Faith Livestock Commission Company

P O Box 397 – Faith, SD  57626

Phone-605-967-2200      Fax-605/967-2203


Owner’s Name: _____________________________ Sale Date: _________________

The following procedures have been done on the following livestock by the owner.


Spring Shots:                ______________________________________________


Month Given: ____     ______________________________________________


Fall Shots:                   _______________________________________________


Month Given: ____    _______________________________________________


Type of pour on: _____________________ Type of Castration: ____________


Spring Implants: _____________________ Fall Implants: ________________


Brand: ______________________Location_____________________________



Birth Period: _______________________ through _______________________


Calves are home raised YES  NO If NO, Length of ownership ______days


Details: ________________________________________________________________




As an affidavit is deemed by USDA as an official record of Country of Origin, I attest through first-hand knowledge, normal business records, or producer affidavit(s) that all livestock referenced by this document or other communications specific to the transaction and transferred are of United States origin.  Should the origin of my livestock become other than that described above, I agree to notify Faith Livestock when this occurs.


This affidavit/declaration shall remain in effect until revoked in writing by the undersigned and is delivered to Faith Livestock.


I certify that the information provided on this form is correct.  I agree to indemnify the above named market against any and all claims, losses, cost and expenses including reasonable attorney’s fees that arise out of or relate to this certification.



____________________________    _________    ____________________________

      Signature                              Date                                 Ranch Name