Agent Authorization Form

I, (Owner Code ),
hereby authorize
(Owner Code )
to conduct ILR Registry business on my behalf.

Signature of Agent

  _________________________________________  Date:__________

Signature of Owner

  _________________________________________  Date:__________

Restrictions and Exceptions (if any)
All text MUST be visible to print correctly.
(Use the enter key to wrap text to the next line)

Mail to:

    ILR
    PO Box 8
    Kalispell, MT  59903