Stanford School of Medicine
Comparative Medicine–

Agreement to Transfer Ownership of Lab Animals

A. ORIGINAL OWNER  
I,  (Primary Investigator),   
hereby relinquish ownership and responsibility and   
transfer the following animal:  
Dog  Cat  Rabbit  Primate  Other     
identified as:      
Protocol #:      
Location of the animal (Bldg/Rm):   
Has animal been utilized in any research project?       
    Yes  No  
If yes, explain nature of project and           
indicate if any surgery was performed:  
    

__________  ___________________________  ____________   
  Date              Signature               Phone  
B. NEW OWNER  I,  (Primary Investigator),   
hereby accept ownership and responsibility of the   
animal identified above and request transfer to:    
Protocol #:      
Desired Housing Location:  
(Bldg/Rm)  
Per diem charges to be levied against:  
(Acct#/Exp Date)   
for the care of this animal, effective this date:  
    

__________  ___________________________  ____________   
  Date              Signature               Phone  
C. APPROVAL    

________________________  __________  _______________  
       VSC APPROVAL          DATE      VSC Per Diem #

Please note that this form requires written signatures, so it cannot be submitted electronically. Please print out, obtain signatures, and fax the form to extension 5-0940.

 

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