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* 1. What is your dog's name?

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* 2. Approximate date of birth

Approximate date of birth:

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* 3. Date of death:

Date of death:

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* 4. Sire’s name:

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* 5. Dam’s name:

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* 6. Age at death:

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* 7. Sex:

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* 8. Mask Color:

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* 9. Has this dog ever produced puppies? If so, approximately how many?

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* 10. Cause of Death:

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