
E-Mail-Kontakt:
0162-5465134 (17.00-21.00 Uhr werktags)
reptilien-auffangstation@gmx.de
TIERVERMITTLUNG
Persönliche Angaben (Pflichtangaben):
Name, Vorname
________________________________________________________
Straße, Nr.
________________________________________________________
PLZ, Wohnort
________________________________________________________
Bundesland, Land
________________________________________________________
E-Mail-Adresse
________________________________________________________
Telefon/Handy
________________________________________________________
Geburtsdatum
________________________________________________________
Angaben zum Abgabetier:
Art
________________________________________________________
Gattung
________________________________________________________
Geschlecht (wenn bekannt)
________________________________________________________
Gifttier
Bekannte Krankheiten
Vergesellschaftung
ja
nein
________________________________________________________
ja
nein
Fütterungs-Intervall
________________________________________________________
Futter/Futtertiergröße
________________________________________________________
Ort, Datum, Unterschrift Halter
Ort, Datum, Unterschrift Auffangstation
_____________________________________
_____________________________________
Abgabetier-Aufnahmeantrag.pdf (PDF, 193.48 KB)
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