Fillable BrandLease DepartmentofAgriculture(ADA) Arizona 1688WestAdams,Phoenix,AZ85007 LicensingandRegistrationSection (Arizona)

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BrandLease DepartmentofAgriculture(ADA) Arizona 1688WestAdams,Phoenix,AZ85007 LicensingandRegistrationSection (Arizona)

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File type: PDF

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For ADA/ESD Use Only
Brand #:_________________
Date Received: ____________
Date Recorded: ____________
Arizona
DepartmentofAgriculture(ADA)
LicensingandRegistrationSection
1688WestAdams,Phoenix,AZ85007
Phone:(602)542‐0347
Fax:(602)542‐0466
BrandLease
Thisistocertifythat isthe
(Currentbrandownersastheyappearonexistingrecordedcertificate)
registeredownerofBrandNo.andhasgiventherighttousesaidbrandonlivestockbeginning
andending
(Month,Day,Year) (Month,Day,Year)
totheapplicantsoutlinedbelow.
NameofApplicant(s):


And☐Or☐(SelectOnlyOne)
_____________________________________________________________________
And☐Or☐(SelectOnlyOne)
And☐Or☐
(SelectOnlyOne)
And☐Or☐(SelectOnlyOne)
MailingAddress:City:State: Zip:
Phone:Email:
Range:County:______________________________________________
(CityorTownwherelivestockwillbelocated)
Bysigningthisdocument,I/weaffirmthatallinformationprovidedhereinistrueandcorrect.
Lessee(s)Signature/Title Lessee(s)Pri
ntedName
X______________________________________________ X____________________________________________
X______________________________________________ X____________________________________________
X______________________________________________ X____________________________________________
X______________________________________________ X____________________________________________
Owner(s)
^ignature/Title Owner(s)Pri
ntedName
X______________________________________________ X____________________________________________
X______________________________________________ X____________________________________________
X______________________________________________ X____________________________________________
X______________________________________________ X____________________________________________
STATE OF )
) ss.
County of )
On this day of , 20 , before me personally appeared
(Name of Signer)
Whose identity was proven to me on the basis of satisfactory evidence to be the person who s/he claims to be and acknowledged that
s/he signed the above/attached document.
____________________________________________________
Signature of Acknowledging Official
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BrandLease DepartmentofAgriculture(ADA) Arizona 1688WestAdams,Phoenix,AZ85007 LicensingandRegistrationSection (Arizona)

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Completed 20 July 2020

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