Ukc Registered Sire Litter Application Form (Page 2 of 4) in pdf

Step 3 - Dam Information —

Indicate the Dam's registered name and UKC Registration Number in this section. For additional information, please see Step 8 of this form.

(Must be filled out by the Registrant(s)/Sole Signatory to whom the dam is registered at the time of breeding.)

UKC # _____________________________

“By signing this application I/We agree to abide by all UKC rules, regulations, and policies.

I/We attest that the information I/We have provided is true and correct.”

Registered Name of Dam ________________________________________________________________

Current ddress ______________________________________________________________________

___________________________________________

Dam Registrant/Sole Signatory (Please print)

City _______________________________________________________________ State __________

______________________________________

Dam Registrant/Sole Signatory Signature (Required)

Zip_________________ Country ________________________________________________________

__________________________________________

Dam Co-Registrant (if applicable, please print)

Phone # (____________ ) ____________________________________________________________

Dam Co-Registrant Signature (Required, if applicable) ________________________________________

E-mail ddress ________________________________ @ __________________________________

Step 4 - Litter Registrant Information

Must be filled out by the Person(s) to whom the litter will be registered. Complete Step 4 only if the litter is being registered to anyone other than the Dam Registrant/

Sole Signatory at the time of breeding or if the dam is registered in an “and/or” partnership under the former policy.

Print the name of the Sole Signatory to whom the litter is being registered. (If this litter is being registered to more than 1 Registrant, a Sole Signatory Form is required. This form may be downloaded from

DM.pdf)

__________________________________________________________________________________________________________________________________________________________________________

Sole Signatory

Signature of the Sole Signatory (Required) __________________________________________________________________________________________________________________________________________

Current Mailing ddress ________________________________________________________________________________________________________________________________________________________

City ______________________________________________________________ State ________________________________________ Zip_________________ Country ______________________________

Phone # ( ______________ )________________________________________ E-mail ddress ______________________________________________ @ ____________________________________________

“By signing this application I agree to abide by all UKC rules, regulations, and policies. I also understand that I am responsible for all information contained herein.”

Step 5 - Litter Registration Fee

$30

Registration of entire litter

...........................................................................

(up to 1 year of age)

Step 6 - Permanent Registration of Pups

(If more than 1 Registrant per pup, please use the Sole Signatory Form; to Permanently Register more than 2 pups, please refer to Step 7.)

You may request a UKC Permanent Registration Certificate for any pup you keep or transfer to another person; that certificate includes a Three-Generation Performance Pedigree ® and Easy Entry

Card; unless otherwise selected below.

If you choose to permanently register, You will need to name the puppy, provide the color, sex, and the Sole Signatory’s name and address information.

Sex ________ Color ______________________________________________________ Variety ________________________ Tattoo# ______________________________________

$24

3-Gen Pedigree ............................

Dog

Name

$29

4-Gen Pedigree ............................

Print the name of the Sole Signatory to whom pup is being registered. ______________________________________________________________________________________________________________________________

dditional

ddress __________________________________________________________ City ______________________________ State ______________ Zip ________________ Country ______________________________

$10

Easy Entry

Card ........................

Phone (_______) _________________________ E-mail ________________________________________________________ Date of Sale _________ / _________ / _________

(If more than one individual is being listed on this

dog’s record, a Sole Signatory Form is required)