Form 4710-10 - Application For Adoption Of Wild Horse(S) Or Burro(S) Page 3
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4Applicant’s Name
TERMS OF ADOPTION
The following terms apply to all wild horses and burros adopted under
(g) Adopters must dispose of remains in accordance with applicable
this Private Maintenance and Care Agreement:
sanitation laws; and
(h) Title will remain with the Federal Government for at least 1 year
(a) Adopters are financially responsible for providing proper care;
after the Private Maintenance and Care Agreement is executed and
(b) Adopters are responsible, as provided by State law, for any personal
until a Certificate of Title is issued by the BLM.
injury, property damage, or death caused by animals in their care, for
(i) Adopters are entitled to a replacement, if, within 6 months of the
pursuing animals that escape or stray, and for costs of recapture;
adoption date, the animal dies or is required to be destroyed due to a
(c) Adopters must not transfer animals for more than 30 days to another
condition that existed at the time of adoption and if the adopter provides
location or to the care of another individual without the prior
a veterinarian statement that certifies that reasonable care would not
approval of the BLM;
have corrected the condition. All replacements will be handled as a
refund (completed within 2 weeks of notification) or a voucher for a
(d) Adopters must make animals available for physical inspection within
replacement animal. A voucher is non-refundable; has a shelf-life of six
7 days of receipt of a written request by the BLM;
months; can be applied to more than one animal; is non-transferable;
(e) Adopters must notify the BLM within 7 days of discovery of an
has to be redeemed at the same type of event as the original adoption;
animal’s death, theft or escape;
and does not give the adopter any kind of preferential treatment.
Additionally, the amount of the voucher has to be redeemed all at one
(f) Adopters must notify the BLM within 30 days of any change in the
time; non-used funds are forfeited; and bids above the voucher amount
adopter’s address;
are due in full at the time of the adoption. This policy will only apply to
replacement animals, and not repossessions or reassignments.
Failure to comply with these terms may result in the cancellation of the agreement, repossession of the animals, and disapproval of requests
for adoption of additional animals. In addition, violation of any term of a Private Maintenance and Care Agreement is a prohibited act.
I have read and understand the above TERMS OF THE ADOPTION and PROHIBITED ACTIONS.
(Date)
(Applicant’s Signature)
Under penalty of prosecution for violating 18 U.S.C. 1001, which makes it a federal crime to make false statements to any agency of the United
States, I hereby state that I have no intent to sell this wild horse or burro for slaughter or bucking stock, or for processing into commercial
products, within the meaning of the Wild and Free Roaming Horse and Burro Act, 16 U.S.C. 1331 et seq., and regulations 43 CFR 4700.0-5(c). I
have read the above statement, understand the terms of this agreement and agree to comply with them.
(Date)
(Applicant’s Signature)
Approved for:
No. of Burros
No. of Horses Younger than 18 mos.
No. of Trained Animals
No. of Horses Older than 18 mos.
Total No. of Animals Approved for Adopter’s Facility
Disapproved (Disapproval will be accompanied by a decision letter to the applicant with appeal rights.)
(BLM Official’s Signature)
(BLM Official’s Printed Name)
(Office)
(Date)
This application expires one year after the date of approval by the BLM Official’s Signature.
(Continued on page 4)
(Form 4710-10, page 3)
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