FV-651 929-Cranberry M.O. Member & Alternate Member Nomination

Generic OMB Fruit Crops, Marketing Order Administration Branch

FV-651 Ballot (09-13)

Generic Fruit Crops (Voluntary)

OMB: 0581-0189

⚠️ Notice: This form may be outdated. More recent filings and information on OMB 0581-0189 can be found here:

Document [docx]

Download: docx | pdf

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

CRANBERRY MARKETING COMMITTEE

MEMBER AND ALTERNATE MEMBER BALLOT

I hereby cast my Ballot for two (2) of the following nominees to serve as one member and one alternate member to represent growers from Cranberry Marketing Order District No. _____ who are not from major cooperatives, on the Cranberry Marketing Committee during the term of office that begins

August 1, 20___. Mark the Ballot for two of the nominees listed below by placing an X in the box next to the nominee’s name.

NOMINEES

□		□
□		□
□		□
□		□
□		□
□		□
□		□
□		□
□		□
□		□

I certify that I am a producer of cranberries in District No. _____. (Please specify District Number.)

District 1: the States of Massachusetts, Rhode Island and Connecticut; District 2: the States of New Jersey and Long Island in the State of New York; District 3: the States of Wisconsin, Michigan and Minnesota; and District 4: the States of Oregon and Washington.

Name of person voting

Signature of person voting

Ballots must be postmarked by _________ in order to 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-651 (Rev. 9/13. Destroy previous editions.)

File Type	application/vnd.openxmlformats-officedocument.wordprocessingml.document
File Title	REPRODUCE LOCALLY
Author	David Farrimond
File Modified	0000-00-00
File Created	2021-01-24

□		□
□		□
□		□
□		□
□		□
□		□
□		□
□		□
□		□
□		□

□		□
□		□
□		□
□		□
□		□
□		□
□		□
□		□
□		□
□		□

□		□
□		□
□		□
□		□
□		□
□		□
□		□
□		□
□		□
□		□