FV-309 Grower Nomination Form

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

American Pecan Council GROWER NOMINATION FORM

____________________ PROPOSED CANDIDATE TO BE INCLUDED ON THE

____________________ AMERICAN PECAN COUNCIL GROWER NOMINATION BALLOT

____________________

Each region shall be represented by three grower seats on the Council. Two seats shall be allocated to growers whose acreage is equal to or exceeds 176 pecan acres and one grower seat allocated to a grower whose acreage does not exceed 175 pecan acres. Proposed candidates will be listed in the nomination ballot sent to growers.

Eastern Region consists of: Alabama, Florida, Georgia, North Carolina, South Carolina

Central Region consists of: Arkansas, Kansas, Louisiana, Mississippi, Missouri, Oklahoma, Texas

Western Region consists of: Arizona, California, New Mexico

If a grower is engaged in producing pecans in more than one region, such grower shall nominate in the region in which they grow the largest volume of their production.

The undersigned are eligible to propose nominations pursuant to section 986.46 of Marketing Order No. 986 (Order), and hereby petition the American Pecan Council (Council) to include on the nominating ballot the name of:

_____________________________________________________________________________________________

NAME OF GROWER NOMINEE (as should appear on the ballot) EMAIL PHONE

_____________________________________________________________________________________________

ADDRESS CITY STATE ZIP CODE

as a candidate for the position of Grower Member to represent the _________ Region for the ____-____ term of office as set forth in the Order.

GROWER’S NAME (print clearly)	SIGNATURE*	ADDRESS/PHONE/EMAIL
(nominator)
(supporter)
(supporter)

*Signature certifies that I have a proprietary interest in 30 acres or more of pecans or produce an annual average of at least 50,000 pounds of inshell pecans and I am a grower in the region of which I am nominating or supporting a nomination.

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 OMB 0581-NEW 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.

THIS PETITION MUST BE RECEIVED NO LATER THAN _____________________, 20___ IN ORDER TO BE VALID.

Please mail the completed form to _______________________ or email to ___________________.

In accordance with Federal civil rights law and U.S. Department of Agriculture (USDA) civil rights regulations and policies, the USDA, its Agencies, offices, and employees, and institutions participating in or administering USDA programs are prohibited from discriminating based on race, color, national origin, religion, sex, gender identity (including gender expression), sexual orientation, disability, age, marital status, family/parental status, income derived from a public assistance program, political beliefs, or reprisal or retaliation for prior civil rights activity, in any program or activity conducted or funded by USDA (not all bases apply to all programs). Remedies and complaint filing deadlines vary by program or incident.

Persons with disabilities who require alternative means of communication for program information (e.g., Braille, large print, audiotape, American Sign Language, etc.) should contact the responsible Agency or USDA’s TARGET Center at (202) 720-2600 (voice and TTY) or contact USDA through the Federal Relay Service at (800) 877-8339. Additionally, program information may be made available in languages other than English.

To file a program discrimination complaint, complete the USDA Program Discrimination Complaint Form, AD-3027, found online at http://www.ascr.usda.gov/complaint_filing_cust.html and at any USDA office or write a letter addressed to USDA and provide in the letter all of the information requested in the form. To request a copy of the complaint form, call (866) 632-9992. Submit your completed form or letter to USDA by: (1) mail: U.S. Department of Agriculture Office of the Assistant Secretary for Civil Rights 1400 Independence Avenue, SW Washington, D.C. 20250-9410; (2) fax: (202) 690-7442; or (3) email: [email protected]. USDA is an equal opportunity provider, employer, and lender.

FV-309 (11/2015)