FV-77 925-CA Desert Grapes Producer Referendum

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

UNITED STATES DEPARTMENT OF AGRICULTURE

AGRICULTURAL MARKETING SERVICE

FRUIT AND VEGETABLE PROGRAMS

PRODUCER REFERENDUM BALLOT

Marketing Order No. 925: Grapes Grown In a Designated Area of Southeastern California

PART I - REFERENDUM INSTRUCTIONS

A. COMPLETE PARTS II, III, AND IV. Incomplete or unsigned Ballots cannot be counted. Ballots must be postmarked by ____________________________, 20___.

B. ELIGIBILITY REQUIREMENTS: Any person who produced grapes for the fresh market during the period ___________________, 20___ through ___________________, 20___, and who is now a producer, is eligible to vote. Such persons may vote on whether they favor continuance of the Marketing Order by using the enclosed Ballot. Additional Ballots may be obtained by contacting the ______________________________________________ or your County Extension Service office.

1. A producer (or grower) is defined as:

   1. any person who produces grapes for the fresh market in the designated production area (_______________________________________________);

   2. a renter or tenant of acreage producing grapes for the fresh market; or

   3. a landlord who received from a renter or tenant such grapes as rent for the land on which such grapes were grown. A cash landlord, lienholder, or person having only a financial interest in the crop is not an eligible voter.

2. Each separate business unit, partnership, family enterprise, corporation, association, estate, or firm is entitled to one vote.

3. Proxy voting is not authorized.

C. INSTRUCTIONS FOR VOTING: Provide the voter information requested in Part II. In Part III, mark the block in favor of or against continuing the Order. Certify your vote by signing the appropriate section of Part IV. If you do not complete Parts II, III, and IV, your Ballot cannot be validated, and your vote will not be counted.

Remove the pages containing Parts II, III, and IV, and mail them in the self-addressed envelope. If you do not have an official envelope, mark your envelope “GRAPE REFERENDUM,” and mail the Ballot to:

USDA-AMS-FV-CAMFO

2202 Monterey Street

Suite 102B

Fresno, CA 93721

Please call (559) 487-5901 if you have any questions.

PART II - VOTER INFORMATION

This information will be held in strict confidence.

A. Your name

(Please print clearly)

B. What is the specific location of your grape acreage represented in this Ballot?

(Highway or street address, if applicable, and county)

(City, State, and Zip Code)

C. Do you reside on the above property which produces the grapes? □ Yes □ No

If no, please provide your residence address and telephone number:

(Street and No. or R.F.D. No., City, State, and Zip Code)

(Telephone number (include area code))

D. If you are not voting as an individual producer, please check the appropriate box indicating your voting status and write the name and address of the business unit you represent.

□ Partnership □ Corporation □ Other (specify) _________________________

(Name and address of business unit)

E. How many lugs of grapes did you produce for fresh market during the period _______________, 20___ through _________________, 20___? ________ acres

F. How many acres of grapes for fresh market did you harvest during the period _______________, 20___ through _________________, 20___? ________ acres

G. Which packing house(s) handled your grapes during the period _______________, 20___ through _________________, 20___?

(Name of packing house(s))

PART III - CONTINUATION OF MARKETING ORDER FOR DESERT GRAPES

Do you favor continuing Marketing Order No. 925 for desert grapes grown in southeastern California?

□ YES □ NO

PART IV - VOTER CERTIFICATION

All information provided in this Ballot will be subject to on-site verification by officials of the Office of Inspector General, U.S. Department of Agriculture.

The information on this Ballot is required to determine the voter eligibility and vote of desert grape producers. Falsification of information on this government document may result in a fine of not more than $10,000 or imprisonment for not more than five (5) years, or both. (18 U.S.C. 1001)

A. Your signature, if signing as an individual.

I am the producer named in Part II of this Ballot, and I certify that I am not a cash landlord, lienholder, or person having only a financial interest in the crop, and that the information provided on this Ballot and any attachment hereto is accurate and correct to the best of my knowledge.

___________________________________________ ___________________

Signature Date

B. If signing as the representative of a producing entity other than an individual, state your title and sign below.

I hereby certify that I have authority to cast the Ballot of the producer named in Part II D of this Ballot, and that I will submit evidence thereof at the request of an authorized agent of the Secretary of Agriculture.

___________________________________________ ___________________

Signature and Title Date

BALLOTS POSTMARKED AFTER ______________________, 20___,

WILL NOT BE COUNTED IN THE REFERENDUM.

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 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.

FV-77 (Rev. 07/10. Destroy previous editions.)