DA-21 Dairy Promotion & Research Producers Referendum Ballot

OFFICIAL REFERENDUM BALLOT:

OMB NO. 0581-0093

United States Department of Agriculture
Agricultural Marketing Service
Dairy Programs
DAIRY PROMOTION AND RESEARCH ORDER CONTINUANCE REFERENDUM
INDIVIDUAL PRODUCERS

DAIRY PROMOTION AND RESEARCH ORDER

See the reverse of this form for instructions for completing the ballot. This ballot and the information provided will
be kept confidential. (Please type or print.)
___________________________________
Last Name of Producer

___________
Middle Initial

_______________________________________
First Name

___________________________________________________________
(Business Name, if applicable)
___________________________________________________________
Business Address
________________________________________________ ___________
_____________________
City
State
Zip Code
_____________________________________________________________________________________________
BALLOT: DO YOU FAVOR HAVING THE SECRETARY OF AGRICULTURE CONTINUE
THE DAIRY PROMOTION AND RESEARCH ORDER?

□ YES, continue the Order

□

(Place an “X” in only one space)
NO, terminate the Order
_____________________________________________________________________________________________
I hereby CERTIFY that during _______________I was engaged in the production of milk for commercial use; and
(CHECK ONLY 1 BLOCK)

□ (A) I am a member of the cooperative association named below that marketed my milk:
□ (B) No cooperative association marketed my milk and I sold my milk to the plant named below:
□(C) I sold my milk directly to consumers under the following business name:
___________________________________________________________
Cooperative, plant, or business name of (A), (B), or (C) above
___________________________________________________________
City and State of Cooperative, plant, or business named above
If this ballot is being cast on behalf of any group of individuals, partnership, corporation, or other business entity
engaged in the production of milk for commercial use, I CERTIFY that I have the authority to cast this ballot and
will submit evidence thereof if so requested by the Referendum Agent.
____________________________________
Name of Ballot Caster (Please Type or Print)

_____________________________________ _________
Signature
Date

FALSIFICATION OF INFORMATION ON THIS GOVERNMENT DOCUMENT MAY RESULT IN A FINE OF NOT MORE THAN
$10,000 OR IMPRISONMENT FOR NOT MORE THAN 5 YEARS, OR BOTH (18 U.S.C. 1001)
(over)
Form DA-21 (08/07)

(FRONT PAGE)

OFFICIAL REFERENDUM BALLOT Instructions

OMB NO. 0581-0093

Dairy Promotion and Research Order Continuance Referendum
A national Order establishing a dairy promotion, research, and nutrition education program was authorized by the Dairy and
Tobacco Adjustment Act of 1983 and was fully implemented on May 1, 1984. The program provides for a 15-cent per
hundredweight assessment on all milk produced in the United States and Puerto Rico and marketed commercially by dairy
farmers. A board of 36 dairy farmers, appointed by the Secretary of Agriculture, administers the program.
The Secretary of Agriculture, pursuant to Section 116 of the Dairy and Tobacco Adjustment Act of 1983, has called for a
referendum among producers during ________to determine whether the Dairy Promotion and Research Order should be
continued. For the program to continue, a majority of producers voting in the referendum must favor keeping the program.
The Referendum Agent has established the referendum period as ___________ through __________. The Act requires that a
cooperative association that votes on behalf of its members must advise its producer members no later than 30 days prior to the
beginning of the referendum as to how it will vote. The Referendum Agent has determined that to meet the notice requirement
such cooperative must inform its members by ___________. A producer member who opposes the cooperative’s vote may cast
an official individual producer ballot with the member’s differing vote.
I. Voting. Voting will be conducted by mail. The Referendum Agent has determined that completed ballots must
be postmarked ___________through __________ as specified in the Referendum Order. Incomplete ballots or ballots
postmarked earlier or later than the dates specified in the Referendum Order will not be counted.
II. Persons Eligible to Vote. A producer engaged in the production of milk for commercial use during ________ is
eligible to vote. In the case of a producer who is other than an individual, the business unit is regarded as the
producer. Only one vote is permitted for each dairy farm business unit. A cooperative association may vote on
behalf of its producer members. A producer member opposed to the cooperative vote may cast an individual ballot.
III. Instructions for Completing the Ballot.
1. Complete the producer name and farm business name (if applicable) including address.
2. Vote in the space provided.
3. Complete the certification section. A producer who is a member of or under contract to a cooperative should
check block (A) and indicate the name and address of the cooperative. A producer who does not market milk
through a cooperative should check block (B) and indicate the name and address of the plant to which the
producer sells milk. A producer who sells milk directly to consumers should check block (C) and indicate the
name and address of the distribution business.
4. Be sure to sign the ballot.
5. Mail the ballot in the return envelope not later than the date specified in the Referendum Order. If you did not
obtain a return envelope, mail your ballot to:
Referendum Agent
USDA, AMS, Dairy Programs
Room 2968-S, Mail Stop 0225
1400 Independence Avenue SW
Washington, D.C. 20250-0225
If you have questions or need information, on the referendum, call the Referendum Agent at (202) 720-6909.
According to the Paperwork Reduction Act of 1995, an agency my 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 this information collection is 0581-0093. The
time required to complete this information collection is estimated to average 6 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 to USDA, Director, Office 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.
Form DA-21 (08/07)

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