This form must be filed with the LAHSA office within 30 days of the date of the point publication in question, in order for the discrepancy to be considered and investigated.
VERBAL DISCREPANCIES WILL NOT BE ACCEPTED.

Rider Name: __________________________________LAHSA # ___________

Owner Name: _________________________________LAHSA # ___________

Horse Name: _____________________________Phone # ________________

Address: ________________________________________________________________

Name and Date(s) of Show(s) in question: ________________________________________________________________

________________________________________________________________

Full Description of the discrepancy: _________________________________

Signature: ______________________________________ Date: ___________