FV-266-10 915-Avocados Grower Ballot to Nominate Members and Alter

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 PROGRAM

GROWER BALLOT TO NOMINATE MEMBERS AND ALTERNATE MEMBERS

FOR DISTRICT I OR DISTRICT II (circle applicable District)

I hereby cast my Ballot for the following nominees to serve as member and alternate member to represent Growers from District I or District II on the Avocado Administrative Committee (Committee), Marketing Order No. 915, during the term of office that begins April 1, 20____ and ends March 31, 20____. Mark the Ballot for no more than eight (8) of the nominees listed below.

	Nominee Name			Nominee Name
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PERSONS VOTING BY MAIL MUST SIGN THIS BALLOT FOR IT TO BE VALID.

I certify that I am District I or District II (circle applicable District) Grower registered with the Avocado Administrative Committee in Homestead, Florida.

Name:

Signature:

Ballots must be received by ______________________________, 20___ to be valid.

Ballots received after that date will not be counted.

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 5 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-266-10 (Rev. 9/13. Destroy previous editions.)