F/H Form F(2) Hazelnut Ballot (Growers)

OMB No. 0581-0178

HAZELNUT MARKETING BOARD

21595-A Delores Way N.E.

Aurora, OR 97002-9738

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GROWER BALLOT

(To be submitted by eligible growers ONLY)

Please write in the name of one grower from your district who you would like to have represent growers from your district on the Hazelnut Marketing Board. This election is for a two year term beginning July 1, 20___.

DISTRICT NO. __________ CANDIDATE NAME ______________________________________________

This Ballot must be postmarked not later than April 30, 20___ to be valid. I hereby certify that I produced hazelnuts during the past season in the district noted above.

County in which orchard is located: ________________________________________________________________

_________________________________________ ___________________________________________

Print Name Signature

_____________________________________________________________________________________________

Address (include 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 3 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.

The following growers have been nominated to serve on the Hazelnut marketing Board (Board) from the districts noted. The person receiving the highest number voters in a district will be the member and the person receiving the second highest number of votes will become the alternate member. Growers may vote for only one candidate and are only eligible to vote only for a candidate in a district in which they produce hazelnuts. Any eligible grower can be elected to the Board. A grower need not be nominated and his/her name does not need to appear below for him/her to be eligible to serve. Write-in candidates are permissible. The Board encourages qualified women, minorities, and physically challenged candidates to participate and seek membership.

NOMINEES

DISTRICT NO. 1 (State of Washington, Clackamas, and Multnomah Counties)

1. _________________________

2. _________________________

DISTRICT NO. 2 (Marion and Polk Counties)

1. _________________________

2. _________________________

DISTRICT NO. 3 (Linn, Lane, and Benton Counties)

1. _________________________

2. _________________________

DISTRICT NO. 4 (Yamhill County)

1. _________________________

2. _________________________

DISTRICT NO. 5 (Washington and all other Counties)

1. _________________________

2. _________________________

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HAZELNUT MARKETING BOARD

21595-A Delores Way N.E.

Aurora, OR 97002-9738

F/H Form F(2) (Rev. 01/2014) Destroy previous editions.