916-Nectarines Administrative Committee Nomination Ballo

REPRODUCE LOCALLY. Include the form number and edition on each form. OMB No. 0581-0189

CALIFORNIA TREE FRUIT AGREEMENT

PO Box 968

Reedley, CA 93654-0968

Phone: (559) 638-8260

BALLOT

District: _____________________________

District __________ consists of _____________________________________ County(ies), and is represented by _________ members and ___________ alternates.

The candidates listed below are running for ___________ member positions and __________ alternate positions (2-year terms ending ______________________, 20___) to represent District _____________ on the Nectarine Administrative Committee. Please vote for ____________ of the listed candidates, and/or write in a candidate of your choice for the member positions only. The candidates receiving the next highest votes will be designated as the alternate positions.

Please return your completed Ballot to the California Tree Fruit Agreement at the address above in the envelope provided, no later than _________________________, 20___, in order to be counted.

Vote for __________ candidates

Candidates:

□		□
□		□
□		□
□		□
□		□
□		□

Write-in Candidates:

Name		Phone Number
□
□

NOTE: Only producers of nectarines in District _______________ may vote. Producers are entitled to one vote. If a producer produces in more than one district, the producer may choose to vote for nominees in another district, provided that the producer does not vote more than once. Please call ___________________ at (559) 638-8260 to exchange district Ballots. The Ballot is invalid if not signed

This portion of the Ballot will be detached prior to Ballot tallying.

By signing this Ballot, I certify that I am authorized to vote on behalf of an eligible voting entity.

______________________________________ _______________________________________

Name (please print) Name of Nectarine Producing Entity

______________________________________ _______________________________________

Signature Nectarine Producing County(ies)

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 5 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.

Rev. 07/10. Destroy previous editions.