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DATE www.liv.mt.gov DEPARTMENT OF LIVESTOCK BRANDS ENFORCEMENT DIVISION APPLICATION FOR ORNAMENTAL BRAND (PLEASE PRINT) OFFICE USE ONLY CHECK/MO: AMOUNT REC'D TRANSMITTAL #

DATE

CHECK/MO

AMOUNT REC’D

TRANSMITTAL

Name of Brand Owner(s)*:

Name of Brand Owner(s

MAILING ADDRESS: PHONE NUMBER(S) ______

MAILING ADDRESS

PHONE NUMBER(S [1]

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PHONE NUMBER(S [2]

CHOICE OF BRAND: (list additional choices on Page 2) 1ST 2ND 3RD

The undersigned agree and fully understand that the issuance of this Ornamental Brand by the Recorder of Marks and Brands, State of Montana, Department of Livestock is for decorative purposes only. Application of this Ornamental Brand to any type of livestock or game farm animals is strictly prohibited.

The statements herein are made in full knowledge of the provisions of Sec. 45-7-203 (MCA) which makes it a criminal offense to make a willingly false statement or misrepresentation, to any Department or Agency of the State of Montana, as to any matter within its jurisdiction.

Applicant’s Signature (required

Date

Subscribed and Sworn to before me this

day of [1]

day of [2]

Subscribed and Sworn to before me this ______ day of ______ 20 ______

Notary Public for the State of

THE FEE TO RECORD A BRAND IS 200; HALF OF THIS FEE (100) IS NON-REFUNDABLE.

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OFFICE USE ONLY BRAND NUMBER OWNER NUMBER

Mail to: Montana Department of Livestock Brands Recorder PO Box 202001 Helena, MT 59620-2001 OFFICE USE ONLY BRAND NUMBER ______ OWNER NUMBER ______