ABC form Litter-Reg redone 6 27 14

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AMERICAN BOLOGNESE CLUB - LITTER APPLICATION
ONE TIME $15 FEE. EXPIRES 1 YEAR FROM BIRTHDATE.
If both parents are not registered with the ABC, then please contact the registrar.
If dam was leased or there was an ownership change, please use a transfer form and file with registrar.
If this application is accepted the registrar will send the litter owner applications for each puppy in the
litter for individual registration. This application form becomes the property of the club. Any
misrepresentation on this application is cause for cancellation of registration(s) and may result in the loss
of club privileges. PLEASE PRINT CLEARLY OR TYPE.
Place of Birth of Litter______________________________________________ City, State, Zip
Date of Birth __________________________ # living males ______ # living females _______
Registered Name and # of Sire ____________________________________________________
Registered Name and # of Dam ___________________________________________________
Owner of Sire Information
I certify that the above Dam was mated to the said Sire. At the time of mating I was the owner of said sire.
The mating took place in _____________________________________________(City, state or country)
I witnessed the mating if live breeding or fresh AI. Circle one: yes or no
If fresh chilled semen, or extender or frozen semen, name, address & email of person/vet collecting
____________________________________________________________________________
Signature of person collecting ____________________________________________________
Print name of Owner of Sire _____________________________________________________
Signature of owner of Sire ___________________________________ Date _______________
Address and email _____________________________________________________________
Owner of Dam Information
I hereby apply to register this litter. I certify that I was the owner of the above named dam on the date of
birth of the litter. I certify that the said dam was not bred to any other dog at this time. All
representations on this application are true. I have read and agree to abide by the rules and ethics for the
American Bolognese Club.
I witnessed mating if live breeding or fresh AI. Circle one: yes or no
If fresh chilled semen, or extender or frozen semen, name, address & email of person/vet inseminating
____________________________________________________________________________
Signature of person inseminating _________________________________________________
Print name of Owner of Dam_____________________________________________________
Signature of Owner of Dam __________________________________ Date _______________
Address and email _____________________________________________________________
Mail check or money order for $15 to Interim Registrar
Marsha England, 24954 T Road, Cedaredge, CO 81413
rec ________ by ______ form rev. 6/14
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