MICHIGAN GAMING CONTROL BOARD / YEAR
THOROUGHBRED
HARNESS / OFFICE OF THE EXECUTIVE DIRECTOR
HORSE RACING SECTION / FEE
QUARTER HORSE
APPALOOSA / REGISTRATION OF
ARABIAN / PARTNERSHIP CORPORATION SYNDICATE STABLE NAME
We declare a partnership, corporation or syndicate
NAME / ADDRESS / SHARE / PAID IN FULL
SIGNED / SIGNED
SIGNED / SIGNED
SIGNED / SIGNED
SIGNED / SIGNED
SIGNED / SIGNED
Are the horse(s) leased? Yes No Terms of lease or other contingency
MGCB-RAL-4033 (Rev. 03/10) 3062 W. Grand Blvd., L-700, Detroit, MI 48202
Phone: (313) 456-4100 Fax: (313) 456-2864
www.michigan.gov/mgcb
ALL ENTRIES AND DECLARATIONS OF FORFEITS TO BE MADE BYALL WINNINGS TO BE CREDITED TO
HORSE TO BE RUN IN NAME OF / NAME OF TRAINER
WE REQUEST THAT THIS PARTNERSHIP, CORPORATION OR SYNDICATE BE REGISTERED IN ACCORDANCE WITH THE RULES OF THE
MICHIGAN GAMING CONTROL BOARD, HORSE RACING SECTION
LIST OF HORSES REGISTERED
NAME / SEX / AGE
The Stable Name of is hereby registered with the Michigan Gaming Control Board, Horse Racing Section
NAME(S) / ADDRESS
NAME OF TRAINER
MGCB-RAL-4033 (Rev. 03/10) 3062 W. Grand Blvd., L-700, Detroit, MI 48202
Phone: (313) 456-4100 Fax: (313) 456-2864
www.michigan.gov/mgcb