Leavitt Bulldog Association 2005

Application for Litter registration

Sire_____________________________________________ Reg. #_____________________________________
Dam____________________________________________ Reg. # _____________________________________
D.O.B. of litter to be registered _____________________ Number of puppies lost or stillborn ____________
Breeder's Name __________________________________ Kennel prefix (if desired) _____________________
Address_________________________________________ City_______________________________________

State_______________________________ Zip________________ Phone#______________________________

E-Mail:____________________________________________________

Please complete the entire form. The recording fee for litter registration is $20.00 U.S. per puppy for litters of 1 or
2 puppies or $30.00 U.S. for litters of 3 or more puppies.
Postal Check or Money Order only made payable to
Marie Morris.

Personal checks cannot be accepted. Naming of individual puppies at this time is optional, but all other
information must be completed to assist in the future identification of the animal. Please print clearly.

Puppy Data - (Please list all puppies. Photos are not required, but may be submitted voluntarily.

Identify puppy with corresponding puppy # or name. Pictures should be E-mailed.)
*
Pied on white are colored markings on a predominately white background.   Please describe.

Puppy#____

Sex

Color

Jaw

Tail

 

 

Circle one


M      F

Solid______

 

Brindle_____

 

 

*Pied on White

White___

Red___

Grey___

Black___

Fawn___

Other________________
_____________________

Wry Jaw
 
 
Yes / No


Pump Handle___
Slight Crook ____

Serious Crook___

Cork Screw_____

Bobbed________

 

Puppy#____

Sex

Color

Jaw

Tail

 

 

Circle one


M     F

Solid______

 

Brindle_____

 

 

*Pied on White

White___

Red___

Grey___

Black___

Fawn___

Other________________
_____________________

Wry Jaw
 
 
Yes / No


Pump Handle___
Slight Crook ____

Serious Crook___

Cork Screw_____

Bobbed________

 

Puppy#____

Sex

Color

Jaw

Tail

 

 

Circle one


M      F

Solid______

 

Brindle_____

 

 

*Pied on White

White___

Red___

Grey___

Black___

Fawn___

Other________________
_____________________

Wry Jaw
 
 
Yes / No


Pump Handle___
Slight Crook ____

Serious Crook___

Cork Screw_____

Bobbed________

 

 

 

 

     

 

   

   

Page 2

 

Puppy#____

Sex

Color

Jaw

Tail

 

 

Circle one


M     F

Solid______

 

Brindle_____

 

 

*Pied on White

White___

Red___

Grey___

Black___

Fawn___

Other________________
_____________________

Wry Jaw
 
Yes / No


Pump Handle___
Slight Crook ____

Serious Crook___

Cork Screw_____

Bobbed________

 

Puppy#____

Sex

Color

Jaw

Tail

 

 

Circle one


M      F

Solid______

 

Brindle_____

 

 

*Pied on White

White___

Red___

Grey___

Black___

Fawn___

Other________________
_____________________

Wry Jaw
 
Yes / No


Pump Handle___
Slight Crook ____

Serious Crook___

Cork Screw_____

Bobbed________

 

Puppy#____

Sex

Color

Jaw

Tail

 

 

Circle one


M      F

Solid______

 

Brindle_____

 

 

*Pied on White

White___

Red___

Grey___

Black___

Fawn___

Other________________
_____________________

Wry Jaw
 
 
Yes / No


Pump Handle___
Slight Crook ____

Serious Crook___

Cork Screw_____

Bobbed________

 

Puppy#____

Sex

Color

Jaw

Tail

 

 

Circle one


M      F

Solid______

 

Brindle_____

 

 

*Pied on White

White___

Red___

Grey___

Black___

Fawn___

Other________________
_____________________

Wry Jaw
 
 
Yes / No


Pump Handle___
Slight Crook ____

Serious Crook___

Cork Screw_____

Bobbed________

(If you have more pups then spaces on the form, print extra of Page 2)
I ________________________ certify that I am the breeder of this litter of Leavitt Bulldogs, and affirm that
the above information is true and correct.

Signature___________________________________ Date__________________________  

Leavitt Bulldog Association Registrations  

Marie Morris

P.O. Box 343

Centenary, SC 29519