I,____________________________________, hereby donate to Appalachian Mountain Border Collie

Rescue the dog known as _________________________________.

Age of Dog (estimate if unknown) ___________

Description:________________________________

Male_____ Female _______ Spayed/Neutered? ________________

I hereby turn over full ownership and responsibility as of this date:

____________________, 200 _____.

I understand that with this instrument the dog becomes the property of Appalachian Mountain Border Collie Rescue . I understand that the AMBCR has complete responsibility for finding the appropriate new home for the dog and that I may not be made aware of the arrangements that are made for the placement of the dog in a new home.

I am donating $_________________ towards the placement of my dog.

____________________________________

Witness

____________________________________

Witness

____________________________________

Signature of Owner

Address:

____________________________________

____________________________________

____________________________________

Telephone:

____________________________________

Appalachian Mountain Border Collie Rescue