2021 Broodmare Domicile Report

Please DO NOT use any 2020 or prior forms, as the 2021 form has been updated and will only be accessible as an online submission.

2021 Broodmare Domicile Form - For Mares Foaling in 2021

2021 PA BROODMARE DOMICILE REPORT – FOR MARES FOALING IN 2021
MANDATORY - MUST File by December 1, 2020, or within 14 days of Broodmare's Arrival in PA
FOAL REGISTRATION CRITERIA - A Thoroughbred foal born in the state of Pennsylvania in 2021 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:

Qualification*
Check the choice below under which the foal of the subject broodmare will qualify.
- (1) The dam of the foal resided continuously in Pennsylvania on or before December 1, 2020, through foaling; or
- (2) The dam of the foal was purchased at a public sale after Dec. 1 of the year of conception and brought into Pennsylvania within 14 days of the purchase date (60 days if outside the U.S.) and remained continuously through foaling. During the year of foaling, the foal or its dam spent at least ninety (90) days in the state. MUST BE A COMPLETED PUBLIC SALE – NOT AN RNA (Reserve Not Attained) or a private transaction after the public sale; or
- (3) Breed back for mares arriving after December 1 of the year of conception and foaling in Pennsylvania: The dam of the foal was bred back to a stallion standing in Pennsylvania (which was registered with the PHBA as a Pennsylvania stallion during the breeding season of the year of foaling), and said dam of the foal resided in the state for at least sixty (60) consecutive days during the year which foaling occurred.
BROODMARE INFORMATION
Broodmare Name*
Broodmare Foal Year*
Broodmare Sire*
Broodmare Dam*
PA Arrival Date*
Date Format: MM slash DD slash YYYY
SIRE INFORMATION
Stallion mare is in foal to:*
State 2020 Covering Stallion Stood*
2021 Covering Stallion*
State 2021 covering stallion stands*
BROODMARE OWNER INFORMATION
Year-Round PA Resident Mare*
- YES
- NO
Broodmare Owner PA Resident*
- YES
- NO
Broodmare owner or managing partner’s name*
First Last
Owners Phone*
(999) 555-1212 10 digit phone number with area code.
FARM INFORMATION
Farm Broodmare Domiciled at:
Farm Name
Farm Owners Name*
First Last
Farm Phone*
Farm Address*
Street Address City State / Province / Region ZIP / Postal Code
AFFIDAVIT OF DOMICILE BY BROODMARE OWNER/Domicile Farm Manager
Checking "I Agree" and filling in the below Captcha is equivalent to a signed printed form*
- I Agree
I, the undersigned broodmare owner/Domicile Farm Manager, 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).
Broodmare Owner/Domicile Farm Manager Email*
Enter Email Confirm Email
2021 BMBR Form filled online
Phone
This field is for validation purposes and should be left unchanged.

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2021 Broodmare Domicile Form - For Mares Foaling in 2021

BROODMARE INFORMATION

SIRE INFORMATION

BROODMARE OWNER INFORMATION

FARM INFORMATION

AFFIDAVIT OF DOMICILE BY BROODMARE OWNER/Domicile Farm Manager