AMERICAN QUARTER PONY ASSOCIATION

PO Box 30
New Sharon, Iowa 50207
Phone:  (641)-675-3669

TRANSFER REPORT AND BILL OF SALE

(see instructions )

__________________________________ ,19___

Data Sold - IMPORTANT

______________________________________________ Number _____________

Registered Name and Number of Pony Sold

From (Seller) _________________________________________________________________(Print)

_________________________________________________________________

Street                                                            City                                                  State

To (Buyer) _________________________________________________________________(Print)

First  Name                                                 Initial                                             Last Name

_________________________________________________________________

Street                                                           City                                                  State

Telephone No. _____________________________

Location of Animal ____________________________________________________________

ACKNOWLEDGEMENT: I have read the rules and regulations as printed on the reverse side of this form and I hereby certify that the animal agrees with the pedigree on the record with the Association.

Further, I acknowledge and certify that I am the last record owner (with the Association) of this pony and have full rights to effect this transfer.

Therefore, I authorize the Association to record this transfer of ownership.

Signature of ) Signed __________________________________________________________

The Seller ) Same name as Last Appearing on Reg. Cart

Signature of) Signed __________________________________________________________

The Buyer )

TRANSFER FEE $5.00

OFFICE USE ONLY

Transfer Fee paid by ____________________________________________________________

Certificate Mailed ____________________________________________ ,19_____________

To __________________________________________________________________________

Address ______________________________________________________________________