Innovarrive Comic [inccacna ficairny P.O. BOX 312 WATERLOO, SC 29384 TELWPHONE # ( 864 ) 800 - 9995 UNITED STATES OF AMERICA APPLICATION FOR LITTER REGISTRATION FORM Breeding Information: A. Dam: Registration #: Breed: Owner(s): Telephone: ( Adare: City: 3 Zip Code: Email; B. Sie; Virtucio Bullies Manila Bo Reyisration #: ABIO-946 Broea: American Bull Owner(s); Timothy Joseph Virtucio Telephone: :<2)917 78 8046 ‘Address: Narding Reyes St. Banay-Banay Country: Philippines: ciy:__Lipa City State: _ Batangos Zip Code: _ 427 Email; _Victuciobullies mnlboy@ yahoocom, Liter Information: Date Bom: L Number of Males:__Females:_ Breed Applying For: Litter Registration mailing address: Country, City: Zip. We, dam/sire owner certify that the two dogs referenced was truly mated and produced the litter mentioned above. Dam/sire owner also agrees that there are no discrepancies and agree to approve the litter to be registered in its entirety. liwe give permission to ICBR to use this information for registration purposes. Timothy JdpepRYirtucio DAMILITTER OWNER STUD/SIRE‘OWNER SIGNATURE OVER PRINTED NAME SIGNATURE OVER PRINTED NAME 12/19/2022. DATE DATE