FV-179 Cooperatives Referendum Ballot (CA Almonds)

REPRODUCE LOCALLY. Include form number on all reproductions. OMB NO. 0581-0178

U.S. DEPARTMENT OF AGRICULTURE

AGRICULTURAL MARKETING SERVICE

FRUIT AND VEGETABLE PROGRAM

COOPERATIVE ASSOCIATION BALLOT

ON PROPOSED AMENDMENT OF MARKETING ORDER NO. 981, REGULATING

THE HANDLING OF ALMONDS GROWN IN CALIFORNIA

I certify that I am an officer or employee of, and have been authorized by, _________________________ Cooperative Association, located at ___________________________________________________, to furnish the following information and cast this Ballot on behalf of such Cooperative Association. There are ______ producers who: (a) are members of, stockholders in, or under contract with this Cooperative Association; (b) are now engaged in the growing of almonds in California, and also were so engaged during the period of July 1, 20___ through March 31, 20___; and (c) during this same period so produced for market _______________ pounds (kernel weight) of almonds.

DOES THE COOPERATIVE ASSOCIATION FAVOR ISSUANCE BY THE SECRETARY OF AGRICULTURE OF THE PROPOSED AMENDMENT OF THE MARKETING ORDER REGULATING THE HANDLING OF ALMONDS GROWN IN CALIFORNIA? (Please indicate your vote by placing an “X” in one of the boxes below.)

□ YES □ NO

	Name of Cooperative Association
Corporate Seal (if none, so state)	Signature of Authorized Agent
	Title

BALLOTS POSTMARKED LATER THAN MIDNIGHT ON ______________________, 20___

CANNOT 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 0581-0178. The time required to complete this information collection is estimated to average 10 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, gender, religion, age, disability, sexual orientation, marital or family status, political beliefs, parental status, or protected genetic information. (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 USDA, Director, Office of Civil Rights, Room 326-W, Whitten Building, 14th and Independence Avenue, SW, Washington, DC 20250-9410 or call (202) 720-5964 (voice and TDD). USDA is an equal opportunity provider and employer.

FV-179 (Rev. 01/2014) Destroy previous editions.