351 Avera Street
Sarepta, LA 71071
352-342-5737 Anna Paul - mobile
318-847-4170 home
318-578-1724 Sales
Fanlew Farm                                    352-342-5737 Anna
351 Avera Street                                                318-578-1866 Ray
Sarepta, Louisiana 71071                                 

                                                       
                                               2013 Mare Information Sheet
                       
THIS FORM MUST BE ON FILE IN OUR OFFICE PRIOR TO BOOKING THE MARE
INTO THE BREEDING SHED.   NO EXCEPTIONS!!

STALLION: _____________________________________________
       
                                            MARE OWNER INFORMATION
                   Please type or print the following information (as it should be reported to the Jockey Club):
Name: __________________________________________________________
Address _________________________________________________________
Phone #’s _______________________________Fax # ___________________
E-Mail _____________________________
Mare Information (Correct Spelling Needed)
Mare's Name __________________________Year ________Color_________
Mare's Sire ____________________________________
Mare's Dam ____________________Dam’s Sire ___________________

             IMPORT STATUS: Is this mare an IMPORT for the 2013 Breeding Season?

( )NO ( )YES  Import Date: _____________ Country of Origin:________________
Mare's Current Status:
(  ) Maiden                 (  ) Barren                 (  ) Slipped
(  ) In Foal         (  ) Not Bred         (  ) Foaled;         Date ______Color ______ Colt/Filly
Stallion Bred To in 2012 _______________ Last Date Bred ______________
Mare's Produce History:         Foaling Date                    Color                       Colt/Filly
Stallion Bred to in 2011                         /12  ________         _________        
Stallion Bred to in 2010                         /11  ________         _________        
Mare will board in Louisiana at __________________________________________
Farm Manager's Name  ____________________________Phone _______________
Fax ______________________ Cell _________________________
Do we have permission to tranquilize this mare if necessary?    YES        NO   
Mare's Veterinarian: ______________________________Phone:_______________
Signature: ___________________________________Date:____________________