Declaration of Origin, form
Declaration of Origin, form
Declaration of Origin, form
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Form<br />
LB 5<br />
Sign<br />
and fax/email this <strong>form</strong> to the point <strong>of</strong> entry:<br />
Kununurra: fax f (08) 9166 4067 or (08) 9168 3190 (a/h);<br />
InterstateLivestockKununurra@agric.wa.gov.au<br />
Kalgoorlie: fax (08) 9093 4839 or (08)(<br />
9091 9854 (a/h).<br />
InterstateLivestockKalgoorlie@agric.wa.gov.au<br />
A signed copyy MUST accompany the stock.<br />
<strong>Declaration</strong><br />
<strong>of</strong> <strong>Origin</strong><br />
Equines, ruminants and camelids<br />
from the Liver Fluke Test Exempt Area <strong>of</strong> Australia<br />
Biosecurity and Agriculture Management Act 2007 and Regulations 2013<br />
This declaration provides<br />
evidence for f the exemption <strong>of</strong> the<br />
describedd livestock from pre-entry testing<br />
and/or pre-entry treatment for liver fluke on movement into<br />
Western Australia A on the basis that the stock<br />
have been born and grazed solely in<br />
the Liver Fluke Test Exempt Area <strong>of</strong> Australia and is to<br />
be attached to<br />
the<br />
<strong>form</strong> Health Certificate for Movement <strong>of</strong> Stock to Western Australia (LB 1). A border treatment will still<br />
apply if required.<br />
Animal species<br />
Number<br />
Sex<br />
Age<br />
Description<br />
(include <strong>of</strong>ficial name/s<br />
<strong>of</strong> registered animal/s)<br />
PIC*<br />
* PIC= property identification code <strong>of</strong> property <strong>of</strong> origin<br />
I,<br />
<strong>of</strong> o<br />
Town<br />
State/<br />
Territory<br />
Postcode:<br />
Telephone: (<br />
)<br />
Email:<br />
being<br />
the owner <strong>of</strong> the livestock described above, declare that these stock were born and have<br />
grazed solely<br />
within<br />
the area defined below as the Liver Fluke Test Exempt Area <strong>of</strong> Australia.<br />
Livestock Biosecurity Form LB<br />
5<br />
current as at 1 May<br />
2013<br />
Page 1 <strong>of</strong> 2
Form LB 5<br />
Declared at this day <strong>of</strong> 20<br />
Signature <strong>of</strong> person making the declaration<br />
Signature <strong>of</strong> witness<br />
(Witness must be a registered Commonwealth elector)<br />
Name <strong>of</strong> witness (block letters)<br />
Address:<br />
Town:<br />
State/<br />
Territory: Postcode:<br />
Telephone: ( )<br />
Definition:<br />
The Liver Fluke Test Exempt Area <strong>of</strong> Australia means:<br />
(i) The Northern Territory and<br />
(ii) Queensland, north and west <strong>of</strong> the line <strong>of</strong> the road which runs from Hungerford to Thargomindah to Quilpie to<br />
Adavale to Blackall to Jericho to Alpha to Clermont to Mount Douglas on the Gregory Development Road, to<br />
Bowen via Collinsville on the Bowen Development Road and<br />
(iii)<br />
South Australia, north <strong>of</strong> Highway 32 from the New South Wales border to Peterborough, Highway 83 from<br />
Peterborough to Carrieton, and north <strong>of</strong> the boundaries <strong>of</strong> the Counties <strong>of</strong> Dalhousie and Frome from Carrieton to<br />
Port Augusta, and those areas <strong>of</strong> the Eyre Peninsular north <strong>of</strong> County Flinders.<br />
Livestock Biosecurity Form LB 5<br />
current as at 1 May 2013<br />
Page 2 <strong>of</strong> 2