Heritage Decker Terrier Registry

   Limited Registration                     NBT 

 HDTR Litter reg#:   

   Dog's Name:   

 Date:       

   Breed:   DECKER TERRIER

Birthdate:          

   Color:         Black/white/tan 162 White/Black/Tan Black/Tan Black/white 163 Red/white 164 Sable/White 165 Red Sable/White Tan sable/white 166 Apricot/lemon/white 167

Markings:        Blanket-back 064 Tuxedo 065 Piebald 067 Saddle Back 063 Calico 066 Irish Marked

Breeder:   

Sire:

HDTR#

Dam:

HDTR#

New Registrant:

New Co-Registrant

Address: 

Address: 

City: State:       Zip:

City: State: Zip:

Phone:                     Cell:

Phone:                       Cell:

Signature:___________________________________

Signature:_________________________________

      Registration Certificate  w/3 generation Pedigree:   $20.00

 Puppy Certificate no pedigree/Limited Registration  $15.00

This form is to be filled out by litter owner and a copy given to each client and or submitted by litter owner. 
One box MUST be checked
I (we) still own this dog, apply to register it and have ownership recorded in my (our) name(s) 
I (we) transferred this dog directly to the above named registrant on Date   mm/dd/yyyy

Signed litter owner  __________________________________________. 
I certify that I am in good standing with the HDTR

   Mail Check/Money order payable to:  Heritage Decker Terrier Registry  28 BriarBey Ln.  Fleming, Ohio 45729

                                                    740-336-8034