CITY                                                           STATE        ZIP                       CITY                                             STATE      ZIP

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DRIVERS LICENSE NO.                                            STATE

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________________________________                                         AUTHORIZATION BY PROPERTY OWNER GRANTING

E-MAIL ADDRESS                                                                          PERMISSION TO BOARD AN ESTRAY HORSE;

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NUMBER OF "WILD" HORSES REQUESTED: _________           PROPERTY OWNER NAME

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                                                                                                       TELEPHONE (include area code)

                                                                                                       _____________________________       ___________

                                                                                                       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

 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