Hopeful Farm Sport Horses

* Please return after final pregnancy check; either positive or negative. *

HOPEFUL FARM SPORT HORSES
4595 Mahoney Road, McFarland WI 53558
608-835-1820

VETERINARY CERTIFICATE OF INSEMINATION
& PREGNANCY EXAMINATION

I, the undersigned Veterinarian, duly licensed in the state/province of ______________________, and holding current license #_______________________, do hereby attest that at the following time(s) on the following date(s) I artificially inseminated the ________________ year old, ________________ (color) mare named _________________________________, owned by ________________________________________, with the fresh-cooled semen labelled as being from the stallion named Remarkable.

Said inseminations were carried out in accordance with standard veterinary practices, and in accordance with the instructions supplied with the semen. I also certify that I examined this same mare for pregnancy on the following date(s), and have correctly indicated the results of these examinations.

I further certify that after careful inspection, the mare inseminated is the mare described on the mare Identification Form to which this certificate is attached.

I further certify that no other mare was inseminated with the semen designated for this mare.

Date of Insemination	Approximate Time	Approximate % Progressive Motility of Properly Warmed Sperm at Time of Insemination

Date of Pregnancy Examination	Results of Examination

WITNESS my signature, under the pains and penalties of perjury, this _______ day of ________________, 200___.

Name:______________________________________ Phone: ____________________________

Address:_______________________________________________________________________

Signature:_______________________________________ Date: __________________________