VETERINARY CERTIFICATE OF INSEMINATION AND

PREGNANCY EXAMINATION  FOR FROZEN SEMEN

I,  the   undersigned Veterinarian,­­­­­­­­­­­­­­­­­­­­___________________, duly licensed in the

State /province/Country 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  frozen semen labeled as being from the stallion  SPECIAL MEMORIES.   Said

inseminations were carried out in accordance with standard veterinary practices, and with the

explicit instructions supplied with the semen. I also certify that I examined this same mare for

pregnancy on the following date(s), and have indicated the results of these examinations.  I

further certify that after careful inspection, the mare inseminated and pregnancy checked is in

fact the same individual that I have named herein. 

WITNESS my signature, under the pains and penalties of perjury, this _______ day of ________,

Signature:____________________________________

Name:_______________________________________