APPLICATION FOR DUPLICATE REGISTRATION
American Dog Breeders Association
P.O. BOX 1771 Salt Lake City, Utah 84110 (801) 936-7513 Fax (801) 936-4229
Please fill out this application to the best of your knowledge. Anything unknown please leave the space blank.
If you have any questions, please contact our office. All owner information asked for in section # 1 must be the same owner as listed in the
A.D.B.A. files. If you are not the owner listed in the A.D.B.A. files, please fill out section # 2 as the new owner
SECTION #1 I, _______________________________________________ of _____________________________________
(Registered owner(s) name) (Street address – new same)
City ___________________________, State __________ Zip ________________, request a Duplicate Registration
For ________________________________________A.D.B.A. Registration Number _________________________________
(Dog’s registered name)
(Dog’s Registered Number)
The dog’s birth date is _____/ ____ / _____ the dog’s color is: _______________________________ Sex: Male Female
Registered owner’s signature _____________________________________________________________________________
e-mail_________________________________________________ phone # (________) ___________-__________________
*I am requesting a duplicate copy because the original was (check one) Lost Stolen Destroyed Other ____________________
Sire’s registered name_____________________________________________ registration #___________________________
Dam’s registered name____________________________________________ registration #____________________________
SECTION #2: If you have the dog but NEVER transferred it into you name before the papers were lost, stolen or destroyed, please have the
person you bought/received the dog from fill out this BILL OF SALE
I,______________________________________________________________ Have sold my interest of the above listed dog
To _________________________________________________________________on this date_______/________/________
New Owners Name
Skip Sellers Signature
ADBA will verify sale by phone. Sellers phone#_______________________ ___
Seller’s signature to release ownership to new owner ___________________________________________________
Breeder’s signature to allow Dogs name to be changed _________________________________________________
Buyer’s signature_______________________________________________________________________________________
Dogs New Registered name _____________________________________________________________________________
Name: (please print)____________________________________________________________________________________
Address:____________________________________________city/state:___________________________zip:____________
e-mail_______________________________________________________ phone # (______) __________-_______________
Duplicate Registration Certificate....$10.00 Skip Sellers Signature..$10.00
Duplicate w/ 4 generation pedigree.$25.00 Duplicate with transfer of ownership & 4gen.............................$35.00
Duplicate w/ 6 generation pedigree(with emailed PDF of pedigree)$35.00 Duplicate w/transfer of ownership & 6gen(with emailed PDF of pedigree)..$45.00
Duplicate w/ 7 generation pedigree(with emailed PDF of pedigree) ...$55.00 Duplicate w/transfer of ownership & 7gen(with emailed PDF of pedigree).....$65.00
Super Rush (2 working days)...$25.00 Rush (10 working days)......$10.00
Show & Pull ID card w/photo....................................... $10.00
Gazette subscription...................................$35.00 Gazette subscription (overseas)...$75. 00
If Duplicate with transfer of ownership is applied for 120 after original date of sale please include late fee $20.00
Credit Card Number _____________________________________________Exp Date _____/_____Security Code________
