PO BOX 202001 HELENA MT 59620-2001 OFFICE: (406) 444-9762 Or: (406) 444-2045 https://liv.mt.gov

Please complete application by printing clearly or typing information. See page 3 for important information regarding livestock sale permits.

Type of Sale Permit being applied for:

O Test Station Sale

Association Sale

Off-Premise Sale

Name of Person / Group / Entity / Livestock Market applying for Permit:

Mailing address (complete – include city, state and zip code):

Physical address (if different from mailing address):

Telephone number (including area code): Email address (required so that you can be contacted quickly if necessary):

Not required for an Off-Premise Sale If Entity or Group is an Association or Corporation, list the Names and Addresses of the Directors and Officers: Mailing address (include city, state and zip code):

Directors and Officers (includes titles):

Sale Name:

Sale Date or Dates: Location of sale (include street address):

Nature of Sale (include types and breeds of livestock to be sold):

Is this an Annual Sale (yes or no)?:

If yes, how many years has the sale been conducted / held?:

Name and address of the Clerk of Sale:

Name and address of Montana domiciled bank where the Custodial Account is established: