FV-216 915-Avocados Proxy Authorization

~

LOCA TION OF EACH AVOCADO

GROVE (either legal or from established

landmarlcs)

NUMBER OF AVOCADO TREES OWNED

NAME OF HANDLER OF THE FRUIT MARKETED

MEETING

NOTE: Committeerules requirethata personactingas proxy shall presentproperauthorizationfrom eachgrowerfor
whom he actsto the electionsubcommitteenot later thantheJanuary20th immediatelyprecedingthedate of the election.

a uthority for requesting this information to be supplied on this form is the Agricultural Marketing Agreement Act of 1937, Secs. 1-19, 48 Stat. 31 , as
amended, (7 U.S.C. 601-674). Furnishing the requested information is necessary for the administratk>n of the marketing order program.
According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to a collection of
information unless it displays a valid OMB contra,1number. The valid OMB control number for this information collection is 0581-0189.
The time required
to complete this information collection is estimated to average 10 minutes per response, induding the time for reviewing instructions, searching existing
data sources, gathering and maintaining the datcl needed, and completing and reviewing the collection of information.
The U.S. Department of Agriculture (USDA) pro/1libits discriminatk>n in all its programs and activities on the basis of race, color, national origin, age, disability,
and where applicable, sex, marital status, familial status, parental status, religion, sexual orientation, genetic information, political beliefs, reprisal, or because
all or part of an individual's income is derived from any public assistance program (Not all prohibited bases apply to all programs.) Persons with disabilities
who reql!ire alternative means for communication of program information (Braill~ large print, audiota~", etc.) should contact USDA's TARGET Center at
(202) 720-2600 (voice and TDD). To file a complaint of aiscrimination, write USuA, Director, Office of vivil Rights, 1400 Independence Avenue, SW,
Washington,

DC 20250-9410

or call (800) 795-3272

FV-216(05-47)Destroyprevious editions.

(voice) or (202) 720-6382 (TDD).

USDA is an equal opportunity provider and employer.