Print this form and use as needed.
BUCK Reg. #____________________________________________
Type of Service _____Natural _____Artificial Collection
ID #_______________(for AI Service only)
Date Does were exposed to the Buck:
From:________________ To:_______________
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Signature (owner of Buck)_________________________________Date:_________________
Signature owner of Doe(s)___________________________Signature of processor(if AI)________________________
# of Does listed on this form_________ Buck
owner must initial after last entry used
Applicant certifies that all information contained
in this application, and furnished
herewith is true and complete.
Applicants Signture:____________________________________________________Date:__________________