APPLICATION FOR REGISTRATION - BRAND AND MARKS OF LIVESTOCK

DRAW BRAND ON BACK OF FORM

Indicate probable position of brand on drawings

FEE ENCLOSED:
____ Registration $10.00
____ Renewal 5.00
____ Transfer 1.00

KNOW ALL MEN BY THESE PRESENT, THAT I of

County, State of Kentucky, desire to adopt the following brands and marks for identifying livestock under provisions of KRS 253.010.

Name of Brand To be Used on

[type of animal(s)]
Brand to be Registered in Name of
Whose Mailing Address is and Phone #
Livestock identified by the described brands or marks will normally graze on the following lands in _ County
in Kentucky, nearest city of: in Kentucky, and on the farm owned by
Describe by giving the name of road, distance from nearest town, and other information where branded animals will be kept

In the event the above listed brand is in conflict with a previously registered brand, then I agree that the following brands may be
registered in the order shown, in compliance with provisions of the Kentucky Brand Registration Law:

Second Choice Position on animal

Third Choice Position on animal

The undersigned verifies that only the (hot iron) (freeze method) (tattoo) (chemical) brand is to be used and that the approved dimension
of iron is as shown on the reverse side of this application.

THIS SECTION MUST BE NOTARIZED

In Witness Whereof, I have set my hand this day of ,

Signature of Applicant

Subscribed and sworn to before me this day of ,

(Notary Seal)
Notary Public

My commission expires on
KYSV-102 (REV. 08/14)
 ENTER DRAWING OF FIRST CHOICE SELECTION HERE

SECOND CHOICE DRAWING THIRD CHOICE DRAWING