FV245 (rev.) Producer Nomination Form

Pistachios Grown in California

FV-245 Producer Nomination Form (rev ) 6-27-11

Pistachios Grown in CA (Voluntary)

OMB: 0581-0215

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REPRODUCE LOCALLY. Include form number and date on all reproductions. OMB No. 0581-0215

NOMINATION FORM

PRODUCER MEMBERS AND ALTERNATE PRODUCER MEMBERS

Marketing Order No. 983 (Order), regulating the handling of pistachios grown in California, Arizona, and New Mexico became effective on November 3, 2009. The Administrative Committee for Pistachios (Committee) is conducting the nomination process for membership on the 12-member committee for the seats that expire June 30, 20___. The Committee consists of 9 producer members, 2 handler members, 1 public member and their alternates. Of the 9 producer members, 4 are producer members and their respective alternates from District 1 (Southern California), 3 are producer members and their respective alternates from District 2 (Central California), 1 is a producer member and his/her respective alternate from District 3 (Northern California), and 1 is a producer member and his/her respective alternate from District 4 (Arizona/New Mexico). The Order provides authority for pistachio producers in each of the four districts to submit the names of candidates for nomination for membership on the Committee. If you are interested in nominating yourself or another producer to serve on the Committee for Districts 1, 2, 3, or 4, please read the following information and submit the completed nomination form. To be valid, the completed nomination form must be signed, and postmarked, faxed, or hand-delivered no later than , 20 .

INSTRUCTIONS FOR COMPLETING THE ATTACHED NOMINATION FORM

1. Please complete a nomination form for the district in which you wish to nominate yourself or another eligible producer to run for office on the Committee for the seats that expire on June 30, 20___. If you produce pistachios in more than one district, you may nominate a candidate from only one district of your choice. List the name of your nominee and accompanying information in the spaces provided on the form. Only producers, including duly authorized officers or employees of producers, may participate in the nomination of candidates for producer members and their alternates. If you are both a producer and a handler of pistachios, you may participate in both producer and handler nominations.

2. The Order prescribes that not more than two members and not more than two alternate members shall be persons employed by, or affiliated with producers or handlers that are affiliated with the same handler and/or producer. “Affiliation” normally appears as “affiliate of,” or “affiliated with,” and means a person such as a producer or handler who is: a producer or handler that directly, or indirectly through one or more intermediaries, owns or controls, or is controlled by, or is under common control with the producer or handler specified; or a producer or handler that directly, or indirectly through one or more intermediaries, is connected in a proprietary capacity, or shares the ownership or control of the specified producer or handler with one or more other producers or handlers. As used in this part, the term “control” (including the terms “controlling,” “controlled by,” and “under common control with”) means the possession, direct or indirect, of the power to direct or cause the direction of the management and policies of a handler or a producer, whether through voting securities, membership in a cooperative, by contract or otherwise.

3. Once all nomination forms are received, nominees will be notified of their nomination, asked to complete a confidential qualification and acceptance statement, and provided an opportunity to submit a short biographical statement not to exceed one half page in length. The short biographical information statement will be sent to eligible handlers with balloting material.

4. The Order specifies that a two-year term of office shall be staggered for elected producer members and their alternates. For this nomination, producer member positions that expire on June 30, 20__ are being filled. The eligible producer(s) receiving the highest number of votes by position will be recommended to the U.S. Department of Agriculture (USDA) as the producer member(s). Those eligible nominees receiving the next highest number of votes by position will be recommended to the USDA as alternate producer members. Each producer member and alternate producer member on the Committee shall be, at the time of selection and during the term of office, a pistachio producer, or an officer or an employee of a producer.

5. The USDA prohibits discrimination in all its programs and activities. Please see the bottom of the district ballot for more details. We request that you be mindful of the USDA’s policy regarding Civil Rights and consider eligible women, minorities, and the physically challenged for membership on the Committee.

6. The completed nomination form must be signed, postmarked, faxed, or hand-delivered by , 20 . Submit the form by mail in the return envelope provided, fax to (559) 255-6485, or hand-deliver to the Administrative Committee for Pistachios, at 4938 East Yale Avenue, Suite 102, Fresno, CA 93727.

UNITED STATES DEPARTMENT OF AGRICULTURE

AGRICULTURAL MARKETING SERVICE

FRUIT AND VEGETABLE PROGRAMS

ADMINISTRATIVE COMMITTEE FOR PISTACHIOS

PRODUCER MEMBER AND ALTERNATE PRODUCER MEMBER NOMINATION FORM

You may nominate yourself or other pistachio producers for one district in which you and your candidate produce pistachios. NOTE: Nominations must be signed to be valid.

DISTRICT 1 (SOUTHERN CALIFORNIA) - Tulare, Kern, San Bernardino, San Luis Obispo, Santa Barbara, Ventura, Los Angeles, Orange, Riverside, San Diego, and Imperial counties. You may nominate FOUR producers and their respective alternates.

___________________________________________ ____________ _____________ ________________________

Name of Producer Member Nominee Phone Number Fax Number Email Address

___________________________________________ ________________________________________________________

Mailing Address City, State, Zip code

___________________________________________ ____________ _____________ ________________________

Name of Producer Member Nominee Phone Number Fax Number Email Address

___________________________________________ ________________________________________________________

Mailing Address City, State, Zip code

___________________________________________ ____________ _____________ ________________________

Name of Producer Member Nominee Phone Number Fax Number Email Address

___________________________________________ ________________________________________________________

Mailing Address City, State, Zip code

___________________________________________ ____________ _____________ ________________________

Name of Producer Member Nominee Phone Number Fax Number Email Address

___________________________________________ ________________________________________________________

Mailing Address City, State, Zip code

CERTIFICATION: I certify that I, or my employer, currently produce pistachios for market in District 1 (you may nominate a candidate in only one district).

