<p> 2016 PENNSYLVANIA SIRE STAKES SUSTAINING PAYMENT FORM NOTE: PAYMENT TO P/M SIRE STAKES INCLUDES ELIGIBILITY TO STALLION SERIES</p><p>2 YR OLD 3 YR OLD ST ** 1 PAYMENT – MARCH 15, 2016 FINAL PAYMENT – MARCH 15, 2016 $150 Pari Mutuel division $500 Pari Mutuel division $ 25 Fair division FINAL PAYMENT – MAY 15, 2016 ND 2 PAYMENT – MAY 15, 2016 $100 Fair division $400 Pari Mutuel division $ 50 Fair division **Horses who make the March 15 payment(s) at 2 retain their eligibility to 3-year-old events even if not **Not making the March 15 2 yr old payment(s) causes making the 2YO May 15 payments, although they are automatic elimination from this stake at 2 & 3. then ineligible at 2 with no 2YO 5-15 payment(s).</p><p>OWNER/AGENT INFORMATION Name(s): Address: City: State: Zip Code: Telephone No: Email: HORSE INFORMATION (Please enter the horse’s previous name if there has been a name change.)</p><p>Name: Previous Name:</p><p>Reg. No: A Foal of (yr): </p><p>Gait (please circle): PACE TROT Sex (please circle): COLT FILLY GELDING</p><p>Sire: Dam: PAYMENT INFORMATION PARI MUTUEL DIVISION FAIR DIVISION □ Two year old 1st sustaining payment - $150 □ Two year old 1st sustaining payment - $25 □ Two year old 2nd sustaining payment - $400 □ Two year old 2nd sustaining payment - $50 □ Three year old sustaining payment - $500 □ Three year old sustaining payment - $100</p><p>All payments must be made in U.S. FUNDS.</p><p>Please note: Mail must be postmarked by the 15th of the payment month to be eligible for the program. Owners of stakes horses are ultimately responsible for timely payments.</p><p>MAKE CHECK PAYABLE TO: PENNSYLVANIA SIRE STAKES MAIL TO: PENNSYLVANIA SIRE STAKES FUND 2301 N. CAMERON ST. ROOM 301 HARRISBURG PA 17110 If you have any questions, please call 1-866-Win In PA/1-866-946-4672.</p><p>NO FURTHER NOTICES WILL BE SENT – CERTIFIED MAIL IS SUGGESTED</p><p> www.agriculture.state.pa.us</p>