PREVIOUS GRANT AWARDS

If you have received a grant from the LLB in the past, what was the money used for?

Please list each year you were awarded a grant(s): ___

If this is a continuation of a previous grant, explain your success/failures from previous grant award(s):

APPLICANT SIGNATURE

Applicant-Grantee assumes sole responsibility for all claims, liabilities, demands, causes of action, judgments, and losses arising in favor of or asserted by Applicant-Grantee's employees and agents, its subcontractors, its subcontractor's employees and agents, or third parties on account of property damage, personal injury, bodily injury, death, or financial or other loss of any kind that in any way, directly or indirectly, in whole or in part, arise or allegedly arise out of or in connection with any loss prevention grant it is awarded.

The State of Montana, its elected and appointed officials, agents, and employees (including, but not limited to, the Montana Department of Livestock, Montana Board of Livestock, and the Livestock Loss Board and Program) assume no responsibility for any claims, liabilities, demands, causes of action, judgments, and losses arising in favor of or asserted by Applicant-Grantee's employees and agents, its subcontractors, its subcontractor's employees and agents, or third parties on account of property damage, personal injury, bodily injury, death, or financial or other loss of any kind that in any way, directly or indirectly, in whole or in part, arise or allegedly arise out of or in connection with any loss prevention grant it awards to Applicant-Grantee.

Applicant Signature: ___ Date: ___

SUBMISSION INFORMATION

2023

Applications are due November 4, 2026. Late applications may be considered if time allows. The Livestock Loss Board will meet on December 9, 2026, to award grants.

BEFORE SUBMITTING THIS APPLICATION, ENSURE YOU HAVE INCLUDED ALL MATERIALS:

• ○ApplicaƟon Form

• ○Maps (if used)

• ○W-9

• ○AddiƟonal supplemental documentaƟon (if used)

• ○Grant Supplement (if required) Total number of pages submitted with this application: ______ Submit your application and any supplemental documentation: Email: LIVLossBoard@mt.gov

• ○Grant Supplement (if required)

Total number of pages submitted with this application: ___

Submit your application and any supplemental documentation:

Email: LIVLossBoard@mt.gov ~ OR ~ Mail: Livestock Loss Board PO Box 202001 Helena, MT 59620-2001

Questions? Call Leslie Doely (406) 465-9319