"Registration of Delaware-Bred Horse" - Delaware

Registration of Delaware-Bred Horse is a legal document that was released by the Delaware Department of Agriculture - a government authority operating within Delaware.

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DELAWARE HARNESS RACING COMMISSION
REGISTRATION OF DELAWARE-BRED HORSE
(1)
Name of Horse ___________________________________________
(2)
Foaling Date of Horse ____________________________________
(3)
Tattoo Number _____________________
(4)
Sire of Horse ____________________________________________
(5)
Dam of Horse ___________________________________________
(6)
Owner of Dam at time of breeding, also include address
_______________________________________________________
(7)
Name, Address and Phone Number of person making request
________________________________________________________
________________________________________________________
I hereby swear or affirm that all of the foregoing information is true and
accurate to the best of my knowledge, information and belief. I understand that
any incorrect, untruthful or fraudulent information provided on this form may
subject me to criminal and administrative penalties, including, but not limited to a
minimum fine of $5,000 and a mandatory two-year revocation of my DHRC
licensing privileges in the State of Delaware.
DATE:_____________________
______________________________
Signature
REVIEWED:_______________ APPROVED DHRC:______________DATE________
DATE ENTERED ON DELAWARE OWNED LIST:____________________________
Print Form
DELAWARE HARNESS RACING COMMISSION
REGISTRATION OF DELAWARE-BRED HORSE
(1)
Name of Horse ___________________________________________
(2)
Foaling Date of Horse ____________________________________
(3)
Tattoo Number _____________________
(4)
Sire of Horse ____________________________________________
(5)
Dam of Horse ___________________________________________
(6)
Owner of Dam at time of breeding, also include address
_______________________________________________________
(7)
Name, Address and Phone Number of person making request
________________________________________________________
________________________________________________________
I hereby swear or affirm that all of the foregoing information is true and
accurate to the best of my knowledge, information and belief. I understand that
any incorrect, untruthful or fraudulent information provided on this form may
subject me to criminal and administrative penalties, including, but not limited to a
minimum fine of $5,000 and a mandatory two-year revocation of my DHRC
licensing privileges in the State of Delaware.
DATE:_____________________
______________________________
Signature
REVIEWED:_______________ APPROVED DHRC:______________DATE________
DATE ENTERED ON DELAWARE OWNED LIST:____________________________