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DEPARTMENT OF LIVESTOCK BRANDS ENFORCEMENT DIVISION MONTANA LIVESTOCK DEALER LICENSE APPLICATION FOR ADDITIONAL AGENT

PO BOX 202001 ATTN: Livestock Dealer Licensing HELENA, MT. 59620-2001 OFFICE: (406) 444-9762 WEBSITE: www.liv.mt.gov

Fee to add additional agent(s) to your MT Livestock Dealer License is $250 per agent being added. Please include fee when sending application for additional agent(s).

Applicant: Please print or type

4. City	5. State	6. Zip
1. Name of Entity (individual or firm)
2. Mailing Address		3. Street Address (if different from mailing address)
9. Email Address		10. Dealers License Number (if available)
To The Department of Livestock Brands Enforcement Division Administrator:
I hereby state that I am fully aware and I do willingly accept full responsibility for all transactions, financial or otherwise, made or entered into, by the following person(s) while acting as an agent for me. I will inform the following agents listed below that they will conduct all transactions under the name of the Entity to be licensed as listed on page 1, part 1. Furthermore, I will send all required information to the Packers & Stockyards Administration (at the times required by Packers & Stockyards) concerning the activities of all agents so that the bond amount for the entity (as listed on page1, part 1) can be determined correctly.
Livestock Dealer Agents: A $250 licensing fee is required for each Livestock Dealer Agent and must be mailed with this form. Please print clearly
Name of Agent(s) being Added	Mailing Address & Phone Number




Printed Name of Licensed Dealer:
Signature:
Date: