(if different)
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CITY
STATE
ZIP CODE
CITY
STATE ZIP CODE
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DRIVERS LICENSE
NO.
STATE
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HOME PHONE ( include area code
)
BUSINESS PHONE ( include area code )
E-MAIL ADDRESS: ____________________________
AUTHORIZATION BY PROPERTY OWNER GRANTING
PERMISSION TO BOARD AN ESTRAY HORSE;
NUMBER OF
"WILD" HORSES REQUESTED: ___________
_______________________________________
PROPERTY OWNER NAME
______________________________________________
TELEPHONE
______________________________ ______________
SIGNATURE
DATE
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Please answer the following questions :
1. Have you read and do you understand the PROHIBITED ACTS and the TERMS
OF MAINTENANCE AND CARE ? ______Yes _____No
2. Describe the facilities that will be provided to the 'wild'
horse(s) you have requested :
a. Shelter size , height , and construction materials:
b. Corral size , fence height and construction materials :
c. Pasture size : ( if available )
d. Water
container
(describe): e.
Feed container (describe:
f. Is
running water available on property? _____________
g. Veterinarian
Name: ___________________________
Telephone: __________________________
h. Farrier Name:
___________________________
Telephone: __________________________
3. Will someone
other than you select , transport , or care for the animal(s) requested ?
____Yes ____No
4. Have you previously maintained and cared for animals through the Storey
County "Wild" Horse Program , Nevada Estray
Program or through the Federal Government’s Wild Horse and Burro Adoption
Program ? ______Yes _____ No
5. Have you ever been convicted of abuse or inhumane treatment of animals ,
violation of the Wild Free Roaming Horse and
Burro Act or the Wild Horse and Burro Regulations ?
____Yes ___No
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TERMS OF MAINTENANCE AND CARE AGREEMENT
The
following terms apply to estray ‘wild’ horses and/or offspring transferred under
this Private Maintenance and Care Agreement:
a)
Care Providers are financially responsible for
providing proper care.
b)
Care Providers are responsible, as provided by
State law, for any personal injury, property damage, or death caused
by animals in their care, for pursuing animals that escape or stray, and for the
cost of recapture.
c)
Care Providers shall not transfer animals for
more than 30 days to another location or to the care of another individual
without the prior approval of Storey County or its representative;
d)
Care Providers shall make animals available for
routine physical inspection within 7 days of receipt of written request by
Storey County or its representative;
e)
Upon receipt by Storey County or its
representative any notice of failure to comply with the Terms of Maintenance and
Care Agreement or notice that a Prohibited act has been performed, no advance
notice is needed for access to inspect and/or repossess the horse(s);
f)
Care providers shall notify Storey County or
its representative within 7 days of discovery of an animal’s birth, death, theft
or escape;
g)
Care Providers shall notify Storey County or
its representative within 7 days of any change in the Care Providers address and
phone number;
h)
Care Providers shall dispose of remains in
accordance with applicable sanitation laws;
i)
Care Providers shall provide
animals with facilities which Storey County or its representative deems to be
suitable for the safe and humane enclosure and maintenance of estray ‘wild’
horses; and
j)
Pursuant to NRS 569.040 - .130, inclusive, and
to protect the property rights of any person who may prove prior ownership of
any transferred estray ‘wild’ horse to the satisfaction of the Nevada State
Department of Agriculture, title to any transferred estray ‘wild’ horse shall
not be issued to Care Provider until at least one year after the execution of
the Private Maintenance Agreement.
PROHIBITED
ACTS
The following are PROHIBITED
ACTS if committed on private land within Storey County, Nevada:
a)
Maliciously or negligently injuring or
harassing an estray ‘wild’ horse;
b)
Treating an estray ‘wild’ horse inhumanely;
c)
Removing or attempting to remove an estray
‘wild’ horse from private lands without authorization;
d)
Destroying an estray ‘wild’ horse without
authorization from the Storey County Sheriff’s Department, except as an act of
mercy;
e)
Selling or attempting to sell an estray ‘wild’
horse or its remains;
f)
Branding an estray ‘wild’ horse;
g)
Removing or altering a freeze mark or other
brand on an estray ‘wild’ horse;
h)
Commercially exploiting any estray ‘wild’
horse.
Failure
to comply with the TERMS OF MAINTENANCE AND CARE AGREEMENT or commission of any
of the PROHIBITED ACTS may result in the cancellation of this Agreement
immediate repossession of the animal, and disapproval of requests for transfer
of additional animals. Adoption fees are non-refundable.
TITLE
QUALIFICATIONS
Title
to the transferred estray ‘wild’ horse and/or any offspring will be issued to
the Care Provider if and when:
1)
No other person has claimed and proved, to the
satisfaction of the Nevada State Department of Agriculture, prior ownership of
the transferred estray ‘wild’ horse; and
2)
One year has passed since the transfer of the
estray ‘wild’ horse to the Care Provider; and
3)
Care Provider has submitted to Storey County or
its representative a written certification from a qualified individual attesting
to the best of his/her knowledge, that the transferred estray ‘wild’ horse is
receiving proper care.
NOTE:
Title to offspring whether taken as a PAIR or born during Care
Provider possession is subject to the above qualifications and will be provided
at the time title is provided to the mare of the foal.
NOTICE
Disclosure of the information is voluntary. If all the
information is not provided, your application cannot be processed. If your
driver’s license and Social Security number are identical, disclosure of the
driver’s license is voluntary. Failure to disclose your license number is this
case will not result in the disapproval of this Agreement.
