Form 48658 - Thoroughbred Mare Application For Foals Of 2011 - Indiana Horse Racing Commission

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For Office Use Only:
DATE
Thoroughbred
: ___________
COMPLETE
Mare Application for
Foals of 2011
State Form 48658 (R13 / 11-10)
* Applications must be postmarked by November 1, 2010.*
Mare Information
Name of Mare
In foal to
Sire
Dam
Age
Last cover date
Est. foaling date
Date entered Indiana
(month, day, year)
(month, day, year)
(month, day, year)
** If mare enters state or is registered after November 1, 2010, please indicate which Indiana Stallion she will breed back to:
Owner Information - If leased please attach lease agreement.
Name of Owner (must match Jockey Club papers)
Address (number and street)
City
State
ZIP Code
Telephone Number
Email address
Farm Information - Where Mare Will Foal
Name of Farm
Farm Contact Person
Address of Farm (number and street)
City
State
ZIP Code
Telephone Number
I, the undersigned, represent that all information above is true and accurate and agree that registration of said foal
may be revoked or denied for misstatement or omission in the foregoing application.
Owner Signature _________________________________________
Date
______________
(month, day, year)
Owner Printed ___________________________________________
A copy of Jockey Club papers (front and back) must be attached and form
MUST be signed in order for application to be processed.

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