Date_____________, 20_____
KENTUCKY 4-H DAIRY CATTLE NON-OWNERSHIP CERTIFICATE
Please fill out completely and have all of the persons sign. Send the original with a
copy of the animal's registration certificate by June 1st to Dr. George Heersche,
Extension Dairyman, 406 W. P. Garrigus Building, University of Kentucky, Lexington,
KY 40546-0215.
Name of Animal________________________________________________________
Date Animal Born__________________ Class Name__________________________
Breed________________________ Registration No.__________________________
Tattoos: Left ear____________________
Right ear_______________________
Ear Tags: Left ear___________________
Right ear_______________________
Please sign below to certify that the animal listed above is being cared for by the 4-H'er
and is officially designated as his/her 4-H project animal for this year.
Owner's Name_____________________________________________________
Address__________________________________________________________
_______________________________________
Signature of Owner
4-H'ers Name______________________________________________________
Address__________________________________________________________
_______________________________________
4-H Member's Signature
Parent/Guardian Name______________________________________________
Address__________________________________________________________
_______________________________________
Parent/Guardian Name Signature
4-H Leader's Name_________________________________________________
Address__________________________________________________________
_______________________________________
4-H Leader's Signature
Agent’s Name_____________________________________________________
Address__________________________________________________________
_______________________________________
Agent's Signature