351 Avera Street
Sarepta, LA 71071
352-342-5737 Anna Paul - mobile
318-847-4170 home
318-578-1724 Sales
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 2012 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 2011 _______________ Last Date Bred ______________

Mare's Produce History:         Foaling Date                    Color                       Colt/Filly

Stallion Bred to in 2010                         /11  ________         _________        

Stallion Bred to in 2009                         /10  ________         _________        

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_________________