KMSHA of KY Inc. Horse Nomination For ...

KENTUCKY Non-Race Horse BREEDER’S INCENTIVE FUND APPLICATION Nominated HORSE: Stud; Mare; Gelding or any Offspring*Horse Name: Date of Birth Bred and Born in County, KentuckyKMSHA/SMHA Registration # SireKMSHA/SMHA Registration # DamOWNER:Name:KMSHA Membership# Address:

Phone: Cell: E-mail

Please fill in all information above to be eligible!

Certification of Nominated HorseAFFIDAVIT BY OWNER OR THE AUTHORIZED AGENT. I hereby certify that above nominated horse has been bred and born in the State of Kentucky. I assume full responsibility for the registration of this horse as a KHBIF registered horse and agree that if a horse is later proved to be ineligible due to false or misleading information provided in this form that (1) the registration of the horse may be denied or revoked; (2) I may be banned from registering horses to the KHBIF; and (3) I may be subject to civil and criminal penalties under the laws of the Commonwealth of the Kentucky for providing fraudulent information. Furthermore, I agree to promptly provide any additional information to the KHBIF upon request to confirm information submitted with this registration, or the registration(s) may be denied or revoked. If submitted by an agent, then the agent, as well as the owner may be subject to the above penalties. All filings are subject to audit by the KHRC and filing fees are non-refundable.

DateSIGNATURE

One Horse Per Form Only

non-profit association

2020

Print Name

Completion of the Horse Nomination Form and the owner’s Certification of Nominated Horse and payment of the required fee’s will entitle the named horse to participate in the KMSHA Breeders Incentive Fund and KMSHA/SMHA Futurity Program for 2020 KHBIF POINTSIMPORTANT: Each Horse can only be nominated into one approved KHBIF Breed program.Nomination Fees and Eligibility to compete for KHBIF Points: $100.00 per horse* any Offspring up to 2 years will compete at the KMSHA/SMHA 2020 Futurity in handDEADLINE: OWNERS ARE RESPONSIBLE FOR SUBMITTING ALL POINTS BY NOVEMBER 16, 2020

Mail completed form, fee and check or send credit card info payable to:KMSHA of Kentucky, PO Box 1405, Georgetown, KY 40324 859 225-5674