EOEEA-AGR

Name of stallion:(Required)

Stallion owner:(Required)

First Last

Stallion owner's address:(Required)

Street Address City State ZIP Code

Stallion owner's phone number:(Required)

Stallion owner's email address:(Required)

Name of Massachusetts farm where this stallion stood for this breeding season (Feb 1-June 30):(Required)

1. Mare's registered name:(Required)

1. Jockey Club Registration Number:(Required)

1. ID (Microchip, Tattoo):(Required)

1. Date last bred:(Required)

MM

DD

YYYY

1. Owner's Name:(Required)

1. Owner's address:(Required)

Street Address City State ZIP Code

1. Owner's phone number:(Required)

1. Owner's email address:(Required)

1. Do you have another mare to enter?(Required)

Yes

No

2. Mare's registered name:(Required)

2. Jockey Club registration number:(Required)

2. ID (Microchip, Tattoo):(Required)

2. Date last bred:(Required)

MM

DD

YYYY

2. Owner's name:(Required)

2. Owner's address:(Required)

Street Address City State ZIP Code

2. Owner's phone number:(Required)

2. Owner's email address:(Required)

2. Do you have another mare to enter?(Required)

Yes

No

3. Mare's registered name:(Required)

3. Jockey Club registration number:(Required)

3. ID (Microchip, Tattoo):(Required)

3. Date last bred:(Required)

MM

DD

YYYY

3. Owner's name:(Required)

3. Owners address:(Required)

Street Address City State / Province / Region ZIP Code

3. Owner's phone number:(Required)

3. Owner's email address:(Required)

3. Do you have another mare to enter?(Required)

Yes

No

4. Mare's registered name:(Required)

4. Jockey Club registration number:(Required)

4. ID (Microchip, Tattoo):(Required)

4. Date last bred:(Required)

MM

DD

YYYY

4. Owner's name:(Required)

4. Owner's address:(Required)

Street Address City State ZIP Code

4. Owner's phone number:(Required)

4. Owner's email address:(Required)

4. Do you have another mare to enter?(Required)

Yes

No

5. Mare's registered name:(Required)

5. Jockey Club registration number:(Required)

5. ID (Microchip, Tattoo):(Required)

5. Date last bred:(Required)

MM

DD

YYYY

5. Owners name:(Required)

5. Owner's address:(Required)

Street Address City State ZIP Code

5. Owner's phone number:(Required)

5. Owner's email address:(Required)

5. Do you have another mare to enter?(Required)

Yes

No

6. Mare's registered name:(Required)

6. Jockey Club registration number:(Required)

6. ID (Microchip, Tattoo):(Required)

6. Date last bred:(Required)

MM

DD

YYYY

6. Owner's name:(Required)

6. Owner's address:(Required)

Street Address City State ZIP Code

6. Owner's phone number:(Required)

6. Owner's email address:(Required)

6. Do you have another mare to enter?(Required)

Yes

No

7. Mare's registered name:(Required)

7. Jockey Club registration number:(Required)

7. ID (Microchip, Tattoo):(Required)

7. Date last bred:(Required)

MM

DD

YYYY

7. Owner's name:(Required)

7. Owner's address:(Required)

Street Address City State ZIP Code

7. Owner's phone number:(Required)

7. Owner's email address:(Required)

7. Do you have another mare to enter?(Required)

Yes

No

8. Mare's registered name:(Required)

8. Jockey Club registration number:(Required)

8. ID (Microchip, Tattoo):(Required)

8. Date last bred:(Required)

MM

DD

YYYY

8. Owner's name:(Required)

8. Owner's address:(Required)

Street Address City State ZIP Code

8. Owners phone number:(Required)

8. Owner's email address:(Required)

8. Do you have another mare to enter?(Required)

Yes

No

9. Mares registered name:(Required)

9. Jockey Club registration number:(Required)

9. ID (Microchip, Tattoo):(Required)

9. Date last bred:(Required)

MM

DD

YYYY

9. Owner's name:(Required)

9. Owner's address:(Required)

Street Address City State ZIP Code

9. Owner's phone number:(Required)

9. Owner's email address:(Required)

9. Do you have another mare to enter?(Required)

Yes

No

10. Mare's registered name:(Required)

10. Jockey Club registration number:(Required)

10. ID (Microchip, Tattoo):(Required)

10. Date last bred:(Required)

MM

DD

YYYY

10. Owner's name:(Required)

10. Owner's address:(Required)

Street Address City State ZIP Code

10. Owner's phone number:(Required)

10. Owner's email address:(Required)

10. Do you have another mare to enter?(Required)

Yes

No

11. Mare's registered name:(Required)

