FV-224 Producers Referendum Ballot (CA Raisins)

OMS No. 0581-0178

u.s. DBPAR'J'IIIEftT OF AGBlCUL'I'IJRB
AGRICUL1URAL MARKETING SERVICE
FRUIT AND VEGETABLE PROGRAMS

PRODUCER'S REPBRErlDlJM BALLOT
ON PROPOSED AMENDMENT,cONfINUATION
OF MARKETING ORDER NO. 989, AS AMENDED,
REGULATING THE HANDliNG OF RAISINS PRODUCED FROM GRAPES GROWN IN CALIFORNIA

TIllS BAlLOT WilL BE HElD CONFIDENTIAL PLFASEREAD TIlE ATfACHED VOTER ELIGIBILIlY AND VOTING
INSTRUcnONS BEFORE COMPLETING TIllS BAlLOT. YOUR BALLOT ENVELOPEMUST BEroslMARKED NOT
LATER THAN
1.

_

I hereby certify that I am an eligibleproducer of grapes for sun-dryingor dehydration into raisins, and during the period of
' through July31, _,
I produced:
tons (dried weight) of raisins for market.
This tonnage was produced from
acres.
(NOTE: If you are farmingon a share-crop basis.report only that part of the ~
representing your share.)
August I,

_

2.
Pleaseindicate the followingabout the business entity for which you are voting:
a)
individual
trust
partnership
corporation
b) tax id#
c)
If a partnership, insert name and mailingaddress of partner(s):

_

3.

_

_

IS TIlE BUSINESSENTITY FOR WHICH YOU ARE VOTING A MEMBEROF TIlE RAISIN BARGAINING ASSOCIATION? YES
NO_

4.
a) IS TIIE BUSINESSENTITY FOR WHICH YOU ARE VOTING A MEMBEROF SUN-MAID GROWERS OF CAUFORNIA?
YES_
NO_
b) DID TIIE ENTITY DELIVERRAISINS FOR CASH 1D SUN-MAID DURING TIlE REPRESENTA11VE PERIOD?
YES_
NO_
5.

DO YOU FAVOR TIIE PROPOSED AMENDMENT/CONTINUA TION?
YES_NO_

6.
PlelR Print Name

L-->

E-mail Address

TelephoneNo.

Producer's Signature (or Name ifItem1 is applicable)
Street or Box No.

City

Zip Code

1.
If this ballot is cast by an OFFICER or EMPLOYEE of a producer such as a corporation, association, institution, school, or similar business
unit, or an ADMINISTRATOR, EXECUTOR, or TRUSTEE of a producing estate, the followingmust also be completed:
I certify to the Secretary of Agriculture that I have authority to cast this ballot for the producer named above in Item 6 and that I willsubmit evidence of
such authority at the request of an Agent of the Secretary.
Signature

TIde and Capacity

MailingAddress:
Street or BoxNo.

City

Zip Code

Note: The following statements are made in acoordance with the Privacy Act of 1974 (S U.S.C. SS2a) and the Papawork Reduction Act of 1995. The authority for
requeslingthis information to be supplied on this form is the Agricultural Marketing Agreement Act of1937, Sees. 1-19,48 Stat. 31, as amended, (7U.S.C. 601-674).
Fumisbing the requested information is necessary for the administration 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 ~1
number. The validOMB ~I
number for this information collection is OS81-0178. The time required to complete this information
collection is estimated to average 20 minutes per respoIL'Ie. including the time for reviewing instructions, searching existing data sources, gathering and maintainil1g 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 ofrace. color, natiooal origin, age. disability, and when:
appIic:able, sex, marital status, fiunilial status, parental status, religion, sexual orientation, genetic information, political belie&, reprisal. or because all or part of an
individual's income is derived ftom any public assistance program (Not all prohibited bases apply to all programs.) Persons with disabilities who require alternative means for
communication ofprogram infonnation (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 to USDA, Director, Office of Civil Rights, 1400 Independence Avenue, S.W., Washington, D.C. 202S0-9410, or call (800) 79S-3272
(yoic.:) or (202) 720-6382 (TOD). USDA is an equal opportunity proyider and employer.

FV-224

(09/07)