Supplemental Transfer Statement

1 Supplemental AC1AE. Transfer Statement Submit this form with the AKC Dog Registration Application or the AKC Registration Certificate when a dog has been transferred more than once before applying for registration in the name of the current owner. Detailed requirements and instructions are on page 2 of this form. Please use black ink and capital letters to fill in the boxes. Information you omit or print outside of the boxes will delay processing. Registration is not guaranteed. New Co-Owner Fee Information There will be a $10 fee added for each final co-owner listed. All owners and co-owners will receive an email copy of the dogs AKC. Certificate when the transaction is complete. Please make all necessary fee adjustments in the Fee section directly on the AKC Dog Registration Application or AKC Registration Certificate. Dog Information (as shown on the Registration Application or Certificate).

2 Sex: Breed: Male Female AKC Registration or Litter Number Dog's Name Transfer Information: name(s) of the New Owner(s) should be printed below as they are to be registered Date of _ _. Transfer Month Day Year New Owner's First Name New Owner's Last Name Mailing Address _. City State ZIP code + 4. _ _. Telephone Number Email Address Provide your email address to receive important AKC communications. New Co-Owner's First Name New Co-Owner's Last Name Mailing Address _. City State ZIP code + 4. _ _. Telephone Number Email Address Provide your email address to receive important AKC communications. New Owner(s) Signature(s). The New Owner(s) listed above must sign this section if they are applying for this dog to be registered in their names(s). The signature(s) certify that the information listed on this form is correct. Each owner must sign individually. Any address corrections must be indicated in the Transfer Information section.

3 I (we) apply to the American Kennel Club to have a Registration Certificate for this dog issued in my (our) name(s). I (we) certify that I (we) acquired this dog directly on the date stated above from the Former Owners and if applicable, that I (we) have complete written authority from the other owner(s) to submit this application to register this dog in all our names. I (we) understand that upon request I (we) will be required to provide to the AKC any such written authorization. I (we) agree to abide by all rules and regulations of the American Kennel Club. I (we) understand that if the Limited box on the Dog Registration Application has been checked by the Litter Owner(s), or if the dog already has Limited Registration, I (we) will receive a Limited Registration Certificate. I (WE) AGREE THAT ANY CAUSE OF ACTION, CONTROVERSY OR CLAIM ARISING OUT OF OR RELATED TO THIS. REGISTRATION OR AS TO THE CONSTRUCTION, INTERPRETATION AND EFFECT OF THIS AGREEMENT SHALL BE SETTLED BY ARBITRATION PURSUANT TO THE APPLICABLE RULES OF.

4 THE AMERICAN ARBITRATION ASSOCIATION. HOWEVER, PRIOR TO ARBITRATION ALL APPLICABLE AKC BYLAWS, RULES, REGULATIONS AND PROCEDURES MUST FIRST BE FOLLOWED. AS SET FORTH IN THE AKC CHARTER AND BYLAWS, RULES, REGULATIONS, PUBLISHED POLICIES AND GUIDELINES. New Owner's Signature New Co-Owner's Signature Former Owner(s) Signature(s) Certifying Transfer PRINT Former Owner's First Name PRINT Former Owner's Last Name PRINT Former Co-Owner's First Name PRINT Former Co-Owner's Last Name I (we) transferred the dog identified above directly to the New Owner(s) listed above on the date of the Transfer indicated. I (WE) AGREE THAT ANY CAUSE OF ACTION, CONTROVERSY. OR CLAIM ARISING OUT OF OR RELATED TO THIS REGISTRATION OR AS TO THE CONSTRUCTION, INTERPRETATION AND EFFECT OF THIS AGREEMENT SHALL BE SETTLED BY ARBITRATION. PURSUANT TO THE APPLICABLE RULES OF THE AMERICAN ARBITRATION ASSOCIATION. HOWEVER, PRIOR TO ARBITRATION ALL APPLICABLE AKC BYLAWS, RULES, REGULATIONS AND.

5 PROCEDURES MUST FIRST BE FOLLOWED AS SET FORTH IN THE AKC CHARTER AND BYLAWS, RULES, REGULATIONS, PUBLISHED POLICIES AND GUIDELINES. Former Owner's Signature Former Co-Owner's Signature AXTRND (4/16) Edit 2016 The American Kennel Club American Kennel Club Supplemental AC2AE. Transfer Statement Requirements, Instructions, and General Information Requirements This form must be completed and submitted with the AKC Dog Registration Application or the AKC Registration Certificate when a dog has been transferred more than once before applying for registration in the name of the current owner. Each person through whose hands the dog passes, whether as owner, dealer, agent on consignment or otherwise, must complete and sign to certify that the dog transferred is the same dog identified on the application or certificate. A separate form must be completed and signed to record each Transfer after the first one recorded on the back of the Registration Application or Certificate.

6 Dog information must be printed exactly as shown on the front of the Registration Application or Certificate. Alterations on this form (except for address changes) require an explanation. Co-Owner There will be a $10 fee added for each final co-owner listed. All owners and co-owners will receive an email copy Fee of the dogs AKC Certificate when the transaction is complete. Please make all necessary fee adjustments in the Fee section directly on the AKC Dog Registration Application or AKC Registration Certificate. Mailing Dog Application Dog Certificate Information Send Transfers with a Send Transfers with a Dog Application to: Dog Certificate to: The American Kennel Club The American Kennel Club PO Box 900053 PO Box 900054. Raleigh NC 27675-9053 Raleigh NC 27675-9054. Additional If there are more than two (2) owners, contact the AKC for an Additional Signature Form. Requirements Note: This form is available on our website: Authorizations Signatures of persons other than the owners will be accepted only if a properly completed authorization form has been filed with the AKC.

7 Note: These forms are available on our website: Assistance Email AKC at or call 919-233-9767 to speak to an AKC Customer Service Representative, Monday Friday, 8:30 AM 5:00 PM. Information about the registration process and downloadable forms are available on our website: Notice The American Kennel Club reserves the right to correct or cancel for cause the registration of this dog and its descendants. Any misrepresentation on this application is one example of for cause cancellation and may result in loss of AKC privileges. By supplying your email address and/or telephone number, you consent to receive communications from AKC and third parties. Registration is not guaranteed. Once submitted, this application becomes the property of the American Kennel Club.