FV-216 915-Avocados Proxy Authorization

REPRODUCE LOCALLY. Include form number and date on all reproductions. OMB No. 0581-0189

U.S. DEPARTMENT OF AGRICULTURE AGRICULTURAL MARKETING SERVICE FRUIT AND VEGETABLE PROGRAMS	PROXY AUTHORIZATION			Avocado Administrative Committee P.O. Box 900188 Homestead, FL 33090-0188 Tel: (305) 247-0848
NAME OF GROWER			EMAIL ADDRESS
MAILING ADDRESS (City, County, State, and Zip Code)
LOCATION OF EACH AVOCADO GROVER (either legal or from established landmarks)
NUMBER OF AVOCADO TREES OWNED
NUMBER OF 55 POUND UNITS OF AVOCADOS MARKETED TO DATE DURING THE CURRENT SEASON
NAME OF HANDLER OF THE FRUIT MARKETED
AUTHORIZATION, INCLUDING THE NAME AND ADDRESS OF THE PERSON WHO IS TO REPRESENT THE GROWER AT THE NOMINATION MEETING
NAME		ADDRESS (City, County, State, and Zip Code)
SIGNATURE		DATE
NOTE: Avocado Administrative Committee rules require that a person acting as proxy shall present proper authorization from each grower for whom he acts, to the election subcommittee not later than the January 20th immediately preceding the date of the election.

NOTE: 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 0581-0189. The time required to complete this information collection is estimated to average 10 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 USDA, Director, Office of Civil Rights, 1400 Independence Avenue, SW, Washington, DC 20250-9410 or call (800) 795-3272 (voice) or (202) 720-6382 (TDD). USDA is an equal opportunity provider and employer.

FV-216 (Rev. 7/10. Destroy previous editions.)