Disposal Frozen Semen

ICSB –Kentucky Frozen Canine Semen Disposal Form
This form must be completed by the semen owner & co-owner(s) and submitted to ICSB- Kentucky before the frozen semen can be destroyed.
I herby authorize ICSB of Kentucky to dispose of semen stored in their facility on the following dog:
Registered Name of Dog
Call Name
Breed
AKC/or Reg.
Name
(Semen Owner)
Phone
Address
Street Address City State / Province / Region ZIP / Postal Code
Signature
(Semen Owner)
Date
If there are Co-Owner(s); signature(s) are required.
Signature
Date
Signature
Date

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