Name * Date / Time * Virginia State Animal Care Statement I certify that I have never been convicted of animal cruelty, neglect or abandonment. Furthermore, I certify that I have no convictions (pending or completed) in Virginia, North Carolina, Maryland or South Carolina that would prevent me from being eligible to house and care for animals. I certify that I have never been convicted of animal cruelty, neglect or abandonment. Furthermore, I certify that I have no convictions (pending or completed) in Virginia, North Carolina, Maryland or South Carolina that would prevent me from being eligible to house and care for animals. * — Select — I agree I do not agree
