NEBRASKA THOROUGHBRED OFFICIAL REGISTRY
PO Box 2215 - Grand Island, NE 68802

APPLICATION FOR REGISTRATION OF BROOMARE
Date _____________
Name of Mare:__________________________________________

Color:___________________Age ___________
Sire: __________________________________________

Dam _____________________________________
Jockey Club Registration Number___________________ 

Tattoo Number ____________________________
Date Acquired_________________________ 

From Whom:______________________________
Present Location of Broodmare  _________________________________________________
Breeding Status: Foal at side __yes__no In Foal __yes__no Expected Foaling Date:__________
Name of Owner(s) - All interest must be indicated

Complete Address of owner/owners
_____________________________           _________________________________
_____________________________           _________________________________
_____________________________           _________________________________
IMPORTANT; A PHOTO COPY OF THE FRONT AND BACK OF THE CERTIFICATE OF FOAL REGISTRATION (Jockey Club Papers) MUST ACCOMPANY THIS APPLICATION.
NOTE: Any change in ownership of a mare (all or in part) cancels this registration. The new owner/owners must register the mare with the Official Registry within 60 days of the purchase.

BROODMARE OWNERSHIP AFFADAVIT
I, ______________________________________herby certify that the above individual/s do possess clear title to the identified broodmare.
I hereby certify that there is no option or ownership interest of any nature other than as stated on this document connected with the ownership of this mare or any foal it might produce.
I swear that this information given above is true to the best of my knowledge; that I have read and know the rules of the Nebraska State Racing Commission pertaining to the above; that I have no knowledge of any facts that are contrary to the content and purpose of these rules; that any false statements or material omissions are subject to penalties prescribed by the rules of the Nebraska Racing Commission, State Statues, or criminal charges of perjury.

Signature of Mare Owner__________________________________

(Any one owner may submit this form on behalf of joint ownership)

Subscribed and Sworn to before me this ____ day of ___________,_____

____________________________________________________________
Notary Public
My Commission Expires on the ____day of_______________, ______

From Nebraska Rules of Racing, Rule 24 (1) (a)

A mare must have been continuously in the State of Nebraska for six months prior to foaling except that this period may be reduced to 90 days in the following situations:
A: Mares in foal and properly registered as broodmares with the Official Registry, but which are being actively trained and raced outside the State of Nebraska, and are returned to the State of Nebraska to remain continuously for 90 days immediately preceding foaling.
B: Mares in foal purchased at a nationally recognized Thoroughbred Bloodstock Sale, with the name and pedigree of said mare appearing in their catalogue; and said mares after being purchased are brought to the State of Nebraska, and remain continuously in the State of Nebraska for 90 days immediately preceding foaling.
Mares purchased at private treay must meet the six (6) months requirement.
OFFICE USE ONLY
NTBA Date of Registration ____________________By: _______________________________________