STATE OF MONTANA COUNTY OF ___ RETURN TO: MONTANA DEPARTMENT OF LIVESTOCK PO BOX 202001 HELENA, MT 59620-2001

，BEING FIRST DULY SWORN, DEPOSES AND SAYS;

(NAME OF SURVIVING HEIR)

THAT (HE, SHE) IS THE SURVIVING ___ OF ___, WHO DIED ON

(SPOUSE, CHILD, HEIR) (NAME OF DECEEDENT)

- - ___ AT ___. THE UNDERSIGNED IS THE CLOSEST NEXT OF KIN (DATE OF DEATH) (CITY AND STATE WHERE DEATH OCCURRED) THAT THE DECEASED OWNED NO ESTATE NECESSITATING ADMINISTRATION. THEREFORE, THERE IS NO ESTATE OR PROBATE PROCEEDINGS BEING CONDUCTED FOR (HIS, HER) ESTATE. FURTHER THE BRAND OR BRANDS:

DRAW BRAND HERE POSITION ON CATTLE

POSITION ON CATTLE

POSITION ON HORSES

POSITION ON SHEEP PAINT COLOR

POSITION ON OTHER (SPECIFY)

IS OF NO INTEREST TO ME, AND I GIVE MY APPROVAL THAT IT BE TRANSFERRED TO:

(NEW BRAND OWNER NAME)

(NEW BRAND OWNER ADDRESS)

(NEW BRAND OWNER CITY, STATE, ZIP)

DATE: ___ - 20

𩽾𩫝𩿡𩬞𩬟𩬞𩬞𩫀𩫀

SIGNATURE(S): ___

(SIGNATURE OF SURVIVING HEIR)

STATE OF MONTANA COUNTY OF ___ SIGNED BEFORE ME ON ___ BY ___

SIGNATURE OF NOTARY

MONTANA NOTARIES MUST COMPLETE THE FOLLOWING IF NOT PART OF STAMP AT LEFT:

PRINTED NAME OF NOTARY ___

NOTARY PUBLIC FOR THE STATE OF ___

RESIDING AT___

MY COMMISSION EXPIRES ___ - 20

(AFFIX NOTARIAL SEAL/STAMP ABOVE)