FV-224 Producers Referendum Ballot (CA Raisins)

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

U.S. DEPARTMENT OF AGRICULTURE

AGRICULTURAL MARKETING SERVICE

FRUIT AND VEGETABLE PROGRAM

PRODUCER REFERENDUM BALLOT ON PROPOSED AMENDMENT/CONTINUATION

OF MARKETING ORDER NO. 989, AS AMENDED, REGULATING THE HANDLING OF

RAISINS PRODUCED FROM GRAPES GROWN IN CALIFORNIA

THIS BALLOT WILL BE KEPT CONFIDENTIAL. PLEASE READ THE ATTACHED VOTER ELIGIBILITY AND VOTING INSTRUCTIONS BEFORE COMPLETING THIS BALLOT. YOUR BALLOT ENVELOPE MUST BE POSTMARKED BY ___________________, 20___ TO BE VALID.

1. I hereby certify that I am an eligible producer of grapes for sun-drying or dehydration into raisins, and during the period from August 1, 20___ through July 31, 20___, I produced: ___________ tons (dried weight) of raisins for market. This tonnage was produced from __________ acres. (NOTE: If you are farming on a share-crop basis, report only that part of the tonnage representing your share.)

2. Please indicate the following about the business entity for which you are voting:

□ Individual □ Trust □ Partnership □ Corporation

Tax Identification Number (TIN) ____________________

If a partnership, insert name and mailing address of partner(s):

3. Is the business entity for which you are voting a member of the raisin bargaining association? □ Yes □ No

4. Is the business entity for which you are voting a member of sun-maid growers of California? □ Yes □ No

5. Did the entity deliver raisins for cash to Sun-Maid during the representative period? □ Yes □ No

6. DO YOU FAVOR THE PROPOSED AMENDMENT/CONTINUATION? □ Yes □ No

______________________________________ (______)___________ ____________________________

Name Telephone Number Email Address

Producer’s Signature (or Name if Item7 is applicable)

Mailing Address (incl. Street ,City, State, and Zip Code)

7. If this Ballot is cast by an officer or employee of a producer, such as a corporation, association, institution, school, or similar business unit, or an administrator, executor, or trustee of a producing estate, the following must also be completed:

I certify to the Secretary of Agriculture (Secretary) that I have authority to cast this Ballot for the producer named above in Item 6 and that I will submit evidence of such authority at the request of an Agent of the Secretary.

Signature ____________________________________ Title and Capacity ___________________________

Mailing Address (incl. Street ,City, State, and Zip Code)

The following statements are made in accordance with the Privacy Act of 1974 (U.S.C. 552a) and the Paperwork Reduction Act of 1995, as amended. The authority for requesting the information to be supplied on this form is the Agricultural Marketing Agreement Act of 1937, Secs. 1-19, 48 Stat. 31, as amended, (7 U.S.C. 601-674). Furnishing the requested information is necessary for the administration of the marketing order program. Submission of the Tax Identification Number (TIN) is mandatory, and will be used to validate ballots and determine affiliation or entity identity. Please note that ballots will not become invalid if a TIN is not disclosed.

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.

FV-224 (Rev. 01/2014) Destroy previous editions.