If the sale is to be conducted by a Management Firm, provide the name and address of the Management Firm:
If a Management Firm is used, provide the names and addresses of the Officers and Directors of the Management Firm:
Directors and Officers (includes titles): Mailing address (include city, state and zip code):
Describe the arrangements made to provide for proper brand inspection requirements (include the Brand Inspector's name(s)):
Describe the arrangements made to meet the requirements related to Animal Health (include the name(s) of the Veterinarians who will be involved and a description of the testing facilities):
Estimated number of livestock to be consigned:
Total proceeds from the prior year's sale:
Estimated total proceeds from this year's sale:
Requirements at the time of application or to be provided to Dept of Livestock prior to the start of a sale:
✓ A List of all Consignors
✓ All Fees and Tariffs imposed on Consignors to the sale and a copy of the All Rules of the Sale including Breed Registration Requirements and Terms and Conditions.
✓ A Custodial Account held in a Montana domiciled bank
✓ If sale type is an Off-Premise Sale - A bond registered with USDA Packers & Stockyards Program (contact Vanette Stewart at (303) 375-4241 or by email: Vanette.L.Stewart@ams.usda.gov
✓ Upon request, if using a Management Firm, a copy of the current financial statement for the Management Firm.
I certify that the information contained in this application is, to the best of my knowledge, true and accurate.
I certify that the Entity applying for this Permit will abide by the applicable rules and statutes dealing with this sale.
RE: Off-Premise Sale: I certify that the livestock market named on this application will use its own selling on commission bond and its own custodial account, as listed in this application, in conducting this Off-Premise Sale.
Print Name & Title of Responsible Officer
Signature & Title of Responsible Officer and Date of signature
Mail application to: MT Dept of Livestock Attn: Dealer Licensing PO Box 202001 Helena, MT 59620-2001 For Dept of Livestock Use Only: Application received date: Application rec'd 60 days prior to sale date: Date permit is issued