AMERICAN RARE BREED MI-KI REGISTRY

PUREBRED MI-KI LITTER REGISTRATION APPLICATION

 

PLEASE READ ALL THE INSTRUCTIONS ON THE REVERSE SIDE BEFORE COMPLETEING THIS APPLICATION. PRINT ALL INFORMATION (except signature). USE BLACK INK AND CAPITAL LETTERS WHEN FILLING OUT THIS APPLICATION.

 

Make all check payable to ARBMR or American Rare Breed Mi-Ki Registry

Mail to: AMERICAN RARE BREED MI-KI REGISTRY c/o Lawrie Willis 139 Mill Street, Delano, Tennessee 37325

 

 

SIRE’S REGISTRATION NAME: __________________________________________________________

SIRE’S REGISTRATION NUMBER: ______________________                SIRE’S DNA #: _______________

NAME OF REGISTRY THE SIRE IS REGISTERED WITH AT TIME OF BREEDING: ______________________

SIRE’S OWNER AT THE TIME OF BREEDING: _______________________________________

Address: _______________________________________  City: ___________________              State: ____  Zip: _________

Home Phone: _______________  Cell: _______________     Email: ___________________________________________

I certify that the sire listed above was bred to the dam listed below and that the sire was owned by me on the date of breeding.

I ___ witnessed ___ did not witness the breeding of this sire and this dam. (Owner of Sire must initial one)

This litter was the result of a ___ Natural Breeding or ___ Artificial Insemination

Signature of Sire’s Owner: _______________________________________   Date: ___/___/20___

 

DAM’S REGISTRATION NAME: __________________________________________________________

DAM’S REGISTRATION NUMBER: ______________________                DAM’S DNA #: _______________

NAME OF REGISTRY THE DAM IS REGISTERED WITH AT TIME OF BREEDING: ______________________

SIRE’S OWNER AT THE TIME OF BREEDING: _______________________________________

Address: _______________________________________  City: ___________________              State: ____  Zip: _________

Home Phone: _______________  Cell: _______________     Email: ___________________________________________

I certify that I am the owner of the above named dam on the date of birth of the litter and that this dam was not bred to any other dog during her season. I apply to register this litter and further certify that all information on this application is true. I agree to comply with ARBMR rules and regulations. I ___ witnessed ___ did not witness the breeding of this sire and this dam. (Owner of Dam must initial one)

This litter was the result of a ___ Natural Breeding or ___ Artificial Insemination.

Signature of Dam’s Owner: _______________________________________   Date: ___/___/20___

 

Breeding Date(s): __________________________________________________________

Location of Breeding(s): (City) _________________________________          (State) _____

Date of Whelp: ___/___/ 20___       Location of Whelp: (City) _____________________________  (State) _____

# of Puppies: ___ Males  ___ Females         # of live Puppies: ___ Males  ___ Females

# of Puppies Born Dead: ___ Males  ___ Females       # of Puppies that Died after Whelp: ___ Males  ___ Females

If there were puppies born dead or that died later, what was the reason for their death?  ______________________

__________________________________________________________________________________________________

Did you have a necropsy done on the dead puppy or puppies?  ___ Yes  ___ No (If you had a necropsy done, please attach the documentation from your veterinarian explaining the findings of the necropsy.)

 

Instructions for Completing ARBMR's Purebred Mi-Ki Litter Registration Application

1. Clearly, print or type ALL INFORMATION.  If we cannot read all information requested, the application will be returned to you. This will delay your litter registration certificates.

2. If the ARBMR finds, at any time, that the owner misrepresents any information on this registration application, or misrepresents their Mi-Kis or the Mi-Ki breed, this will be considered cause for cancellation and will result in loss of all ARBMR privileges.

3. Sire and Dam must be registered with the ARBMR or with another ARBMR recognized Mi-Ki registry. Sire and Dam must be recorded with the ARBMR in the person(s) name who was the actual owner(s) on the dates when the breedings and birth accrued, before this application is submitted.

4. Litters eligible for registration with the ARBMR MUST be registered in owner’s name only.  The ARBMR WILL NOT accept Co-ownership litter applications. 

5. Failure to sign and date this application or incorrect fee amount will result in delay of processing this Litter Registration application.

6. If this application is accepted, the ARBMR will send the litter owner one individual registration certificate for each puppy in the litter. These individual registration certificates should be furnished AT THE TIME ownership of the puppy is transferred.

7. The owner of the litter must have this application submitted to the ARBMR by the time that the litter is 4 weeks of age. If application has not been submitted to the ARBMR by the time the litter is 4 weeks of age, an additional $5.00 per week will be due to the ARBMR in additional to the $15.00 Litter Registration Fee.

8. If you have any questions regarding this registration application, please contact Lawrie Willis at 139 Mill Street, Delano, TN 37325 or call me at 423-263-0301 or send an e-mail message  (include your phone number) to tristatemikis@comcast.net .

 

 

 

Registration Form (7/7/2006)