Application for Duplicate Registration Certificate or

Urc-
UTITED KENNEL CIUB
a Duplicate Application for Permanent Hegistration
$ee reyeme sffe at thk lam tar lnstmetians on haw ta tilt out t re tafln.
This form must be completed and signed by the Registrant(slSole $ignatory 0n record at UKCo.
Applications submitted by anyone other than the Registrant(s)/Sole Signatory on record will not be accepted.
STEP 1: lnformation; Bot* stgrafures ara reguried regardless af an "and"' ar "ar" pafinership.

RegistranVSole Signatory's Name Signature

Co-Registrant's Name Signature

(requircd, it Wplicabto) (required, i{ appticabla}

Address {222 hl " Lrtfr sr.

as rccotM by UKC. ,f address ,s dillarcnt you must include an Official Change o, Addless Form. The lorm e,an be downloaded at www.ukcdogs.com.

CityCi rerr: $tatelProvinc

"
IL roxarcoae kWo!- country U C f+ -

Phone{ 70v tlrs.' }7Lpl Email AddreSS (Requked tor Expedited Servics) (dlh
STEP 2: Dog lnlonnation

UKCo Begistration Number Dateor s1n, J ul+ A t r,2A l -7

UKCo Registered Narne

sex l-lal& coror Breed
Pu lot fih
\{hat is the reason you are applying for this duplicate? f€ cieo'r Ha. ,)
$TEP 3: lf dog's UKC& Registrdion number is unknswn please complete the information

Sire's UKCe Registration Number Ak+A 1-7 k Sire's UKCo Registered Name
V,-n ct < o''l/t;(.' 74 acA
Dam's UKCo Begistration Number A ttq B 5 Dam's UKCo Registered Name furz.
STEP 4: Fees 5: Payment
Checks and money orders must be payable in US funds and
made to the order of: Uniied Kennel Club
Application for Permanent Registration 100 E. Kilgore Rd., Kdamaeoo Ml4gX,2-5584
(alsoknawnaspuppypapers). -tr $tS Phone: {269) 343-S020 Fax (269) 3'1il-70$7
Breeder'sRecord.."........,. ............tr $eO
www.ukedogs.eom
Championship Degrees/AllBreeds....,........ .........tr $20
Easy Entry'" Card................. .......EI $10
Late Fee (Applies when the dog is over one year of age at tinte Mleo regresthg an acce&r:aaed servtue, wib nU$4, gp/EDilEb ar Nill DAY AIR
of Permanent Registration. Late fee does not apply to dogs o,r Sre oulsid€ fronf ot fue awelope. Faxaf, or qn]f,il€d appfbadons within lhe US Ml,
already Permanenty Regisfered with UKC)..-..........,..................tr $ZS fu chaged an EXFEDIIED Sevice Fee oI $aO. Appfications ouBido the llS wilt be
Permanent Registration Certificate with &Generation charged a RUSH se|he fee of $50. Ilo ronrnd.r ryfr, !e ist*rsd .tre b d
,ncofipra{e
Performance Pedigreee & Easy Enlry'" Card............................fI S24
Epprkrfor. {1g;cf/leated drpp,iag savr'ces mV WN ,o /Egriltr4fbn paperwo*,
Permanent Registration Certifi cato with 4-Generation
)
excI ucbs Ho duct dclivo*y

Performance Pedigree@ & Easy Entry* Card.....,,..................... $ZS il Maior Credit Cards Accepted
Gold Foil Aplian {Anly avaitable on the 4 Generation Pertarmance
Ped4rree@ for Purple Ribban (PR) Dogs). (Fee is in addition to the
oiginal Duplicale Begisfrafen Fee) ................ ..D $tS Cardholder's Name
Permanent Registration Gertificate, &Generation Pedigree,
+Generation Performance Pedigree" & Easy Entry'" Card...,..[ $45
Permanent Registration Ceriificate, 7€eneration Pedigree, Cardholder's Complete Address
4-Generation Perforrnance Pedigree" & Easy Entry* Card......U $60
Acceleraled Service Fees:
Next Day Air Sewice....,. -..........f,1 $60 Cardholder's Signature
(AvaMa for physical ma?i,irg addresses in bntinenal US W / Satuday delyeryis
nat available.)
Expedited Service -..-*-.......,...8 S40
Credit Card Number
Apan receifi d. UKC, ptr,cassEd snd rend
wdlxn lfr/e bu$iness &y6 w'rh tracking
number Valid e,rglil adress musf be pmrued" A,raihbb in Mirenbl US any.)
Rush Service .....f1 $30
(Processed withk fiw h/sr)ress days of rpcsi?rat Uxcidoas notincludetime in,"ansit) Expiration Date
Tube mailing ol pedigree ------fl $tS Only: DEclined tr
(option to place pediglee rh a tube irstead af $ envehr€) UKC Office Usr Approved tr
Toial Fees Due $ Authorizatlon #

UKC@ is the Registered Trademark of the United Kennel Club. We reserve the right to change any and all rules, fees, etc. withoul notice. Completed
iorms become the sole property of United Kennel Club and will not be returned FOISADM neY 2-1?