Form Dl 105 PDF Details

Every business is required to file a Form Dl 105 with the California Secretary of State. This form is used to notify the state of your company's formation and to identify the individuals responsible for its management. Filing this form is a necessary step in setting up your business, and it's important to make sure that it's done correctly. In this blog post, we'll walk you through the process of filing a Form Dl 105 and tell you what information is required. We'll also provide some tips on how to make the process as easy as possible. So if you're ready to start your business in California, keep reading!

QuestionAnswer
Form NameForm Dl 105
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesHistopathology_ Submission_Form cornell histopathology form

Form Preview Example

Histopathology Submission Form

Animal Health Diagnostic Center

College of Veterinary Medicine, Cornell University

Histopathology Contacts

In Partnership with the NYS Dept of Ag & Markets

Phone: 607-253-3312

US Postal Service Address:

FedEx/UPS Service Address:

 

(8-4:30, M-F)

Fax:

607-253-3357

PO Box 5786

240 Farrier Rd

Web: diagcenter.vet.cornell.edu

Ithaca, NY 14852-5786

Ithaca, NY 14853

E-mail: diagcenter@cornell.edu

 

 

LAB USE ONLY

__________________________________

AHDC Accession No./ Date

__________________________________

Pathology Case Number

PLEASE NOTE: SAMPLES SUBMITTED FOR TESTING BECOME THE PROPERTY OF THE ANIMAL HEALTH DIAGNOSTIC CENTER AND MAY BE

TESTED AS PART OF STATE/FEDERAL SURVEILLANCE PROGRAMS

PLEASE COMPLETE ALL FIELDS, PRINT LEGIBLY, AND TYPE OR USE BLACK INK ONLY

Cornell Acct No. __________ Check if URGENT! (Fee+add'l $60)

Your Internal Case/Reference No.** ______________________________

Submitting

 

Owner _____________________________________________________

Veterinarian* ________________________________________________

Clinic Name _________________________________________________

Address ____________________________________________________

Address ____________________________________________________

City, State, Zip _______________________________________________

City, State, Zip _______________________________________________

Phone Number ( ________ ) ____________________________________

Phone No. ( ___________ )

___________-_______________________

County ________________________ Town _______________________

Submitting Vet's Signature:

___________________________________

NYS Premises ID ____________________________________________

Add’l instructions:

 

ATTENTION:

Histopathology specimens are referred to:

Surgical Pathology Service, Pathology Section, Department of Biomedical Sciences, College of Veterinary Medicine, Cornell University

ANIMAL IDENTIFICATION

SEX CODES: M=Male, MR=Mare (equine only), MC=Castrated Male, F=Female, SF=Spayed Female

AGE CODES: Y=Years, M=Months, W=Weeks, D=Days; DOB=Date of Birth

ANIMAL NAME / IDENTIFIER NO.

SPECIES

BREED

SEX

AGE/DOB

 

 

 

 

 

HISTOPATHOLOGY

POST MORTEM

DATE SPECIMEN

SUBMISSION TYPE

INTERVAL

TAKEN

Biopsy Post Mortem

 

 

 

 

 

HISTORY: Clinical history required. Give detailed information regarding affected animal. (NY State Contract pricing may apply; see AHDC Test & Fee Schedule.)

General (Clinical presentation, treatment, etc.)

Description of lesion(s) (Describe location, distribution, size, color, consistency):

Date: onset of illness:

_____________

In animals submitted:

______________

Herd size:________

No. dead:________

No. affected:______

Check here if add’l history is on back or attached.

Clinical Diagnosis:

_________________________________________________________________________________________________________

Tissues Submitted:

_________________________________________________________________________________________________________

Has previous material been submitted for this problem?

YES NO UNKNOWN

If so, enter

Date(s): ____________________________________ Histopathology Nos.: _____________________________________

PLEASE NOTE: SAMPLES SUBMITTED FOR TESTING BECOME THE PROPERTY OF THE ANIMAL HEALTH DIAGNOSTIC CENTER.

*The submitting veterinarian is responsible for the requested tests, fees associated with this submission, and for notifying the owner of test results.

 

LAB USE ONLY

 

NON-CONTRACT CONTRACT

No. cassettes prepared: __________

No. tissues prepared: ___________

Additional AHDC testing requested: _______________________________________________________________________________

Special Stains: _______________________________________________________________________________________________

Comments: __________________________________________________________________________________________________

OPENED BY:

DHL

Mail

DATE AND

TISSUES RECEIVED FIXED

TISSUES RECEIVED UNFIXED

 

FX

Pri Mail

TIME REC’D: ______________

UNFIXED TISSUES FIXED ON: Date:

Time:

 

UPS-Grnd

Exp Mail

 

 

 

 

 

 

 

UPS-ND

 

SHIPPED: _____________

Receipt Status of Unfixed Tissue:

FROZEN

NOT FROZEN

_________

Other: __________________

COMMENT:

 

 

** If your Internal Reference No. is entered on this form, it will be used to identify this case on the test result form and on the billing statement (max. 17 character field).

DL-105 10/10

How to Edit Form Dl 105 Online for Free

It is possible to prepare Form Dl 105 without difficulty with our online tool for PDF editing. The editor is constantly upgraded by our staff, getting new awesome features and turning out to be much more convenient. This is what you will need to do to begin:

Step 1: Access the PDF file inside our editor by pressing the "Get Form Button" above on this page.

Step 2: As soon as you open the online editor, you'll notice the document prepared to be completed. Besides filling in different blank fields, you could also do other sorts of things with the PDF, that is writing your own words, editing the initial textual content, adding illustrations or photos, putting your signature on the PDF, and much more.

So as to finalize this PDF form, ensure that you provide the right information in each blank field:

1. First, once filling out the Form Dl 105, start in the area that has the following blank fields:

Filling out part 1 in Form Dl 105

2. Once your current task is complete, take the next step – fill out all of these fields - SEX CODES MMale MRMare equine only, ANIMAL NAME IDENTIFIER NO, SPECIES BREED SEX AGEDOB, HISTOPATHOLOGY SUBMISSION TYPE, INTERVAL, TAKEN, Biopsy Post Mortem, HISTORY Clinical history required, Description of lesions Describe, Check here if addl history is on, Clinical Diagnosis, Tissues Submitted Has previous, Dates Histopathology Nos, YES NO UNKNOWN, and PLEASE NOTE SAMPLES SUBMITTED FOR with their corresponding information. Make sure to double check that everything has been entered correctly before continuing!

Form Dl 105 conclusion process described (part 2)

When it comes to Dates Histopathology Nos and SPECIES BREED SEX AGEDOB, be sure that you review things here. Both of these could be the most important ones in the PDF.

3. Completing NONCONTRACT CONTRACT Additional, DATE AND Mail DHL TIME RECD, TISSUES RECEIVED FIXED TISSUES, Time, and If your Internal Reference No is is essential for the next step, make sure to fill them out in their entirety. Don't miss any details!

Completing segment 3 in Form Dl 105

Step 3: As soon as you've reviewed the information in the fields, press "Done" to conclude your FormsPal process. Sign up with us now and easily access Form Dl 105, prepared for download. Every change made is handily saved , enabling you to modify the file later on if required. If you use FormsPal, you can certainly complete documents without worrying about data leaks or entries getting shared. Our secure system helps to ensure that your private details are maintained safe.

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