4-H MEMBER'S NAME  (Please Print): ____________________________________

ST. JOSEPH COUNTY FAIR 4-H ANIMAL AFFIDAVIT (1)

CHECK ONE SPECIE:

                          _____BEEF    _____DAIRY    _____DAIRY BEEF    _____GOAT    _____HORSE

                                                    _____POULTRY    _____RABBIT    _____SHEEP    _____SWINE

I hereby certify that:

1.    My 4-H animal has been in my continuous ownership since the date printed on the respective 4-H 

enrollment Form; (except for Poultry and Rabbits, which do not have such a form).

2.    The exhibitor and the exhibitor's parents and/or legal guardians agree that they are the people absolutely 

responsible for the care and custody of their animals in preparation for and while at the St. Joseph County 4-H 

Fair; including, but not limited to, policies regarding drug use and animal well being.

3.    I am responsible for: adhering to withdrawal times on all drugs administered to my animal, only giving 

my animal drugs that are approved by the FDA, and keeping my animal free of illegal drugs prior to and 

during the St. Joseph County 4-H Fair.

4.    My 4-H animal had not been maintained at a professional fitter's facilities:

5.    My submission of a 4-H entry expressly binds me to all terms and conditions contained in any and all parts 

of the St. Joseph County 4-H Handbook, to include, but not limited to, consent to drug, steroid, tissue tests,

examination of my animal's carcass and insertion of a micro chip for identification as a condition of entering 

the St. Joseph County 4-H Fair.

Violation of Indiana Health Requirements for the exhibition of domestic animals,   is punishable under Indiana Law. (Code 15-2.1-21-9) (2)

 I swear or affirm under the penalties of perjury (3) (4) that I have read, understand, and accept the above                 statements to be true accurate, and complete.

_______________________________________                _______________________________________   Parent/Guardian Signature                                Date                                4-H Exhibitor Signature                                       Date

OATH  (5)                                                                                                                                                     Before me, _________________________________a Notary Public in and for ____________________County,
State of Indiana, personally appeared ____________________________and he being first duly sworn by me upon his oath,
says that the facts alleged in the forgoing instrument are true.

(Signed) _________________________________________     My commission expires: ___________________________

Print your name __________________________________    County in which you reside: _________________________

(SEAL)                                                                                                                                                         1.    Affidavit - a written statement of fact which is sworn to as the truth before an authorized officer.
2.    (code15-2.1-21.9) - A person who knowingly or intentionally violates or fails to comply with this article commits a Class D Felony. (6)
3.    Perjury - knowingly making a false material statement under oath or affirmation.  In Indiana, a person who commits perjury
       commits a Class D felony (6), which may be punishable by imprisonment, fine or restitution.  (Indiana Code 35-44-2-1 and 35-50-2-7)
4.    Prosecution for violation of truth of a statement before an authorized person.
5.    Oath - An affirmation of truth of a statement before an authorized person. 
6.    Felony - A crime of graver or more serious nature than those designated as misdemeanors.

(A)    My Animals listed below have not received any drug(s), steroids(s) or other
medication(s) within the past 30 days:

(B) Below is a complete list of all drug(s), steroid(s), and/or medication(s) given to each of
my animals listed within the past 30 days: