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LIVESTOCK LOSS BOARD PO BOX 202005 HELENA, MONTANA 59620-2001

BOARD OFFICE: (406) 444-5609 WEBSITE: www.llb.mt.gov EMAIL: LIVLossBoard@mt.gov

Review all grant requirements prior to completing this form.

Project Start Date: ___ Project End Date: ___

Please describe your project in detail. Attach additional sheets/documentation as needed:

Grant Amount: ___

(The Grant Amount cannot be more than 70% of Total Project Amount)

Grant Match Amount: ___

(Total from cash & in-kind services, below. Must be at least 30% of the Total Project Amount)

Total Project Amount:

___

(Cost of the entire project: Grant Amount + Grant Match Amount)

List cash and in-kind services in the boxes below (must be a minimum of 30% of the Total Project Amount). Cash Contribution:

Cash Source (list each name and amount individually for multiple cash sources) Amount

Amount

Total Cash Contributions:

In-Kind Services:

Labor type Description Hourly wage Total Hours Amount

Equipment Type Description Rental Rate Total Time Amount

Total In-Kind Services: Grant Match Amount: (Total Cash Contributions + Total In-Kind Services) $

County: Total acres:

Project Location: (Enter legal description(s) of property on which project will take place. Attach maps as needed)

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Please list the number and type of animals that will be protected by this project:

Species Number Description (breed, age, sex, commercial vs registered, etc.)

Which predator species have killed your livestock in the last 5 years?

Wolves Grizzlies Mountain Lions Black Bears

List depredations that were investigated by USDA-Wildlife Services:

Year # Losses Livestock Type Predator Comments

Please describe any unconfirmed losses or other impacts on your livestock caused by large predators:

Please describe any preventative practices that you currently utilize to reduce livestock losses caused by large predators:

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-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: ___

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:

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