FV-39 Producer Referendum Ballot (WA Potatoes)

REPRODUCE LOCALLY. Include (onn uumber and date on all reoroductions.

OMB No. 0581-0178

PRODUCER REFERENDUM BALLOT
Marketing Order NO. 946 -Irish Potatoes Grown in Washington
Please read the enclosed VOTING INSTRUCTIONS AND RULES GOVERNING PRODUCER ELIGIBILITY
TO VOTE before completing this bal/ot.
This referendum is being held to determine producer support for the federal marketing order regulating the
handling of potatoes grown in Washington. The Secretary of Agriculture will consider termination of this
order if less than two-thirds of those voting and less than two-thirds of the volume represented in the
referendum favor continuance.

A.

Do you favor continuance of Marketing Order No. 946, regulating the handling of potatoes grown in
Washington?

DYES

DNO

PRODUCER ELIGIBILITY STATEMENT
B.

I hereby certify that I am currently a producer of potatoes within the production area and that during
, through
, I produced for the fj-eshmarket:

the representativeperiod

on
Hundredweight

In
Acres

County(ies)

c.
Name of Packing House(s) that
Handled your Potatoes

Hundredweight

Affiliation
(co-op or independent)

D.

Phone Number

Producer's Name

Name of Business
Mailing Address
City

E.

State

Zip

If this ballot is cast by an officer or employee of a partnership, LLC, corporation, association or other
business unit, my signature below further certifies that I am duly authorized to vote on behalf of the
producing entity name on this ballot and that I will submit evidence of such authority at the request of
an Agent of the Secretary.

D Partnership D LLC D Corporation D Association D Other
Signature*

Title

If Partnership or Joint Venture, list name(s).

F.

I hereby certify that the information I provided on this baUot is accurate and correct to the best
of my knowledge.

Signature*

Title

*Your signature certifies that you have the authority to take such action and will submit supplementary evidence of such authority
at the request of an agent of the Secretary of Agriculture. The information provided in this ballot is required to determine voter
eligibility and vote of Washington State potato producers. Falsification of information on this government document may result in
a fine of not more than SI0,OOOor imprisonment of not more than five (5) years, or both (18 U.S.c. 1001).
According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to
respond to collection of information unless it displays a valid OMB control number. The valid OMB control number for this
information collection is 0581-0178. The time required to complete this information collection is estimated to average 20 minutes
per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data
needed, and completing and reviewing the collection of information.
The U.S. Department of Agriculture (USDA) prohibits discrimination 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 require alternative means for
communication of program information (Braille, large print, audiotape, etc.) should contact USDA's TARGET Center at (202)
720-2600 (voice and TTY).
To file a complaint of discrimination, write USDA, Director, Office of Civil Rights, 1400 Independence Avenue, SW,
Washington, DC 20250-9410 or call (800) 795-3272 (voice) or (202) 720-6382 (TDD). USDA is an equal opportunity provider
and employer.

FV-39 (1107)

WASHINGTON STATE POTATO BALLOT
UNITED STATES DEPARTMENT OF AGRICULTURE
Agricultwal Marketing Service
Fruit and Vegetable Programs
Northwest Marketing Field Office
1220 SW 3RD AVE STE 385
PORTLAND OR 97204-2807

Referendum Agent
USDA-AMS-F&V-NWMFO
1220 SW 3RD AVB STE 385
PORTLAND OR 97204-2807

WASHINGTON STATE
POTATO BALLOT

VOTING INSTRUCTIONS AND RULES GOVERNING PRODUCER ELIGIBILITY TO VOTE

I.

VOTING PERIOD:

through

II.

REPRESENTATIVE PERIOD:

ID.

PRODUCTION AREA:

IV.

PERSONS ELIGffiLE TO VOTE: Any person who is currently a ftesh market potato producer in
the production area and produced such potatoes during the representative period
through
, is entitled to cast one ballot. Each separate business unit, partnership, LLC, family
enterprise, corporation, association, estate, or firm is entitled to one vote.

through

State of Washington

"Producer" means any individual, partnership, LLC, corporation, association, institution, estate, or
other business unit who:
·

·
·

V.

Owns and farms land resulting in ownership of the potatoes produced thereon;
Rents and farms land resulting in ownership of all or a portion of the potatoes produced thereon;
or
Owns land ftom which, as rental for such land, ownership is obtained of a portion of the potatoes
produced thereon. (A lien holder, cash landlord, or person having only a financial interest in the
potato crop is not eligible to vote.)

HOW TO VOTE:
A. Indicate your vote by placing an "X" in the appropriate box.
B. Certify your potato production by listing the volume in hundredweight that you produced, the
number of acres in production, and the county or counties in which such potatoes were produced
during the representative period
through
. If you are renting on a sharecrop basis, you should show only that part of the crop represented by your share.
C. List the names of packing houses that handled your potatoes, the hundredweight, and affiliation
(co-op or independent).
D. Print or type your name, phone number, business name, and address.
E. Proxy voting is not authorized. Ifballot is cast by an officer or employee of a partnership, LLC,
corporation, association or other business unit, check box to indicate your business designation,
and sign to indicate authority to vote. If partnership or joint venture, list names of partners.
F. Sign below the certification. Incomplete or unsigned ballots cannot be counted. Fold your ballot
so the Referendum Agent's address is displayed, seal with tape and mail to Referendum Agent,
USDA-AMS-FV-NWMFO, 1220 SW 3RD AVE STE 385, PORTLAND OR 97204-2807. For
further information, please call (503) 326-2724.

Ballots must be postmarked by

.