PA BROODMARE DOMICILE REPORT – FOR MARES FOALING IN 2008
Report to be Signed by Broodmare Owner - File by October 15, 2007, or within 15 days thereafter of PA Arrival
FOAL REGISTRATION CRITERIA - A Thoroughbred foal born in the state of Pennsylvania in 2008 and registered as such with The Jockey Club is eligible for Pennsylvania-Bred registration with the Pennsylvania Horse Breeders Association if one of the following conditions is met:
(1) The dam of the foal resided continuously in Pennsylvania on or before October 1, 2007, through foaling; or
(2) The dam of the foal was purchased at a public sale after October 1, 2007, then brought into Pennsylvania within 14 days of the date of purchase, and remained in Pennsylvania through foaling. During the year of foaling (2008), the foal or its dam must spend at least 90 days in the state; or
(3) The dam of a foal will be bred in 2008 to a stallion standing in Pennsylvania which is registered with the Pennsylvania Horse Breeders Association as a Pennsylvania stallion, and said dam of the foal will remain in Pennsylvania for at least the next 90 days after foaling.
Circle the condition(s) above under which the foal of the subject broodmare will qualify: 1 2 3
BROODMARE INFORMATION
Broodmare Name ______________________________________ Year foaled ________ PA Arrival Date ___________
Sire ________________________ Dam _______________________ Anticipated Foaling Date ___________________
Stallion mare is in foal to: _______________________________ State in which 2007 covering stallion stood _________
Stallion to be bred to in 2008 _______________________________State in which 2008 covering stallion stands ______
BROODMARE OWNER INFORMATION
Broodmare owner or managing partner’s name __________________________________________________________
Farm or Stable Name _____________________________Address __________________________________________
City __________________________________________ State _____ Zip ___________Phone ___________________
Last four digits ONLY of Broodmare Owner’s Social Security Number or Federal Tax ID Number _________________
FARM BROODMARE DOMICILED AT
Farm Name ___________________________________________ Farm Owner _______________________________
Farm Address __________________________________________ City __________________ State ___ Zip ________
Farm Veterinarian _________________________Vet’s Phone _________________ Farm Phone _________________
AFFIDAVIT OF DOMICILE BY BROODMARE OWNER
I, the undersigned broodmare owner, certify all information provided in order for this foaling broodmare to be eligible for participation in the Pennsylvania Breeding Fund program. I assume full responsibility for all information regarding this broodmare, and agree that if the broodmare is determined to be ineligible based upon inaccurate, false, or fraudulent information: (1) the foal may be ineligible for registration as a Pennsylvania-Bred; (2) I may be forever denied the privilege of registering PA-Breds; (3) I may be forever denied the benefit of any and all breeder awards; and (4) any awards paid based upon the performance of an ineligible foal shall be returned in full by the recipient to the Pennsylvania Breeding Fund. Furthermore, I agree to promptly provide any additional information requested by the official registrar, PA Horse Breeders Association, to confirm information submitted with this broodmare domicile form. I understand that the statements herein are made subject to the penalties of 18 PA C. S. 4904 (relating to unsworn falsification to authorities).
Broodmare Owner’s Printed Name _________________________________ Signature __________________________________ Date ________________
PENNSYLVANIA HORSE BREEDERS ASSOCIATION
701 E. Baltimore Pike - Suite E, Kennett Square, PA 19348 (610) 444-1050 www.pabred.com
Date Rcvd ________ Date Entered ________ Confirmation ________ PA Mare No ________ Category ________
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