Producer’s Name Address Telephone Number

Signature Print Name Date

The making of any false statements or representations in any matter within the jurisdiction of any agency of the United States, knowing it to be false, is a violation of title 18, section 1001 of the United States Code, which provides for a fine or imprisonment, or both.

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 control number. The valid OMB control number for this information collection is 0581-0215. The time required to complete this information collection is estimated to average 20 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.

UNITED STATES DEPARTMENT OF AGRICULTURE

AGRICULTURAL MARKETING SERVICE

FRUIT AND VEGETABLE PROGRAMS

ADMINISTRATIVE COMMITTEE FOR PISTACHIOS

PRODUCER MEMBER AND ALTERNATE PRODUCER MEMBER NOMINATION FORM

You may nominate yourself or other pistachio producers for one district in which you and your candidate produce pistachios. NOTE: Nominations must be signed to be valid.

DISTRICT 2 (CENTRAL CALIFORNIA) - Kings, Fresno, Madera, and Merced counties. You may nominate THREE producers and their respective alternates.

___________________________________________ ____________ _____________ ________________________

Name of Producer Member Nominee Phone Number Fax Number Email Address

___________________________________________ ________________________________________________________

Mailing Address City, State, Zip code

___________________________________________ ____________ _____________ ________________________

Name of Producer Member Nominee Phone Number Fax Number Email Address

___________________________________________ ________________________________________________________

Mailing Address City, State, Zip code

___________________________________________ ____________ _____________ ________________________

Name of Producer Member Nominee Phone Number Fax Number Email Address

___________________________________________ ________________________________________________________

Mailing Address City, State, Zip code

___________________________________________ ____________ _____________ ________________________

Name of Producer Member Nominee Phone Number Fax Number Email Address

___________________________________________ ________________________________________________________

Mailing Address City, State, Zip code

CERTIFICATION: I certify that I, or my employer, currently produce pistachios for market in District 2 (you may nominate a candidate in only one district).

Producer’s Name Address Telephone Number

Signature Print Name Date

UNITED STATES DEPARTMENT OF AGRICULTURE

AGRICULTURAL MARKETING SERVICE

FRUIT AND VEGETABLE PROGRAMS

ADMINISTRATIVE COMMITTEE FOR PISTACHIOS

PRODUCER MEMBER AND ALTERNATE PRODUCER MEMBER NOMINATION FORM

You may nominate yourself or other pistachio producers for one district in which you and your candidate produce pistachios. NOTE: Nominations must be signed to be valid.

DISTRICT 3 (NORTHERN CALIFORNIA) - consists of all counties in California where pistachios are produced that are not included in Districts 1 and 2. You may nominate ONE producer and their respective alternate.

___________________________________________ ____________ _____________ ________________________

Name of Producer Member Nominee Phone Number Fax Number Email Address

___________________________________________ ________________________________________________________

Mailing Address City, State, Zip code

___________________________________________ ____________ _____________ ________________________

Name of Producer Member Nominee Phone Number Fax Number Email Address

___________________________________________ ________________________________________________________

Mailing Address City, State, Zip code

CERTIFICATION: I certify that I, or my employer, currently produce pistachios for market in District 3 (you may nominate a candidate in only one district).

Producer’s Name Address Telephone Number

Signature Print Name Date

UNITED STATES DEPARTMENT OF AGRICULTURE

AGRICULTURAL MARKETING SERVICE

FRUIT AND VEGETABLE PROGRAMS

ADMINISTRATIVE COMMITTEE FOR PISTACHIOS

PRODUCER MEMBER AND ALTERNATE PRODUCER MEMBER NOMINATION FORM

You may nominate yourself or other pistachio producers for one district in which you and your candidate produce pistachios. NOTE: Nominations must be signed to be valid.

DISTRICT 4 (THE STATES OF ARIZONA AND NEW MEXICO) – consists of the States of Arizona and New Mexico. You may nominate ONE producer and their respective alternate.

___________________________________________ ____________ _____________ ________________________

Name of Producer Member Nominee Phone Number Fax Number Email Address

___________________________________________ ________________________________________________________

Mailing Address City, State, Zip code

___________________________________________ ____________ _____________ ________________________

Name of Producer Member Nominee Phone Number Fax Number Email Address

___________________________________________ ________________________________________________________

Mailing Address City, State, Zip code

CERTIFICATION: I certify that I, or my employer, currently produce pistachios for market in District 4 (you may nominate a candidate in only one district).

Producer’s Name Address Telephone Number

Signature Print Name Date

The making of any false statements or representations in any matter within the jurisdiction of any agency of the United States, knowing it to be false, is a violation of title 18, section 1001 of the United States Cod e, which provides for a fine or imprisonment, or both.

FV-245 (Rev. 08/10. Destroy previous editions.)

File Type	application/msword
File Title	NOMINATION FORM FOR COMMITTEE MEMBERS
Author	vemmer
Last Modified By	USDA
File Modified	2011-06-27
File Created	2011-06-27