FV-258 Peanut Official Referendum Ballot

FORM APPROVED OMB NO. 0581-0093
United States Department of Agriculture Agricultural Marketing Service OFFICIAL REFERENDUM BALLOT Peanut Promotion, Research, and Information Order To be counted, completed ballots must be received by the U.S. Department of Agriculture on Month __, 20__, by x:xx p.m., Eastern Daylight Saving Time. NOTE: Only one vote will be counted for each eligible producer. Incomplete ballots will be INVALID and will not be counted in the referendum.					I. CERTIFICATION 1. I paid assessments under the National Peanut Board Check-off during the period from Month xx, 20xx to Month xx, 20xx. YES  NO 
					II. VOTE Instructions: Mark one box only. Do you favor the continuance of the National Peanut Board Check-off implemented under the Peanut Promotion, Research, and Information Order? YES  NO 
FV-258					III. MAILING Return ballot in the enclosed postage-paid envelope.

If postage-paid envelope is not available, mail your ballot(s) to:

U.S. Department of Agriculture, AMS

PEANUT REFERENDUM

P.O. Box xxxxxx

Washington, D.C xxxxx-xxxx

FALSIFICATION OF INFORMATION OR MISREPRESENTATION OF IDENTITY ON THIS GOVERNMENT DOCUMENT MAY RESULT IN A FINE OF NOT MORE THAN $10,000, OR IMPRISONMENT FOR NOT MORE THAN FIVE YEARS, OR BOTH. (18 U.S.C. 1001)

According to the Paperwork Reduction Act of 1995, an agency may or 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.

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FV-258