DEPARTMENT OF LIVESTOCK BRANDS ENFORCEMENT DIVISION AFFIDAVIT OF PRINCIPAL

Do you own livestock in Montana? If so, you are required to pay a PER CAPITA FEE. Visit www.liv.mt.gov for more information. RETURN FORM TO: MT DEPT OF LIVESTOCK ATTN: BRAND RECORDER PO BOX 202001 HELENA, MT. 59620-2001

RETURN FORM TO: MT DEPT OF LIVESTOCK ATTN: BRAND RECORDER PO BOX 202001 HELENA, MT. 59620-2001

STATE OF ___

COUNTY OF ___

BEING FIRST DULY SWORN, DEPOSES AND SAYS:

(PRINTED NAME OF PRINCIPAL/OFFICER)

THAT (HE, SHE) IS THE ___ OF

(TITLE OF PRINCIPAL-President, Director, etc.)

(NAME OF BUSINESS/COMPANY)

AND HAS THE LEGAL AUTHORITY TO TRANSFER THE BRAND, ON BEHALF OF THE BUSINESS, AS DESCRIBED ON THIS FORM.

POSITION ON CATTLE:

POSITION ON HORSES:

POSITION ON SHEEP & PAINT COLOR:

POSITION ON OTHER (SPECIFY):

DRAW BRAND HERE

IN MY CAPACITY AS THE ___ OF (TITLE OF PRINCIPAL-President, Director, etc.)

(NAME OF BUSINESS/COMPANY)

I APPLIED MY SIGNATURE TO THE ASSIGNMENT OF BRAND FORM.

SIGNATURE OF PRINCIPAL: ___

DATE: ___

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SEAL

NOTARY SIGNATURE: DATE: