Assurance of Origin

Breeder Name_____________________________________________________________________________

 

Farm/Ranch Name_________________________________________________________________________

 

Address____________________________________________ City_______________ AR   ZIP___________

 

Animal Description:

 

Heifer:  _______Commercial            _____Registered __________________(breed)

Bull:      _____                                    _____Registered___________________(breed)

Steer:    _____

Sheep: ____ Ewe _____Ram _____Wether           _____Commercial _____Registered

Goat:  _____Doe _____Buck _____Wether           _____Commercial _____Registered

Hog:   _____Gilt _____Boar _____Barrow            _____Commercial _____Registered

 

 

Registration # (if registered breed)_________________________________________________________

 

My signature indicates that the above animal was born in Izard County, Arkansas.  To the best of my knowledge this animal meets the requirements set forth by the Izard County Fair Board and is eligible to compete in the “County Bred” division of the Izard County Fair.

 

_______________________________________________________________       __________________

Signature of Breeder                                                                                                                    Date

 

 

Statement of Ownership
 

My signature indicates that I am the current owner of the above animal.

 

Exhibitor Name__________________________________________________________________________

 

Address____________________________________________ City_________________ AR  ZIP________

 

______________________________________________________________        ____________________

Signature of Owner/Exhibitor                                                                                                    Date

 

 

My signature indicates that I believe the above animal is eligible to compete in the “County Bred” division of the Izard County Fair.

 

______________________________________________________________          ___________________

Signature of FFA Advisor/ 4-H Leader/County Ext. Agent                                                     Date