===== PAGE 1 =====
# AFFIDAVIT OF CHANGE OF NAME

STATE OF MONTANA

COUNTY OF ___

RETURN TO: MONTANA DEPARTMENT OF LIVESTOCK

PO BOX 202001

HELENA, MT 59620-2001

___, BEING FIRST DULY SWORN, DEPOSES AND SAYS; THAT (HIS) (HER) MAILING ADDRESS IS: ___

COUNTY OF ___, STATE OF MONTANA;

AND THAT _____ AND ___

ARE ONE AND THE SAME PERSON.

THIS AFFIDAVIT IS SUBMITTED ON ORDER THAT THE RECORDS OF THE RECORDER OF MARKS AND BRANDS OF THE STATE OF MONTANA MAY BE CORRECTED AND A DUPLICATE CERTIFICATE ISSUED AS EVIDENCE THEREOF.


<table border=1 style='margin: auto; word-wrap: break-word;'><tr><td rowspan="4">DRAW BRAND HERE</td><td rowspan="4"></td><td style='text-align: center; word-wrap: break-word;'>POSITION ON CATTLE</td><td style='text-align: center; word-wrap: break-word;'></td></tr><tr><td style='text-align: center; word-wrap: break-word;'>POSITION ON HORSES</td><td style='text-align: center; word-wrap: break-word;'></td></tr><tr><td style='text-align: center; word-wrap: break-word;'>POSITION ON SHEEP</td><td style='text-align: center; word-wrap: break-word;'>PAINT COLOR</td></tr><tr><td style='text-align: center; word-wrap: break-word;'>POSITION ON OTHER (SPECIFY)</td><td style='text-align: center; word-wrap: break-word;'></td></tr></table>

SIGN PRESENT NAME: ___

___

DATE: ___

STATE OF MONTANA COUNTY OF ___ SIGNED BEFORE ME ON ___ BY ___

SIGNATURE OF NOTARY ___

MONTANA NOTARIES MUST COMPLETE THE FOLLOWING IF NOT PART OF STAMP AT LEFT:

PRINTED NAME OF NOTARY ___

NOTARY PUBLIC FOR THE STATE OF ___

RESIDING AT___

(AFFIX NOTARIAL SEAL/STAMP ABOVE)

MY COMMISSION EXPIRES ___ - 20