Glendevon Stables
3480 Sam’s Creek Road, New Windsor, MD, 21776
ph: 301.706.4642, fax: 410.775.0262
email: info@glendevonstables.com
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Veterinary Certificate of Insemination and Pregnancy Examination

I, THE UNDERSIGNED veterinarian, duly licensed in the state/province of_________________ and holding current license #________________, do hereby attest that at the following time(s) on the following dates(s) I artificially inseminated the __ year old, _____________________(description) mare named ____________________________ and owned by____________________________, with the (fresh cooled / frozen) semen labeled as being from the stallion GLENDEVON’S MOUNTAIN MAN.

SAID INSEMINATIONS WERE carried out in accordance with standard veterinary practices, and in accordance with the instructions supplied with the semen. I also certify that I examined this same mare for pregnancy on the following date(s), and have correctly indicated the results of these examinations.

I FURTHER CERTIFY that no other mare was inseminated with the semen designated for this mare, and that any excess was properly destroyed.

DATE and TIME of Insemination 
 
Approximate % Progressive Motility of properly warmed semen
 








Date of Pregnancy Exam
 

Results (Twin check? fluid, tone, size, etc.)
 







WITNESS MY SIGNATURE, under the pains and penalties of perjury, this ______ day in the month of________________________, in the year________.
 

Veterinarian Signature: ______________________________________________________
Print Name/Practice: ______________________________________________________
Address/Phone: ______________________________________________________