FV-136B Cooperatives Certificate of Resolution (Hazelnuts)

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

COOPERATIVE’S CERTIFICATE OF RESOLUTION

Marketing Order No. 982: Hazelnuts Grown in Oregon and Washington

At a duly convened meeting of the Board of Directors of ______________________________________

Name of Cooperative Association

held at _____________________________ on the _____ day of _______________, 20___, the following

resolution was adopted:

RESOLVED, that we authorize _______________________________________________, who is

Authorized agent’s name

____________________________________ of the Cooperative Association, to cast the attached

Title

cooperative association referendum Ballot for the membership of the aforesaid organization.

CERTIFICATION

I, __________________________________, Secretary of ______________________________________

do hereby certify that this is a true and correct copy of a resolution adopted at the above-named meeting as said resolution appears in the minutes thereof.

IN WITNESS WHEREOF, I have hereunto set my hand and the seal of said organization this _____ day of ________________________, 20___.

_______________________________________

(Corporate Seal: Signature

if none, so state)

_______________________________________

Address of Firm

_______________________________________

City, State, and Zip Code

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 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-136B (Rev. 01/2014) Destroy previous editions.