Must be signed by owner of stud dog, certifying that below named bitch was bred to his or her stud dog.
This is to certify that the bitch, Reg No:_______________,Owned by:________________________
Street:_______________________________________________
City:___________________________
State:__________________________
Zip:___________________________
Phone:_________________________
Was bred to my stud dog,__________________________________,Reg. No:_______________
Date bred:______________________
Date Whelped:___________________
No. Of pups in litter:_____ Males,____ Female____
Owner of Stud Dog:_________________
Street:____________________________
City:_____________________________
State:_____________________________
Zip:______________________________
Phone:____________________________
I certify that the information provided in this certificate is correct to the best of my knowledge.
__________________________________________ __________________________
Signature