Free 00550.PDF - Indiana

APPLICATION FOR LIVESTOCK BRAND REGISTRATION
State Form 550 (R / 5-96) Approved by State Board of Accounts 1996

Return to:

INDIANA STATE BOARD OF ANIMAL HEALTH 805 Beachway Drive, Suite 50 Indianapolis, Indiana 46224-7785

Name of individual

Name of business / farm (if applicable)

Name as it should appear on the certificate: County Telephone number

Address of business / farm (street, city, state, ZIP code)

Mailing address (if different)

County

Telephone number

Amount enclosed (see instructions)

$
Check number

New application Renewal (if a renewal, skip to signature) NOTE: BRANDS ARE NOT RECORDABLE ON THE HEAD OR NECK AREA OF LIVESTOCK OR ON THE RIBS OF HORSES. (See instructions) (LEFT SIDE) (RIGHT SIDE)

EARS L R

(LEFT SIDE)

(RIGHT SIDE)
(RIGHT SIDE)

(LEFT SIDE)

Draw your first choice on livestock above and on the attached sketch form, and write the name of the brand as you read it here:

SECOND CHOICE:

Draw your second choice in the space above and write the name of the brand as you read it here:

NOTARY CERTIFICATE STATE OF SS: COUNTY OF The undersigned, being duly sworn upon his oath, states or affirms that he is the applicant (or duly authorized representative of the applicant herein named, to make this affidavit) and that he has read the foregoing statemants and that to the best of his knowledge and belief they are true and correct and that he will comply with all laws and regulations of the Board of Animal Health pertaining to his business.
Signature of applicant Date signed (mo., day, yr.) Signature of Notary Public

Signature of applicant's representative

Date signed (mo., day, yr.)

Printed or typed name of Notary Public

Date subscribed and sworn to (Notary Public)

County of residence

Date commission expires

Please draw an exact size facsimile of your proposed brand below. The squares on the sketch form are 1-inch.

Specify livestock to be branded:

Specify livestock to be earmarked: