"Affidavit Form" - Maine

Affidavit Form is a legal document that was released by the Maine Department of Agriculture, Conservation and Forestry - a government authority operating within Maine.

Form Details:

  • Released on June 1, 2017;
  • The latest edition currently provided by the Maine Department of Agriculture, Conservation and Forestry;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of the form by clicking the link below or browse more documents and templates provided by the Maine Department of Agriculture, Conservation and Forestry.

ADVERTISEMENT
ADVERTISEMENT

Download "Affidavit Form" - Maine

Download PDF

Fill PDF online

Rate (4.8 / 5) 36 votes
MAINE STATE HARNESS RACING COMMISSION
AFFIDAVIT
I, __________________________________, swear and affirm that _________________
(Trainer)
(Horses Name)
Tattoo #______________ which is entered in the ____________ race on ___________________
(Date)
at __________________ is known to have the presence of and received medication for
(Track)
Exercised Induced Pulmonary Hemorrhage (E.I.P.H.) in ________________________,
(State)
the jurisdiction from which it was shipped.
Under penalty of punitive sanctions which may be imposed by the State Stewards, I
_______________________________, of full age say that all of the above facts and
information is in all respect true to the best of his/her knowledge, information, and belief.
__________________________________
_____________________
Signature of Trainer
Date
__________________________________
_____________________
State Veterinarian Signature
Date
6/2017
MAINE STATE HARNESS RACING COMMISSION
AFFIDAVIT
I, __________________________________, swear and affirm that _________________
(Trainer)
(Horses Name)
Tattoo #______________ which is entered in the ____________ race on ___________________
(Date)
at __________________ is known to have the presence of and received medication for
(Track)
Exercised Induced Pulmonary Hemorrhage (E.I.P.H.) in ________________________,
(State)
the jurisdiction from which it was shipped.
Under penalty of punitive sanctions which may be imposed by the State Stewards, I
_______________________________, of full age say that all of the above facts and
information is in all respect true to the best of his/her knowledge, information, and belief.
__________________________________
_____________________
Signature of Trainer
Date
__________________________________
_____________________
State Veterinarian Signature
Date
6/2017