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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
Continued on Page 2
Page 1
Retain 75 yearsForest Service Manual 2260
Section B2. Horse Information:
Horse 6 Neck Tag Number
Horse 6 Gender Male Female
Horse 6 Color
Horse 6 Markings
Horse 6 Age
Horse 6 Pen Number
Horse 6 Adoption Purchase
Horse 7 Neck Tag Number
Horse 7 Gender Male Female
Horse 7 Color
Horse 7 Markings
Horse 7 Age
Horse 7 Pen Number
Horse 7 Adoption Purchase
Horse 8 Neck Tag Number
Horse 8 Gender Male Female
Horse 8 Color
Horse 8 Markings
Horse 8 Age
Horse 8 Pen Number
Horse 8 Adoption Purchase
Horse 9 Neck Tag Number
Horse 9 Gender Male
Horse 9 Color
Horse 9 Markings
Horse 9 Age
Horse 9 Pen Number
Horse 9 Adoption Purchase
Horse 10 Neck Tag Number
Horse 10 Gender Female Male Female
Horse 10 Color
Horse 10 Markings
Horse 10 Age
Horse 10 Pen Number
Horse 10 Adoption Purchase
Section C.2. Forest Service Only
Horse 6 AvailabilityConfirmed
Horse 6 AdoptionComplete
Horse 6 Purchase Complete
Horse 7 AvailabilityConfirmed
Horse 7 AdoptionComplete
Horse 7 Purchase Complete
Horse 8 AvailabilityConfirmed
Horse 8 AdoptionComplete
Horse 8 Purchase Complete
Horse 9 AvailabilityConfirmed
Horse 9 AdoptionComplete
Horse 9 Purchase Complete
Horse 10 AvailabilityConfirmed
Horse 10 AdoptionComplete
Horse 10 Purchase Complete
Comments
Sorting Complete and Tag Numbers Verified Loading Complete and Tag Numbers Verified
Forest Service Approving Official Printed Name Forest Service Approving Official Title
Forest Service Approving Official Signature Date Approving Official Signed (dd/mm/YYYY)
Modoc FS-2260-003 (April 2020) File Code 2260 Retain 75 Years Forest Service Manual 2260
Continued on Page 3
Page 2
Adopter/Purchaser Information carried over from page 1.
Retain 75 yearsForest Service Manual 2260
Section B.3. Horse Information:
Horse 11 Neck Tag Number
Horse 11 Gender Male Female
Horse 11 Color
Horse 11 Markings
Horse 11 Age
Horse 11 Pen Number
Horse 11 Adoption Purchase
Horse 12 Neck Tag Number
Horse 12 Gender Male Female
Horse 12 Color
Horse 12 Markings
Horse 12 Age
Horse 12 Pen Number
Horse 12 Adoption Purchase
Horse 13 Neck Tag Number
Horse 13 Gender Male Female
Horse 13 Color
Horse 13 Markings
Horse 13 Age
Horse 13 Pen Number
Horse 13 Adoption Purchase
Horse 14 Neck Tag Number
Horse 14 Gender Male Female
Horse 14 Color
Horse 14 Markings
Horse 14 Age
Horse 14 Pen Number
Horse 14 Adoption Purchase
Horse 15 Neck Tag Number
Horse 15 Gender Male Female
Horse 15 Color
Horse 15 Markings
Horse 15 Age
Horse 15 Pen Number
Horse 15 Adoption Purchase
Section C.3 Forest Service Only
Horse 11 Availability Confirmed
Horse 11 AdoptionComplete
Horse 11 Purchase Complete
Horse 12 Availability Confirmed
Horse 12 AdoptionComplete
Horse 12 Purchase Complete
Horse 13 Availability Confirmed
Horse 13 AdoptionComplete
Horse 13 Purchase Complete
Horse 14 Availability Confirmed
Horse 14 AdoptionComplete
Horse 14 Purchase Complete
Horse 15 Availability Confirmed
Horse 15 AdoptionComplete
Horse 15 Purchase Complete
Comments
Sorting Complete and Tag Numbers Verified Loading Complete and Tag Numbers Verified
Forest Service Approving Official Printed Name Forest Service Approving Official Title
Forest Service Approving Official Signature Date Approving Official Signed (dd/mm/YYYY)
Modoc FS-2260-003 (April 2020) File Code 2260 Retain 75 Years
Forest Service Manual 2260 Page 3
Adopter/Purchaser Information carried over from page 1.
