Peruvian Paso Horse Registry of North America

   
   FORM FOR REPORTING 
  THE DEATH OF A REGISTERED HORSE




The following horse has died and its Certificate of Registration is enclosed.  
The Rules and Regulations state:  "Upon the death of a horse its Certificate 
of Registration, along with a statement indicating the date of death and cause, 
must be sent to the Registry for recording and cancellation.  Upon request, 
the cancelled Certificate will be returned."


NAME OF HORSE:_________________________________________________________


PPHRNA REGISTRATION NUMBER:____________________________________________         


DATE OF DEATH:_________________________________________________________         


CAUSE:_________________________________________________________________         
[If put down, give reason for euthanasia.]



Signature of Recorded Owner(s):

_______________________________________________________________________                         

_______________________________________________________________________
                                                                              


ADDRESS:______________________________________________________________          


CITY, STATE, ZIP:_____________________________________________________           


TELEPHONE:____________________________________________________________           




If Certificate is to be returned after cancellation, please check box   [ ]


                        BE SURE TO ATTACH CERTIFICATE!!


           
   PPHRNA * 3077 Wiljan Court, Ste. A, Santa Rosa, CA 95407 * (707) 579-4394

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