Foreign Registration Application Form - American Kennel Club (Page 4 of 4) in pdf

SECTION V: SUPPLEMENTAL TRANSFER STATEMENT — SECOND TRANSFER (USA RESIDENT ONLY)

This section must be completed and signed by the person who acquired the dog, ONLY if such person does not apply

to register the dog, but transfers the dog to a new owner.

Date of Transfer

MM/DD/YY

Print Name(s) of New Owner(s): _____________________________________________________________________________

Address: __________________________________________________________________________________________________

Phone #: ______________________________________________ Fax #: _______________________________________________

Signature(s) of Owner(s) Transferring Dog_____________________________________________________________________

If the dog has been transferred more than twice in the USA, write to the AKC for Supplemental Transfer Statement forms

or contact the AKC Customer Relations Dept. at (919) 233-9767. A Supplemental Transfer Statement must be completed

and attached to this application for each transfer of the dog in the USA after the second transfer covered in Section V.

SECTION VI: POSITIVE IDENTIFICATION

What type of actual identification (numbers, letters or combination) is on the dog? If a DNA profile was used, list the

name of the AKC approved laboratory where the test was processed.

Tattoo:

Microchip:

Other

Type:

(explain)

Is the identification registered with an organization or agency?

Yes

If yes, with whom is it registered?

SECTION VII: OWNERSHIP AND CERTIFICATION

I hereby certify that, to the best of my knowledge and belief, the information contained in this application is true and

accurate and that the ancestors are of the same breed as the dog identified on this application. I certify that the accom-

panying photographs are a true representation of the dog identified on this application and supporting pedigree. I agree

to abide by American Kennel Club rules and regulations.

Signature of Owner ______________________________ Signature of Co-Owner ____________________________________

Printed Name of Owner __________________________ Printed Name of Co-Owner ________________________________

Street Address __________________________________ Street Address ___________________________________________

City, State, Zip___________________________________ City, State, Zip ___________________________________________

Phone #:________________________________________ Phone #: ________________________________________________

Fax #: __________________________________________ Fax #: ___________________________________________________

E-mail address __________________________________ E-mail address ___________________________________________

SECTION VIII: PHOTOGRAPHS

3”x 5" COLOR PHOTO PRINT

OF DOG IN A STANDING POSITION

CLOSE-UP

FRONT VIEW

SIDE VIEW

(DO NOT GLUE PHOTOS)

Foreign Registration Application Form - American Kennel Club Page 4