FV-165 Prune Marketing Committee Nominee Questionnaire

OMS No. 0581-0178

REPRODUCE LOCALLY. Include form number and date on all reproductions.
UNITED STATES DEPARTMENT OF AGRICULTURE
AGRICULTURAL MARKETING SERVICE
FRUIT AND VEGETABLE PROGRAMS

CONFIDENTIAL PRUNE MARKETING COMMITTEE NOMINEE QUESTIONNAIRE
The following information will be used by the Secretary of Agriculture to determinethe eligibilityand willingness of nomineesto serve on the
California Prune Marketing Committee:
(Please fill in all spaces.)

1.

Name

2.

(a) Residence
(Street)

(City)

(State)

(ZipCode)

(City)

(State)

(ZipCode)

(b) MailingAddress:
(If same, so state)

(c) Telephone Number:

(Street)
Home: (
Cell: (

)

L-.J

Business:

)

Fax:

L-1

E-mail:
3.

Number of years experience in the Prune Industry:

4.

Are you a commercial producer of prunes? Yes <-)

5.

Didyou produceprunesduringthe currentyear? Yes<-)
The tonnage of prunes produced was

No <-)
No <-).

tons.

6.

Are you a member of a Cooperative MarketingAssociation?Yes (_)
of firm which handled your prunes:

No (->.

7.

Are you a prune handler, employee, or officer of a prune handler. Yes <-)

Ifyes, give name of Cooperative;if not, give name

No <-).

If yes, pleasestate the following:

(a) The name of the handler(s)
(b) Your title or capacity
(c) Number of years experience in the position
(d) Pleasestate the tonnage of prunes handled by your firm during the current crop year:

tons.

When acting in myofficialcapacity as a committee representative, Ishall engage in onlythose activitiesthat are
authorized under the Prune Marketing Order. Ialso understand that the committee cannot become involved in
lobbying and political activities.
Iwill serve as a member or alternate member on the Prune Marketing Committee if selected by the Secretary of
Agriculture.
Signature

Date

(Ifany part of this questionnaire does not apply, please indicate by stating "N.A."for non-applicable.)
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data needed, and completing and reviewing the collection of information.
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(USDA) prohibits discrimination
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FV-165 (05/04)