| Date of Breeding_______/_______/______ | Date of Birth________/________/_______ | |
| Breed______________________________ | Breed______________________________ | |
| Sire _______________________________ | Dam_______________________________ | |
| Reg.#______________________________ | Reg.#______________________________ | |
| Owner’s Signature__________________________ | Owner’s Signature__________________________ | |
| Address____________________________ | Address____________________________ | |
| City______________State_____Zip_____ | City______________State_____Zip_____ | |
| Phone_____________________________ | Phone_____________________________ | |
| IPDBA Kennel Name ________________ | IPDBA Kennel Number_______________ | |
| COLOR |
COLOR |
|
| 1._____________________ _______ | 6._____________________ _______ | |
| 2._____________________ _______ | 7._____________________ _______ | |
| 3._____________________ _______ | 8._____________________ _______ | |
| 4._____________________ _______ | 9._____________________ _______ | |
| 5._____________________ _______ | 10.____________________ _______ |
| Submit this form completed with $15.00 to the
registry office
below. The owner of the dam will receive a blue puppy
registration for
each puppy in the litter. Blue puppy papers must be
kept or transferred
and later submitted for permanent registration. |
|
|
|
P.O. Box 311 Upton, KY 42784 Phone: (270) 531- 3662 Email: ipdbaregistry@gmail.com |
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