DEPARTMENT OF LIVESTOCK

PO BOX 202001 HELENA MT 59620-2001 OFFICE: (406) 444-9762 Or: (406) 444-2045 https://liv.mt.gov

Please complete application by printing clearly or typing information Application Fee: Dealer license fees are $50 for first-time dealers and $50 for each additional buyer. Application fee must be submitted with application.

Name of Entity to be Licensed (individual or firm):

Mailing address (complete – include city, state and zip code):

Physical address (if different from mailing address):

Telephone number (including area code): Email address (required so that you can be contacted quickly if necessary):

You must be registered with USDA before applying for a MT Livestock Dealer License. Are you currently registered with the USDA – Grain Inspection, Packers & Stockyards (USDA-GIPSA)? Yes No

Species of Livestock Handled (circle all that apply): Cattle Horses and Mules Sheep and Goats Swine

Type of Organization (Circle the appropriate type): Individual Corporation Partnership Association Other (specify):

If Entity is a corporation or Association, Designate State of Incorporation and Date Incorporated:

Owners, Partners, or Offices (Name and Title) Mailing Address

Principal Place of Business Activity – Stockyard(s), Auction Markets, Other:

If Licensed Previously, Name in which the License was Issued Under

Livestock Dealer's Accounting Period Calendar Year: ________ Fiscal Year: ________ to ________ Name of Bank Where Business Accounts are Held: __________ Officer: ________ City: ________ State: ________ Zip: ________

• I understand that as a livestock dealer, I shall maintain records that disclose all purchases and sales of livestock. I understand that as a livestock dealer, I shall, at all reasonable times, give the department access to and let the department copy any of the records relating to my business, as provided by Sec. 81-8-278(MCA). • The statements in this Montana Livestock Dealer License Application are made in full knowledge of the provisions of Sec. 45-7-203(MCA) which make it a criminal offense to make a willfully false statement or misrepresentation, to any Department or Agency of the State of Montana, as to any matter within its jurisdiction.

Signature of Owner, Partner, or Responsible Officer Title Date