American Trakehner Association Application for Duplicate Certificate of Registration
Instructions: Please read carefully
Part 1: To be completed in ALL INSTANCES by recorded owner:
I,* , hereby affirm that the sentence marked below describes the circumstances surrounding the loss or destruction of the certificate for the horse identified in this affidavit.
One of the boxes below must be marked in order for us to proceed*: I lost the certificate I never received the certificate from the ATA I mailed or delivered the certificate to: NAME: ADDRESS: If given to an auction company, please list the date of the sale: Other (explain)
The undersigned agrees to indemnify and hold harmless the ATA from any and all liability, whenever or however arising, by virtue of its reliance on this affidavit and its issuance of the replacement certificate; agrees to defend the ATA at his expense; and if judgment is made against the ATA, to pay judgment and obtain written release in form acceptable to the ATA.
Sworn to before me this ____ day of ______________, ______ ____________________________________________ Signature of Recorded Owner Notary Public ________________________________________ ____________________________________________ Address My commission expires________________________________ ____________________________________________ City State Zip ____________________________________________ Owner's Phone Number ____________________________________________ e-mail address
Sworn to before me this ____ day of ______________, ______ ____________________________________________ Signature of Recorded Owner
Notary Public ________________________________________ ____________________________________________ Address
My commission expires________________________________ ____________________________________________ City State Zip
____________________________________________ Owner's Phone Number
____________________________________________ e-mail address
Mail Certificate to: ___________________________________________________________________________ Name
__________________________________________________________________________ Address
__________________________________________________________________________ City Address State Zip
__________________________________________________________________________ Daytime telephone number
__________________________________________________________________________ e-mail address
Enclosures: Four Recent Photos Owner Transfer Form Bills of sale, unbroken chain of ownership
Part 2: To be completed IN ADDITION to Part 1 if the certificate was not lost by recorded owner:
One of the boxes below must be marked in order for us to proceed *:
I lost the certificate I never received the certificate from the ATA I mailed or delivered the certificate to: NAME: ADDRESS: If given to an auction company, please list the date of the sale: Other (explain)
I lost the certificate
I never received the certificate from the ATA
I mailed or delivered the certificate to: NAME: ADDRESS: If given to an auction company, please list the date of the sale:
Other (explain)
The undersigned agrees to indemnify and hold harmless the ATA from any and all liability, whenever or however arising, by virtue of its reliance on this affidavit and its issuance of the replacement certifiate; agrees to defend the ATA at his expense; and if judgement is made against the ATA, to pay judgement and obtain written release in form acceptable to the ATA.
Sworn to before me this ____ day of ______________, ______ ____________________________________________ Signature of Person requesting Certificate (not recorded owner) Notary Public ________________________________________ ____________________________________________ Address My commission expires________________________________ ____________________________________________ City Address State Zip ____________________________________________ Owner's Phone Number ____________________________________________ e-mail address
Sworn to before me this ____ day of ______________, ______ ____________________________________________ Signature of Person requesting Certificate (not recorded owner)
My commission expires________________________________ ____________________________________________ City Address State Zip
*Please select one of the following payment forms: Invoice Me I will call a credit card # to the ATA I am mailing a check