Free Mare Form.pmd - Indiana

INDIANA MARE REGISTRATION
State Form 53921 (4 - 09)

FOR OFFICE USE ONLY

INDIANA HORSE RACING COMMISSION

Registration for the 2009 Indiana Standardbred Mare Registry
(Foals of 2010) Applications must be postmarked by June 1, 2009

DATE__________________ `09 REG

REGISTRATION FEE: None NAME OF MARE SIRE TATTOO # CURRENTLY IN FOAL TO ESTIMATED FOALING DATE MARE OWNED BY

YEAR FOALED DAM MARKINGS

(Please include complete address)

OWNER PHONE # NAME OF FARM WHERE MARE WILL RESIDE FROM JUNE 1 UNTIL FOALING: OWNER / MANAGER OF FARM ADDRESS OF FARM
(Please include complete address)

FARM PHONE # NAME OF VET SERVICING FARM

OTHER PHONE #

DETAILED & SPECIFIC DIRECTIONS TO FARM FROM THE NEAREST INTERSTATE OR STATE ROAD:

I, the undersigned, do hereby make application for mare registration for the above mare for the year 2009. I understand and agree that the above mare will remain in the State of Indiana from June 1, 2009 through thirty (30) days after foaling for the breeding season of 2009-2010, and at no time from June 1, 2009 through the time of foaling and thirty (30) days after be removed from the State of Indiana. In addition, if at any time the mare is moved from this location, I must immediately notify the IHRC. This registration is subject to all rules and conditions established by the IHRC. Owner/Lessee
(Printed) (Signature)

USTA NO.

Date

THIS FORM MUST BE SIGNED FOR REGISTRATION TO BE PROCESSED Please return this form to: Indiana Horse Racing Commission ISTA Center, Suite 530 150 West Market Street Indianapolis, IN 46204 Phone: (317) 233-3120 Fax: (317) 233-4470