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 Owner or Ranch Name
Primary Contact (if different
Address
Phone
City
State
Zip

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.)

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 ___

Name of Organization

Signature: ___

Signature
Date

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.