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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

LOSS PREVENTION GRANT APPLICATION SUPPLEMENT

Livestock loss prevention projects conducted by an organization working on behalf of livestock producers require a representative from each ranch indicating their participation in the project.

Livestock Owner or Ranch Name Primary Contact (if different)

LIVESTOCK INFORMATION:

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.)

I attest that I am a livestock owner or ranch manager participating in a livestock loss prevention project conducted by ___

Signature: ___

When providing information to the board for qualification under this section, applicants are subject to the false swearing penalties established in 45-7-202. Any person who knowingly and willfully gives false information for the purpose of prevention grants as provided in this section is guilty of a misdemeanor, punishable by a fine not to exceed $5,000 or imprisonment in the county jail for a term not to exceed 1 year, or both.