FV-269 Olives Producer Nomination Ballot (Dist. 1)

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

Ballot No. __________

UNITED STATES DEPARTMENT OF AGRICULTURE

AGRICULTURAL MARKETING SERVICE

FRUIT AND VEGETABLE PROGRAM

PRODUCER NOMINATION BALLOT

CALIFORNIA OLIVE COMMITTEE

DISTRICT NO. 1: Counties of Alpine, Tuolumne, Stanislaus, Santa Clara, Santa Cruz,

and all counties north thereof:

MEMBER CANDIDATES [VOTE FOR THREE (3)]		ALTERNATE CANDIDATES [VOTE FOR THREE (3)]

I certify that I am authorized to vote on behalf of the producing entity and that such producing entity delivered or intended to deliver olives for use as packaged olives for the 20___ - 20___ crop year.

THE BALLOT IS NOT VALID (AND WILL NOT BE COUNTED) IF THE PRODUCER NAME, SIGNATURE, AND ADDRESS ARE NOT ON THE RETURN ENVELOPE.

Return in envelope provided to: California Olive Committee

770 E. Shaw Avenue, Suite 310

Fresno, CA 93710

BALLOTS MUST BE POSTMARKED NO LATER THAN _____________, 20__.

This information is used to verify the provisions of the Marketing Order, 7 CFR 932.129. Making any false statements or representations in any matter within the jurisdiction of any agency of the United States, knowing it to be false, is a violation of title 18, section 1001, of the United States Code, which provides for penalty or imprisonment, or both.

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 15 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-269 (Rev. 01/2014. Destroy previous editions.)