State Form 48655 - Thoroughbred 2012 Stallion Application
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For Office Use Only:
DATE
Thoroughbred
: ___________
COMPLETE
2012 Stallion Application
* In order to be included in 2012 Stallion Directory,
State Form 48655 (R13 / 4-11)
application must be postmarked by October 15, 2011. *
Stallion Information
Name of Stallion
Year Foaled
Stud Fee
Sire
Dam
Owner Information– If leased please attach lease agreement
Name of Owner (must match Jockey Club papers)
Address (number and street)
Telephone Number
City
State
ZIP Code
Email address
Standing Farm Information
Name of Farm
Farm Contact Person
Address (number and street)
Telephone Number
City
State
ZIP Code
Award Recipient Information - See back for information
Name of designated recipient of award
Address (number and street)
City
State
ZIP Code
Social Security or Federal ID Number
Please check the telephone number(s) to be listed in Stallion Directory for booking inquiries:
Standing Farm
Owner
Lessee
Other _________________________
I, the undersigned, represent that all information above is true and accurate and agree that registration of said stal-
lion 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 must be attached and form MUST be signed in
order for application to be processed.
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Parent category: Financial