11. Jockey Club registration number:(Required)

11. ID (Microchip, Tattoo):(Required)

11. Date last bred:(Required)

MM

DD

YYYY

11. Owner's name:(Required)

11. Owner's address:(Required)

Street Address City State ZIP Code

11. Owner's phone number:(Required)

11. Owner's email address:(Required)

11. Do you have another mare to enter?(Required)

Yes

No

12. Mare's registered name:(Required)

12. Jockey Club registration number:(Required)

12. ID (Microchip, Tattoo):(Required)

12. Date last bred:(Required)

MM

DD

YYYY

12. Owner's name:(Required)

12. Owner's address:(Required)

Street Address City State ZIP Code

12. Owner's phone number:(Required)

12. Owner's email address:(Required)

12. Do you have another mare to enter?(Required)

Yes

No

13. Mare's registered name:(Required)

13. Jockey Club registration number:(Required)

13. ID (Microchip, Tattoo):(Required)

13. Date last bred:(Required)

MM

DD

YYYY

13. Owner's name:(Required)

13. Owner's address:(Required)

Street Address City State ZIP Code

13. Owner's phone:(Required)

13. Owner's email address:(Required)

13. Do you have another mare to enter?(Required)

Yes

No

14. Mare's registered name:(Required)

14. Jockey Club registration number:(Required)

14. ID (Microchip, Tattoo):(Required)

14. Date last bred:(Required)

MM

DD

YYYY

14. Owner's name:(Required)

14. Owner's address:(Required)

Street Address City State ZIP Code

14. Owner's phone number:(Required)

14. Owner's email address:(Required)

14. Do you have another mare to enter?(Required)

Yes

No

15. Mare's registered name:(Required)

15. Jockey Club registration number:(Required)

15. ID (Microchip, Tattoo):(Required)

15. Date last bred:(Required)

MM

DD

YYYY

15. Owner's name:(Required)

15. Owner's address:(Required)

Street Address City State ZIP Code

15. Owner's phone number:(Required)

15. Owner's email address:(Required)

15. Do you have another mare to enter?(Required)

Yes

No

16. Mare's registered name:(Required)

16. Jockey Club registration number:(Required)

16. ID (Microchip, Tattoo):(Required)

16. Date last bred:(Required)

MM

DD

YYYY

16. Owner's name:(Required)

16. Owner's address:(Required)

Street Address City State ZIP Code

16. Owner's phone:(Required)

16. Owner's email address:(Required)

16. Do you have another mare to enter?(Required)

Yes

No

17. Mare's registered name:(Required)

17. Jockey Club registration number:(Required)

17. ID (Microchip, Tattoo):(Required)

17. Date last bred:(Required)

MM

DD

YYYY

17. Owner's name:(Required)

17. Owner's address:(Required)

Street Address City State ZIP Code

17. Owner's phone number:(Required)

17. Owner's email address:(Required)

17. Do you have another mare to enter?(Required)

Yes

No

18. Mare's registered name:(Required)

18. Jockey Club registration number:(Required)

18. ID (Microchip, Tattoo):(Required)

18. Date last bred:(Required)

MM

DD

YYYY

18. Owner's name:(Required)

18. Owner's address:(Required)

Street Address City State ZIP Code

18. Owner's phone:(Required)

18. Owner's email address:(Required)

18. Do you have another mare to enter?(Required)

Yes

No

19. Mare's registered name:(Required)

19. Jockey Club registration number:(Required)

19. ID (Microchip, Tattoo):(Required)

19. Date last bred:(Required)

MM

DD

YYYY

19. Owner's name:(Required)

19. Owner's address:(Required)

Street Address City State ZIP Code

19. Owner's phone number:(Required)

19. Owner's email address:(Required)

19. Do you have another mare to enter?(Required)

Yes

No

20. Mare's registered name:(Required)

20. Jockey Club registration number:(Required)

20. ID (Microchip, Tattoo):(Required)

20. Date last bred:(Required)

MM

DD

YYYY

20. Owner's Name:(Required)

20. Owner's address:(Required)

Street Address City State ZIP / Postal Code

20. Owner's phone number:(Required)

20. Owner's email address:(Required)

Stallion Owner's Residency Declaration:

I, (we) the undersigned do declare that the Thoroughbred Stallion (named below)(Required)

did stand the entire breeding season, February 1st through June 30th, inclusive in the Commonwealth of Massachusetts at (name of farm)(Required)

Owner/Agent name for signature:(Required)

Owner/Agent email:(Required)

Address:(Required)

Street Address City State ZIP / Postal Code

Today's date:(Required)

MM

DD

YYYY