Basenji Club of America - Application for Submitting Native Stock - 24 January 2019 Page 1

Application for

Submitting Native Stock

Dog’s name Goldie du Congo .

Owner(s) Ethel Blair, Louise Marsden, Jon Curby . Date imported 8th March 2018 USA_Proof of Origin must be provided with application (See Attached photo) Importer(s) Ethel Blair & Louise Marsden . Actual area imported from (area found in Africa) Nadogolo Village 4kms south Dungu (3.580, 28.556) . Dam (if known) Color Red & White . Age at this time As at 24th January 2019 age: 1 year and 3 months Weight 24.3 Lbs .

Height (ground to top of shoulder) 17 ¾ ins Length (sternum to rear extension of hip): 18 ins .

Provide Photographs: The required 3 photographs must be in color and show full body (from ears to feet): 1) front

on, 2) left side and 3) right side. Size: 8” X 10”. These are the photos as required by AKC and they will be used

when the dogs are to be registered.

Optional photos: up to 4 additional photos and an optional short video of the dog. The video will only appear on

the BCOA website.

Note: A short description of dog is to be attached to this application or be on the reverse of this page (See Attached) Health Testing: Dog must be permanently identified by tattoo or microchip.

Give tattoo or chip number 982 000 357 366 805 .

Health Testing Results Completed (HA and Fanconi required – more tests will help in decisions):

CERF Normal OFA hips Good OFA patella Normal PRA DNA_Clear / Normal__

Fanconi direct DNA test Clear /Normal HA test Clear Thyroid test Normal

Has dog produced puppies Yes No Mated with .

Number of puppies born If more litters repeat this section on reverse or additional page to include all offspring. Enclose pictures of mate and all offspring. Photos must be at least one clear side view of entire dog. Contact

information for person making this application:

Name Ethel Blair c/o Jon Curby . Address 1201 South Rustic Road, Columbia Missouri 65201 . Email jcurby@offa.org / ethel.Blair@gmail.com Telephone: 5734248691

. AKC Basenji Judge Evaluator Marianne Klinkowski . AKC Basenji Breeder Judge Evaluator Terri Lyddon . Basenji Breeder Evaluator Karen Parmer Hutchinson . Fee of $50 made payable to BCOA. Mail application, required 3 photos and fee to: Pam Geoffroy, 197 Mt. Hope St, North Attleboro, MA 02760. Fee is not refundable. This form is due by March 1. If your dog fails to get a rating of Fair or above you will have one chance to reapply and pay an additional fee of

$50.

Basenji Club of America - Application for Submitting Native Stock - 24 January 2019 Page 2

Description – Goldie Du CongoImported March 8, 2018

Description accompanying BCOA Application For Submitting Native Stock

Goldie was located February 2018 in Democratic Republic of Congo 4kms south of Dungu in Nadogolo

Village. At that time I met her, she was a young puppy living in a typical Congolese settlement.

Goldie is a female Basenji with a red coat, white on her chest and legs, a small white collar, and white

markings on her face. Her coat is short and close to the skin, with a bit more length around the withers.

Goldie has fine wrinkle, her eyes are almond shaped with a lighter eye colour, she has a black nose, hooded

ears and her head and muzzle are nicely proportioned. Her feet are small and compact.

Goldie carries her tail in an open curl over her back, or she will hold it high in the air or will drop it

sometimes. Also it appears that she has had an injury in the middle of her tail, which has left a thickening of

the bone.

Goldie is a taller girl with a lovely crest of neck, and her forelegs are elegant and of good length with fine

bone. She presents an effortless gait with a level top line.

Goldie is very independent and stubborn, but friendly, and she exhibits typical Basenji personality traits.

Basenji Club of America - Application for Submitting Native Stock - 24 January 2019 Page 3

VetGen DNA Analysis Report 3278 Plaza Drive Suite One Ann Arbor MI 48108 USA

vetgen@vetgen.com 800-483-8436 US & Canada

Vetgen ID 40917

Animal Name

Registration

Breed

Goldie du Congo

982 000 357 366 805

Basenji Gender F Date of Birth 10/20/2017

Color-Coat Not Provided NoseNot Provided

Jon Curby Ethel Blair, Louise Marsden 1201 South Rustic Road Columbia, MO 65201 USA

DISEASE TEST RESULTS

Report Number Report Date Test Results

143527 11/2/2018 Pyruvic Kinase Deficiency Clear

This DNA testing is for the mutation typically found to cause the disease in this breed.

Date 11/02/2018 Findings reviewed and approved by: Dr. George J. Brewer

Within twenty (20) calendar days after receipt of these test results, Customer must notify VetGen in writing of any nonconformity of the testing

services, describing the nonconformity in detail, otherwise all testing services and data shall be deemed as accepted by Customer without

qualification. Customer’s sole and exclusive remedy under VetGen’s limited warranty shall be to re-perform the testing at no cost and/or to

provide Customer with a full refund for the purchase price of the test. The entire VetGen, LLC Terms and Conditions may be viewed online at

http://www.vetgen.com/about-business.html.

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