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Extension > Extension in your Community > Mahnomen > 4-H > Articles > Poultry Statement of Origin Form

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Poultry Statement of Origin Form

  • All chicken, guinea, and turkey exhibitors must have a “Statement of Origin” indicating their bird is from a PullorumTyphoid free flock within 12 months prior to entry day.
  • If you do not have a “Statement of Origin”, you must provide a Minnesota State Board of Animal Health Certificate stating that your bird tested negative at the Pullorum-Typhoid test.
  • The “Statement of Origin” or negative Pullorum-Typhoid test certificate must be attached to the county computer generated 4-H State Fair Species Verification Report (poultry).
  • No health certificates are required for waterfowl, pigeons or doves.

The board of animal health "Statement of Origin" can be found at

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