MBAH Permits
Avian Permit Request
Requestor Company
Requestor Name
Requestor Phone
Requestor Email
Email To Send Permit To
Permit Number(If Applicable)
Date of Movement
Chicks
Pullets
Broilers
Spent Hens
Eggs
Feed
Litter
Other (Specify)
Specify
Quantity To Move
Do not use commas
Lab Results
Lab Date
Comments
Send Lab Results to msstatevet@mdac.ms.gov
Origination
Origin Company
Origin Premises Name
Contact Name
Contact Phone
Premises Number
Flock Number
Address
Zip
City
State
Zone Location
Destination
Company Name
Contact Name
Contact Phone
Destination Premises Name
Premises Number
Address
Zip
City
State
Zone Location
Slaughter Date
Submit
Clear
For questions, please call 601-359-1170.
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