IMPORTANT
0
NEW Registration
0
Transfer of Ownership
SIGNATURE
OF
TRADER DATE SOLD
EQUINE REGISTRATION APPLICATION
Arizona Department of Agriculture
Licensing and Registration
1688 West Adams
Phoenix, Arizona 85007
Phone (602) 542
-6406
(Do
not call
a
livestock officer for this transfer)
PLEASE PRINT
-
USE PEN
PRESS DOWN WHEN WRITING
$10.00
FEE AND SELLER'S HAULING CARD
MUST
BE ATTACHED
IF EQUINE WAS PREVIOUSLY REGISTERED.
Name of Equine
Equine Age or D.O.B.
FOR OFFICE USE
ONLY
New Owner
Certificate
#
Date Mailed
Fees Received
0
Cash
Check
#
Processor's Initials:
0
Check
Each completed application must include a $10.00 registration fee
-
DO NOT SEND CASH!
Each application for a NEW registration must also include three
color photographs showing views of the front and both sides of the equine including its legs. Photographs may be submitted in
"jpg" format via e
-
mail to:
licensing@azda.gov.
Out
-
of
-
state equine
-
registration applications must include a copy of the out
-
of
-
state health certificate with record of a negative
equine infectious anemia test
(Coggins test), and a copy of the out
-
of
-
state brand inspection, or Bill of Sale, or an association registration. Buyers of in
-
state
equine must include the seller's original Equine Ownership Certificate or other document proving Arizona ownership. If Arizona ownership cannot be determined,
use out
-
of
-
state requirements. Replacement/duplicate card requires a $10.00 fee. Each completed new or transfer application must include a $10.00 registration
(A.R.S.
$8
3
-
1344 and 3
-
1345).
Hauling card must accompany transfer,
if
applicable
Month, Day
&
Year Sold
DESCRIPTION:
0
Mare
0
Stallion
0
Gelding
Markings Brand
SELLER:
(Owner@) of Record): Phone
Equine Ownership Certificate Number
Must be filled in at time of sale
Color D.0.B.L Weight
(Please Print)
Street
or
Box
Number
City
State
Zip
Code
I
certify that the equine sold is the animal recorded with the Arizona Department of Agriculture (ADA) as described
on
the Equine Ownership Certificate that accompanies
this request. I authorize the ADA to record this transfer of ownership.
I
understand that providing false information
is
a felony in Arizona.
SIGNATURE
OF
OWNER(S)
If co
-
ownership is
in
the name of "and" both owner and co
-
owner must sign. Signature of Owner and Co-owner(sbRequired
For Corrections
See
Back
of
White Copy
I
New Owner(s) Name
(Please
Print)
Owner's SSN# or
Tax
ID# Date of Birth Co
-
owner's SSN# Date of Birth
I
Mailing Address
City County
State
Zip
Code
Date
Acquired
Animal will be located at
I/We certify the purchase of the above animal and request a new Equine Ownership Certificate be issued to the undersigned. I(we) understand providing false
information is a felony in Arizona.
I
I
TRADER'S NAME PERMIT
#
OwnerlAgent Name SSN#
Mailing Address Daytime Phone
Type of Equine
0
Horse
0
Burro
0
Mule
0
Mare
0
Stallion
0
Gelding Color Describe Markings
(Please
Print)
Location
&
Description of Brand@), Tattoo or Microchip
If registered with a breed association, which association
&
registration
#
Certificate
#
of Dam
I
affirm that I am the legal owner or agent of the described equine, that the information provided is true and correct, the photographs are of the equine being
registered and the health information, if required, is for the equine being registered.
I
understand that providing false information is a felony in Arizona.
Signature of Owner and Co
-
owner@)
-
Required Date
lEVISED
07/02
WHITE COPY
-
ADA
YELLOW COPY
-
BUYER
PINK
COPY
-
SELLER
