Rev. 1/16

CountyorFFAChapter

Date

PhoneNo.

LastName FirstName(s) Age(s)(Jan.1currentyear) MailingAddress

StreetorP.O.Box,Town,State,Zip

ClubName

NEBRASKA4-HANDFFADAIRYIDENTIFICATION AFFIDAVIT

Seereversesideforimportantinstructionsandleaseaffidavit.

Thisanimalisidentifiedas4-H ORFFA

BREED

REGISTERED GRADE

BREDBYEXHIBITOR: YES

NO

NameofAnimal

TattooorEarTagNo. RightLeft

RegistryNo.

DateBorn

MonthDayYear

Needtohavetattooortagidentificationforanimalswithoutdistinctmarkings.

Sketchmarkingsandindicatecolororattach photographsshowingbothsidesoftheanimal.

I(we)certifythatthisisa4-HorFFAprojectanimalthisyearandthattothe bestofmy(our)knowledgetheaboveinformationiscorrect.

Date

Signatureof4-HorFFAMember(s)(Atleastoneofthoselistedabovemustsign.)

This(these)youthhas(have)submitted thislivestockidentification affidavitinaccordance withallrulesofthestateandcounty4-H Program orFFAProgramandalsohas(have)successfullycompletedaFoodAnimal QualityAssuranceprogram/testforthisperiod.

Date

ParentSignature

ExtensionStafforFFAAdvisor

4-HAnimalExhibitorandAnimalProjectRegulations

Ageof4-HExhibitor

A4-Hanimalowner/exhibitor8to18yearsold onJan.1ofthecurrentcalendarshowyeariseligibletoexhibitin4-H-sponsored events.Exhibitorswhoare10asofJan.1mayexhibitat theStateFairandat theAKSARBEN LivestockExposition.4-Hmembers maybecertifiedforstateandinterstateshowsiftheymeetagerequirementsforthateventandhaveproperly enrolledanimals.

4-H/FFAExhibits

AnyanimalshownasanFFAexhibitisineligibletoshowasa4-Hexhibitbyanyexhibitor.Ananimalmaybenominatedforshow participationin4-HorFFA,butnotboth.

AnimalOwnership

Alldairyordairygoatproject animalsmustbeowned:

a) solelybythe4-Hexhibitor,or

b) theexhibitorinpartnershipwithothermember(s)ofhisorherimmediatefamily.Onlythenameoftheshowmancanbeon theshowentry.Immediatefamilyisdefinedasmembersofahousehold,including parents,brothersandsisters,andyouthin thecareoftheheadofthehousehold.

c)Bysomeoneoutsidetheimmediatefamily,butidentifiedbytheexhibitor,providedtheexhibitormanages(caresfor,feeds, trains,grooms,etc.),hasuseoftheanimalasa4-Hproject animalat least75percentofthetimeduringtheproject yearand permissionfortheuseoftheanimaliscertifiedintheowner’saffidavit(below).

RegistrationPapers

ForStateFairandAKSARBEN,registrationpapers mustshowoneofthefollowing:

a) themember’snameasowner,or

b) thenameoftheexhibitorand/oraco-owner whoisamemberoftheexhibitor’simmediatefamily(seeimmediatefamily definitionabove),or

c)thefamilyfarm orranchnameorparent’sname, or

d) registeredanimalsowned bysomeoneoutsidetheimmediatefamilymustberegisteredtothesamepersonorfarmnameas listedintheowner’saffidavit below.Theexhibitormusthaveregistrationpapersavailableat theshowforinspectionbythe showsuperintendent.

IdentificationofAnimals

a) Allanimalsmustbeindividuallyidentified,listedontheappropriate4-HformandonfileinthelocalExtensionofficeby

June15.Positiveidentification willconsistofeartag,tattooorcolormarkingidentifiedbyphotoordrawing.Onecopywillbe returnedtothe4-Hmembertobebroughttotheshowforinspectionbytheshowsuperintendent.

b) A4-Hdairyanimalmaybeidentifiedinonlyonecounty.Ananimalcannotbeshowninmorethanonecountyfair.

Species / IdentificationMethod / StateIdentificationDeadline* / Form
Dairy
DairyGoat / Sketch,picture, tattooortag
Sketch,picture, tattooortag / June15ofthecurrentyear
June15ofthecurrentyear / 4HF109

*Individualcounties andothershowsorcontestsmayusedifferentinformationdeadlinesand/orrules,butforNebraskaState4-H,thesedeadlinesandinformation minimumsmustbemet.

NOTE:USEBALLPOINT PEN,PRINTLEGIBLY,BECERTAIN OFINFORMATIONBEFOREFILLINGOUTFORM, CORRECTIONSAREDIFFICULTTOMAKE.

Owner’sAffidavit

Asowneroftheanimaldescribedontheattached4-HDairyIdentificationCertificate,Icertifythat

hasmypermissiontousethisanimalin4-Hprojects.

Name

Iunderstandthe4-Hmembermustmanage(includingfeeding,grooming,fitting,etc.)andhaveaccesstotheanimalat least75percent ofthetimeduringtheproject year.

DateOwner

Approvedby Date

ExtensionStaff