Wild Horse(s) Selection USDA Forest Service/Modoc National Forest 225 W 8th Street Alturas, CA 96101 (530) 233-5811 TTY (530) 233-8708 You may submit your form using e-mail or facsimile. E-mail: [email protected]Facsimile : 530-233-8709 Section A. Adopter/Purchase Information: How did you hear about this program? Today’s Date (mm/dd/yyyy) Last Name First Name Middle Initial L Name(s) of Person(s) transporting Horse(s) Trailer Description and Loading requests Pick-up Date 1 (mm/dd/yyyy) Request Horses to be Haltered Yes No Request Horses Neck Tag to be removed by Forest Service Yes No Request Health Certificate 2 Yes No Section B. Horse Information: Horse 1 Neck Tag Number Horse 1 Gender Male Female Horse 1 Color Horse 1 Markings Horse 1 Age Horse 1 Pen Number Horse 1 Adoption Purchase Horse 2 Neck Tag Number Horse 2 Gender Male Female Horse 2 Color Horse 2 Markings Horse 2 Age Horse 2 Pen Number Horse 2 Adoption Purchase Horse 3 Neck Tag Number Horse 3 Gender Male Female Horse 3 Color Horse 3 Markings Horse 3 Age Horse 3 Pen Number Horse 3 Adoption Purchase Horse 4 Neck Tag Number Horse 4 Gender Male Female Horse 4 Color Horse 4 Markings Horse 4 Age Horse 4 Pen Number Horse 4 Adoption Purchase Horse 5 Neck Tag Number Horse 5 Gender Male Female Horse 5 Color Horse 5 Markings Horse 5 Age Horse 5 Pen Number Horse 5 Adoption Purchase Section C. Forest Service Only Horse 1 Availability Confirmed Horse 1 Adoption Complete Horse 1 Purchase Complete Horse 2 Availability Confirmed Horse 2 Adoption Complete Horse 2 Purchase Complete Horse 3 Availability Confirmed Horse 3 Adoption Complete Horse 3 Purchase Complete Horse 4 Availability Confirmed Horse 4 Adoption Complete Horse 4 Purchase Complete Horse 5 Availability Confirmed Horse 5 Adoption Complete Horse 5 Purchase Complete Note 1: Horse(s) must be picked up within 30 days of the Completion of Bill of Sale and/or Care and Maintenance Agreement. Mare/Foal pairs will be released when foal is 4 weeks old, if traveling less than 2 hours; and 8 weeks old, if traveling more than 2 hours from Double Devil Wild Horse Corrals. Note 2: Adopter/Purchaser is responsible for obtaining the Health Certificate. It can be purchased from the Modoc Veterinary Center (530) 233-4156 for $55. Call in advance and the Forest Service can pick up if requested. Modoc FS-2260-003 (April 2020) File Code 2260 Retain 75 Years Forest Service Manual 2260 Continued on Page 2 Page 1
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Retain 75 yearsForest Service Manual 2260
Wild Horse(s) SelectionUSDA Forest Service/Modoc National Forest 225 W 8th Street Alturas, CA 96101 (530) 233-5811 TTY (530) 233-8708 You may submit your form using e-mail or facsimile. E-mail: [email protected] Facsimile : 530-233-8709
Section A. Adopter/Purchase Information:
How did you hear about this program? Today’s Date (mm/dd/yyyy)
Last Name First Name Middle Initial
LName(s) of Person(s) transporting Horse(s)
Trailer Description and Loading requests Pick-up Date 1 (mm/dd/yyyy)
Request Horses to beHaltered
Yes No Request Horses Neck Tag to be removed by Forest Service
Yes No Request Health Certificate2
Yes No
Section B. Horse Information: Horse 1 Neck Tag Number
Horse 1 Gender Male Female
Horse 1 Color
Horse 1 Markings
Horse 1 Age
Horse 1 Pen Number
Horse 1 Adoption P urchase
Horse 2 Neck Tag Number
Horse 2 Gender Male Female
Horse 2 Color
Horse 2 Markings
Horse 2 Age
Horse 2 Pen Number
Horse 2 Adoption Purchase
Horse 3 Neck Tag Number
Horse 3 Gender Male Female
Horse 3 Color
Horse 3 Markings
Horse 3 Age
Horse 3 Pen Number
Horse 3 Adoption Purchase
Horse 4 Neck Tag Number
Horse 4 Gender Male Female
Horse 4 Color
Horse 4 Markings
Horse 4 Age
Horse 4 Pen Number
Horse 4 Adoption Purchase
Horse 5 Neck Tag Number
Horse 5 Gender Male Female
Horse 5 Color
Horse 5 Markings
Horse 5 Age
Horse 5 Pen Number
Horse 5 Adoption Purchase
Section C. Forest Service Only
Horse 1 AvailabilityConfirmed
Horse 1 AdoptionComplete
Horse 1 Purchase Complete
Horse 2 AvailabilityConfirmed
Horse 2 AdoptionComplete
Horse 2 Purchase Complete
Horse 3 AvailabilityConfirmed
Horse 3 AdoptionComplete
Horse 3 Purchase Complete
Horse 4 AvailabilityConfirmed
Horse 4 AdoptionComplete
Horse 4 Purchase Complete
Horse 5 AvailabilityConfirmed
Horse 5 AdoptionComplete
Horse 5 Purchase Complete
Note 1: Horse(s) must be picked up within 30 days of the Completion of Bill of Sale and/or Care and Maintenance Agreement. Mare/Foal pairs will be released when foal is 4 weeks old, if traveling less than 2 hours; and 8 weeks old, if traveling more than 2 hours from Double Devil Wild Horse Corrals.
Note 2: Adopter/Purchaser is responsible for obtaining the Health Certificate. It can be purchased from the Modoc Veterinary Center (530) 233-4156 for $55. Call in advance and the Forest Service can pick up if requested.
Modoc FS-2260-003 (April 2020) File Code 2260 Retain 75 Years Forest Service Manual 2260