2018 Broodmare Domicile Report

2018 Broodmare Domicile Form - For Mares Foaling in 2018

2018 PA BROODMARE DOMICILE REPORT – FOR MARES FOALING IN 2018 Report to be Signed by Broodmare Owner - Please keep a copy for your records to confirm completion MANDATORY - MUST File by December 1, 2017, or within 14 days of Broodmare's Arrival in PA FOAL REGISTRATION CRITERIA - A Thoroughbred foal born in the state of Pennsylvania in 2018 and registered as such with The Jockey Club is eligible for Pennsylvania-Bred registration with the Pennsylvania Horse Breeders Association if one of the following conditions is met:
  • 2018 BMBR Form filled online
    Check the choice above under which the foal of the subject broodmare will qualify.
  • BROODMARE INFORMATION

  • BROODMARE OWNER INFORMATION

  • (999) 555-1212 10 digit phone number with area code.
  • Not Required
  • Last four digits ONLY of Broodmare Owner’s Social Security Number or Federal Tax ID Number
  • FARM INFORMATION

    Farm Broomare Domiciled at:
  • (999) 555-1212 10 digit phone number with area code.
  • AFFIDAVIT OF DOMICILE BY BROODMARE OWNER

    I, the undersigned broodmare owner, certify all information provided in order for this foaling broodmare to be eligible for participation in the Pennsylvania Breeding Fund program. I assume full responsibility for all information regarding this broodmare, and agree that if the broodmare is determined to be ineligible based upon inaccurate, false, or fraudulent information: (1) the foal may be ineligible for registration as a Pennsylvania-Bred; (2) I may be forever denied the privilege of registering PA-Breds; (3) I may be forever denied the benefit of any and all breeder awards; and (4) any awards paid based upon the performance of an ineligible foal shall be returned in full by the recipient to the Pennsylvania Breeding Fund. Furthermore, I agree to promptly provide any additional information requested by the official registrar, PA Horse Breeders Association, to confirm information submitted with this broodmare domicile form. I understand that the statements herein are made subject to the penalties of 18 PA C. S. 4904 (relating to unsworn falsification to authorities).
  • This field is for validation purposes and should be left unchanged.