Not For Illegal Sale Print Name:__________________

Peace River Game Farm

I hereby state that these fowl(s) bought by me from a Mr. Brian Whidden, are not for use in any kind of illegal venture and I was told if they were, that they would not be sold.  These fowl are for Personal, Show, or Breeding purposes only, as stated by me.  Therefore, this sale and shipment of birds is not in violation of any Animal Welfare Acts or State Laws. 

Signed: ___________________________________

Name Printed: ______________________________

Address: __________________________________

__________________________________________

__________________________________________

__________________________________________

Phone: ______________________

Date: _______________________

This form must be filled out and sent to me for a sale to continue.

Brian Whidden

Peace River Game Farm

P.O. Box 511284

Punta Gorda, FL 33951-1284