VERIFICATION OF RECEIPT OF SEMEN
AND INSEMINATION
OF MARE
NAPHA SHIPPED, FRESH SEMEN TEST PROGRAM
Name of Mare ________________________________________________________
Mare's NAPHA Registration Number ______________________________________
Mare's Color ___________________________________________________ Mare's Description _____________________________________________ Recorded Owner(s) of Mare ___________________________________________ Mare Owner(s) Veterinarian or AI Technician _________________________ Stallion's Name ____________________________________________________ Stallion's NAPHA Registration Number _______________________________ Method of Shipment of Semen _________________________________________ I hereby certify that on the dates listed I received shipped, fresh semen from the stallion shown. I have used this semen as instructed to inseminate the mare listed above. I have made a thorough examination of this mare to determine that she is the mare registered with the NAPHA under the name and registration number given above. I further certify that I inseminated said mare and only said mare with the semen provided and that I personally discarded any excess, unused semen in the semen package. Dates of Insemination Volume of Semen Used 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Date __________________________________________ Signature of Recorded Owner(s) of Mare _____________________________ Signature of Veterinarian or AI Technician _________________________ This form must be filed by January 10th of the year following these breedings. The fine for late filing is $50. The resulting foal will not be registered and Mare Owner not allowed to continue to participate in this Test Program until any fine due is paid.
Contact NAPHA at:
3095 Burleson Retta Road
Burleson, Texas 76028
Tel: (817) 447-7574 Fax: (817) 447-2450
e-mail: info@pphrna.org