Broodmare Domicile Report

Please DO NOT use any 2019 or prior forms, as the 2020 form has been updated and will only be accessible as an online submission. If you need a printed version, please call our office to make other arrangements.

2020 Broodmare Domicile Form - For Mares Foaling in 2020

2020 PA BROODMARE DOMICILE REPORT – FOR MARES FOALING IN 2020
MANDATORY - MUST File by December 1, 2019, or within 14 days of Broodmare's Arrival in PA
FOAL REGISTRATION CRITERIA - A Thoroughbred foal born in the state of Pennsylvania in 2020 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:
    Check the choice above under which the foal of the subject broodmare will qualify.
  • BROODMARE INFORMATION

  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
  • BROODMARE OWNER INFORMATION

  • (999) 555-1212 10 digit phone number with area code.
  • Not Required
  • FARM INFORMATION

    Farm Broomare Domiciled at:
  • AFFIDAVIT OF DOMICILE BY BROODMARE OWNER/Domicile Farm Manager

    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).
  • 2020 BMBR Form filled online
  • This field is for validation purposes and should be left unchanged.