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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

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.

Name of Agent Agent Type (Owner, Co-Owner, Agent, Employee, Clearee, Independent Contractor) Mailing Address & Phone Number

Printed Name of Licensed Dealer: ___

Signed: ___

Date: ___

(from page 1, part 1 – Owner, Partner, or Responsible Officer)

(from page 1, part 1 – Owner, Partner, or Responsible Officer)

Name of the entity - type or print the name of the entity to be licensed on the line below)

As provided for by section 81-8-234(1) of Montana Code Annotated which requires that "every livestock market or livestock dealer shall maintain a financial condition of total assets in excess of total liability, including total current assets in excess of total current liabilities," livestock markets and livestock dealers may sign and date this affirmation (at the bottom) in lieu of submitting a current balance sheet to the Montana Department of Livestock.

As an owner, officer, or authorized agent of the livestock dealer or livestock market, specified above, I hereby affirm the following:

As of the date written below, the total assets of the owners of the above entity are greater than the total liabilities of the owners. In addition, the total current assets of the owners of the above entity are greater than the total current liabilities of the owners.

As of the date written below, the total assets of the entity, specified above, are greater than the total liabilities. In addition, the total current assets of the entity, specified above, are greater than the total current liabilities.

The statements in this Montana Livestock Dealer License Application are made in full knowledge of the provisions of Sec. 45-7-203 (MCA) and Sec. 45-7-208 (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, officer, or authorized agent

Printed Name:

Date:

Call Montana Livestock Crimestoppers 800-503-6084