FV-229 Official Referendum Ballot Mushroom Promotion, Research

FORM APPROVED

United States Department of Agriculture
Agricultural Marketing Service
OFFICIAL REFERENDUM BALLOT
MUSHROOM PROMOTION, RESEARCH, AND
CONSUMER INFORMATION ORDER
Please read the Voting Instructions (see separate sheet) carefully to
determine your voting eligibility. Then complete Sections I, II, and II
of this ballot. Mail your completed ballot. To be counted, completed
ballots must be received by the U.S. Department of Agriculture on or
after Month XX, 20XX and before 4:30 p.m. Eastern Standard Time
on Month XX, 20XX.

OMB NO. 0581-0093

I. ELIGIBILITY
Mark an "X" in the box that applies to you. In the space provided, write the total number of pounds of
mushrooms you produced or imported during the specific period.

D During
the period Month xx, 20XX through Month xx, 20XX, I
produced
pounds of mushrooms.
D During the period Month xx, 20XX through Month xx, 20XX, I
imported

pounds of mushrooms.

II. VOTE
Note: Only one vote will be counted for each
entity. Incomplete and unsigned ballots will be
INVALID and will not be counted in the
referendum.

(Mark one box only.)

Do you favor the amendments to [continuance of] the Mushroom
Promotion, Research, and Consumer Information Order?

YEsD

NoD

III. SIGNATURE
ALL BALLOTS MUST BE SIGNED AND DATED BELOW IN ORDER TO BE COUNTED.

PLACE LABEL HERE

I CERTIFY that I am an eligible producer or importer as defined in the Voting Instructions,
and that the information contained on this ballot is true, complete, and correct to the best of
my knowledge and belief, and is made in good faith. If this ballot is being cast on behalf of
any group of individuals, partnership, corporation, or other business entity engaged in the
production or importation of mushrooms, I also CERTIFY that I have the authority to cast
this ballot and will submit evidence thereof if requested by the Referendum Agent.
X
SIGNATURE

DATE

NAME/COMPANY NAME (Print legibly).

(}
BUSINESSTELEPHONENUMBER

IV. MAILING
Return ballot in the enclosed, postae:e-paid envelope.
FV-229 (03/09)

FALSIFICA TION OF INFORMATION OR MISREPRESENTATION OF IDENTITY ON THIS GOVERNMENT
THAN $10,000, OR IMPRISONMENT FOR NOT MORE THAN FIVE YEARS, OR BOTH. (18 U.S.C. 1001)

DOCUMENT MA Y RESULT IN A FINE OF NOT MORE

According to the Paperwork Reduction Act of 1995, an agency mayor may not conduct or sponsor, and a person is not required to
respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for the
information collection is 0581-0093. The time required to complete this information collection is estimated to average 15 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
TDD). To file a complaint of discrimination, write USDA, Director of Civil Rights, 1400 Independence Avenue, S.W., Washington,
D.C. 20250-9410 or call (800) 795-3272 (voice) or (202) 720-6382 (TDD). USDA is an equal opportunity provider and employer.

FV -229 (03/09)

IMPORTANT: DO NOT ENLARGE, REDUCE OR MOVE the FIM and POSTNET barcodes. They are only valid as printed!
Special care must be taken to ensure FIM and POSTNET barcode are actual size AND placed properly on the mail piece
to meet both USPS regulations and automation compatibility standards.

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FV-1177
United

States

Department

of Agriculture

NO POSTAGE
NECESSARY
IF MAILED

USD'~A

Marketingand RegulatoryPrograms
AgriculturalMarketingService
FV, RPB,STOP0244,Room0634-SouthBldg. _

~

INTHE
UNITED

STATES

1400 Independence Avenue, SW
Washington, DC 20250-0244
Official

Business

Penafty

for Private

Use $300

BUSINESS REPLY MAIL

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FIRST-CLASS MAIL PERMIT NO. 12558 WASHINGTON, DC
POSTAGE WILL BE PAID BY U.S. DEPARTMENT OF AGRICULTURE

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US DEPARTMENT OF AGRICULTURE AMS
FV RESEARCH AND PROMOTION BRANCH
MUSHROOM REFERENDUM
4700 RIVER ROAD UNIT 1
RIVERDALE MD 20737-9903

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March 18, 2009

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