Form FV-136 Producer Referendum Ballot (Hazelnuts)

REPRODUCE LOCALLY. Include form number and date on all reproductions. OMB No. 0581-0178

HAZELNUT BALLOT

UNITED STATES DEPARTMENT OF AGRICULTURE

AGRICULTURAL MARKETING SERVICE

FRUIT AND VEGETABLE PROGRAMS

NORTHWEST MARKETING FIELD OFFICE

805 SW BROADWAY, SUITE 930

PORTLAND, OR 97205

__________

TO HAZELNUT PRODUCERS:

Marketing Order No. 982 (Order), regulating the handling of Hazelnuts grown in Oregon and Washington, requires the Secretary of Agriculture to conduct a referendum approximately once every 10 years to ascertain whether producers favor continuance of the Order. As a consequence, an order directing that a referendum be held was published in the Federal Register on _______________, 20___.

A Producer Referendum Ballot is on the reverse side of this page. Also enclosed are:

1. Voting Instructions and Rules Governing Producer Eligibility to Vote;

2. News Release issued on the Referendum; and

3. Copy of the Referendum Order dated _______________, 20___.

The voting period for the referendum is ______________, 20___ through ______________, 20___. Please vote promptly because Ballots postmarked later than ________________, 20___, cannot be opened or counted. Each Ballot will be held in strict confidence.

________________________________________

Referendum Agent

Phone: (503) 326-2724

PRODUCER REFERENDUM BALLOT

Marketing Order No. 982: Hazelnuts Grown in Oregon and Washington

Please read the enclosed VOTING INSTRUCTIONS AND RULES GOVERNING PRODUCER ELIGIBILITY TO VOTE before completing this Ballot.

This referendum is being held to determine producer support for the Marketing Order No. 982, regulating the handling of hazelnuts grown in Oregon and Washington. The Secretary of Agriculture (Secretary) will consider termination of this Order if less than two-thirds of those voting and less than two-thirds of the volume represented in the referendum favor continuance.

A. Do you favor continuance of Marketing Order No. 982, regulating the handling of hazelnuts grown in Oregon and Washington?

 YES  NO

PRODUCER ELIGIBILITY STATEMENT

B. I hereby certify that I am currently a producer of hazelnuts within the production area and that during the representative period from __________________, 20___, through _________________, 20___, I produced for the fresh market ____________________ tons on _____________________ acres in _______________________________________ county(ies).

C.

Name of Packing House(s) that Handled your Hazelnuts	Tons	Affiliation (co-op or independent)

D. Producer’s Name ________________________________ Phone Number _____________

Name of Business _______________________________________________________________

Mailing Address ________________________________________________________________

City _______________________________ State _____________ Zip _______________

E. If this Ballot is cast by an officer or employee of a partnership, LLC, corporation, association or other business unit, my signature below further certifies that I am duly authorized to vote on behalf of the producing entity name on this Ballot and that I will submit evidence of such authority at the request of an Agent of the Secretary.

Partnership LLC Corporation Association Other ________________

________________________________________ ________________________________

Signature* Title

______________________________________________________________________________

If Partnership or Joint Venture, list name(s).

F. I hereby certify that the information I provided on this Ballot is accurate and correct to the best of my knowledge.

________________________________________ ________________________________

Signature* Title

*Your signature certifies that you have the authority to take such action and will submit supplementary evidence of such authority at the request of an agent of the Secretary. The information provided in this Ballot is required to determine the voter eligibility and vote of hazelnut producers. Falsification of information on this government document may result in a fine or imprisonment of not more than five (5) years, or both. (18 U.S.C. 1001)

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 0581-0178. 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.

HAZELNUT BALLOT

UNITED STATES DEPARTMENT OF AGRICULTURE

AGRICULTURAL MARKETING SERVICE

FRUIT AND VEGETABLE PROGRAMS

NORTHWEST MARKETING FIELD OFFICE

805 SW BROADWAY, SUITE 930

PORTLAND, OR 97205

REFERENDUM AGENT

USDA-AMS-F&V-NWMFO

805 SW BROADWAY, SUITE 930

PORTLAND, OR 97205

FOLD HERE, TAPE AT THE TOP, AND MAIL PROMPTLY 

HAZELNUT

BALLOT

VOTING INSTRUCTIONS AND RULES GOVERNING PRODUCER ELIGIBILITY TO VOTE

1. VOTING PERIOD: __________________, 20___ through __________________, 20___

2. REPRESENTATIVE PERIOD: _______________, 20___ through _______________, 20___

3. PRODUCTION AREA: States of Oregon and Washington.

4. PERSONS ELIGIBLE TO VOTE: Any person who is currently a hazelnut producer in the production area and produced such hazelnuts during the representative period from _______________, 20___ through ________________, 20___, is entitled to cast one Ballot. Each separate business unit, partnership, LLC, family enterprise, corporation, association, estate, or firm is entitled to one vote.

“Producer” means any individual, partnership, LLC, corporation, association, institution, estate, or other business unit who:

• Owns and farms land resulting in ownership of the hazelnuts produced thereon;

• Rents and farms land resulting in ownership of all or a portion of the hazelnuts produced thereon; or

• Owns land from which, as rental for such land, ownership is obtained of a portion of the hazelnuts produced thereon. (A lien holder, cash landlord, or person having only a financial interest in the hazelnut crop is not eligible to vote.)

5. HOW TO VOTE:

1. Indicate your vote by placing an “X” in the appropriate box.

2. Certify your hazelnut production by listing the volume in tons that you produced, the number of acres in production, and the county or counties in which such hazelnuts were produced during the representative period from _______________, 20___ through _______________, 20___. If you are renting on a share-crop basis, you should show only that part of the crop represented by your share.

3. List the names of packing houses that handled your hazelnuts, the tonnage, and affiliation (co-op or independent).

4. Print or type your name, phone number, business name, and address.

5. Proxy voting is not authorized. If the Ballot is cast by an officer or employee of a partnership, LLC, corporation, association or other business unit, check the box to indicate your business designation, and sign to indicate authority to vote. If a partnership or joint venture, list the names of the partners.

6. Sign below the certification. Incomplete or unsigned Ballots cannot be counted. Fold your Ballot so the Referendum Agent’s address is displayed, seal with tape and mail to:

Referendum Agent

USDA-AMS-FV-NWMFO

805 SW BROADWAY, STE 930

PORTLAND, OR 97205

For further information, please call (503) 326-2724. Ballots must be postmarked by __________, 20___.

FV-136 (Rev. 10/2010) Destroy previous editions.