Registration Form

Application for Registration of American Lineback Dairy Cattle

Use one form per each animal to register. Please complete the form with as much information as possible. You must have a metal ear tag # or US Fair Tag # to complete this form and the registration process. Mail with fees to: Marjorie Kuszlyk, 7982 Batavia-Byron Rd, Batavia, NY 14020 ph: 585.343.4800 email: kuszlykcattleco@yahoo.com

Fees: Member-Animal, 0-6 mon. $8; 6 mon.-1 yr $10; 13-24 mon. $14; 2 yrs & up $20. Non-member-Animal, 0-6 mon. $16; 6 mon.-1 yr $20; 13-24 mon. $28; 2 yrs & up $40. Transfers: Member-$5, Non-member-$7 Dupl/reprints $5. RUSH FEE-$10 anything less than 30 days Note: Membership MUST be current to register your animal at member rates.

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Owner’s information Herd Name/Prefix: ________________

Name: ___________________________________

Address: _____________________________________________________________

Telephone: ____________ Email: ____________________________

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Animal’s Registration Name: _________________________

Bull or Heifer/cow (circle) Date of Birth: ____________________

Twin? Yes or No (circle) Sex of Twin: Bull or Heifer (circle)

Bangle Ear Tag: ______ L or R Tatoo or Metal Ear Tag: ______________ L or R

Breeder’s Name: ____________________________

Lineback Type: White Classic Witrick, Dark Sided Witrick, Gloucester, Dark Speckled Witrick, Unmarked Lineback (circle one)

If animal falls somewhere in-between these types, circle the type that most closelyresembles your animal. Note any unusual markings in drawing.

Color: Black, Red, Brown, White, Blue (predominate color __________) (circle one) if roan mixture

White Line:: Narrow (less than 3-4”), Normal (4-5”,) Wide (to hip or shoulder bones)

Legs & Feet: Socks: Left Fore, Right Fore, Left Hind, Right Hind Horns: yes or no

Garters: Left Fore, Right Fore, Left Hind, Right Hind Polled: yes or no

(circle all that apply)

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Please include two (2) clear photographs of the animal to register. This photo will be printed on the registration certificate to show the actual identity of the registered Lineback. The photo must show each side, with one including the face.

Heritage Information

(if parents are not Lineback, please note the breed)

Sire: _______________________ Breed: _____________ Registration #_________

Metal Ear Tag: ____________________ Semen Available: Yes or No (circle)

Breeder: __________________________ Current Owner: ____________________

Sire’s Sire: ______________________ Breed: ________________Registration #: ___________

Metal Ear Tag: ______________ Breeder: _________________________

Sire’s Dam ______________________ Breed: ________________Registration #: ___________

Metal Ear Tag: _______________ Breeder: _____________________

Production details or any additional information:

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Dam: __________________ Breed: ______________ Registration #_________

Metal Ear Tag: __________________________

Breeder: __________________________ Current Owner: ____________________

Dam’s Sire: ______________________ Breed: _______________ Registration #: ___________

Metal Ear Tag: _______________ Breeder: ________________________

Dam’s Dam ______________________ Breed: ________________Registration #: ___________

Metal Ear Tag: _______________ Breeder: _____________________

Production details or any additional information: