===== PAGE 1 ===== # 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 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.
DRAW BRAND HEREPOSITION ON CATTLE:
POSITION ON HORSES:
POSITION ON SHEEP & PAINT COLOR:
POSITION ON OTHER (SPECIFY):
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: ___ 1/2
SEAL
NOTARY SIGNATURE: DATE: