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<table border=1 style='margin: auto; word-wrap: break-word;'><tr><td style='text-align: center; word-wrap: break-word;'>DATE\nwww.liv.mt.gov</td><td colspan="3">DEPARTMENT OF LIVESTOCK\nBRANDS ENFORCEMENT DIVISION\nAPPLICATION FOR ORNAMENTAL BRAND\n(PLEASE PRINT)</td><td style='text-align: center; word-wrap: break-word;'>OFFICE USE ONLY\nCHECK/MO:\nAMOUNT REC&#x27;D\nTRANSMITTAL #</td></tr><tr><td colspan="5">Name of Brand Owner(s)*:</td></tr><tr><td colspan="3">MAILING ADDRESS:</td><td colspan="2">PHONE NUMBER(S) <img src="imgs/img_in_image_box_1919_594_2082_725.jpg" alt="Image"" /> ______</td></tr><tr><td rowspan="2" colspan="2">CHOICE OF BRAND:\n(list additional choices on Page 2)</td><td style='text-align: center; word-wrap: break-word;'>1ST</td><td style='text-align: center; word-wrap: break-word;'>2ND</td><td style='text-align: center; word-wrap: break-word;'>3RD</td></tr><tr><td style='text-align: center; word-wrap: break-word;'><img src="imgs/img_in_image_box_693_761_1150_1191.jpg" alt="Image"" /></td><td style='text-align: center; word-wrap: break-word;'><img src="imgs/img_in_image_box_1272_758_1742_1200.jpg" alt="Image"" /></td><td style='text-align: center; word-wrap: break-word;'><img src="imgs/img_in_image_box_1856_751_2285_1197.jpg" alt="Image"" /></td></tr><tr><td colspan="5">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. \n Application of this Ornamental Brand to any type of livestock or game farm animals is strictly prohibited.</td></tr><tr><td colspan="5">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.</td></tr><tr><td colspan="5">Applicant&#x27;s Signature (required): ______ Date ______</td></tr><tr><td colspan="5">Subscribed and Sworn to before me this ______ day of ______ 20 ______</td></tr><tr><td colspan="5">Notary Public for the State of ______</td></tr><tr><td colspan="5">THE FEE TO RECORD A BRAND IS 200; HALF OF THIS FEE (100) IS NON-REFUNDABLE.</td></tr><tr><td colspan="3">Mail to: Montana Department of Livestock Brands Recorder PO Box 202001 Helena, MT 59620-2001</td><td colspan="2">OFFICE USE ONLY BRAND NUMBER ______ OWNER NUMBER ______</td></tr></table>