Power of Attorney
for a dachshund left in the CARE of
Billy & MaryJudith Jordan
2453 Bonny Dr
Cocoa Fl 32926
321-632-4148

I______________________________________________
have left my/said Dachshund_______________________________
in the care of
Billy & MaryJudith Jordan
This is to serve notice that said dachshund_________________________
needs medical attention they have the right to take my dachshund to
a vet of choice to care for and /or make decisions as to maintain the
HEALTH OF SAID DACHSHUND
Owner will be advised as to the situation

OWNER______________________________________________________
ADDRESS____________________________________________________
CITY____________________STATE__________ZIP________________
HOME#___________________CELL#____________________________
OWNER______________________________________________________
BREEDER____________________________________________________
ADDITIONAL COMMENTS
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
INITIALS
OWNER___________BREEDER_____________
DATED___________________________________
Payment of said veterinary cost will be paid by owner int:_______