FV-39 Producer Referendum Ballot (WA Potatoes)

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

WASHINGTON STATE POTATO BALLOT

UNITED STATES DEPARTMENT OF AGRICULTURE

Agricultural Marketing Service

Fruit and Vegetable Program

Northwest Marketing Field Office

1220 SW 3^rd Avenue, Suite 305

Portland, OR 97204

_____________________________________________________________________________________

TO WASHINGTON STATE POTATO PRODUCERS:

The U.S. Department of Agriculture is conducting a referendum to determine whether potato producers in Washington State favor continuance of Federal Marketing Order No. 946. As a consequence, an order directing that a referendum be held was published in the Federal Register on __________________, 20___.

A Producer Referendum Ballot is on the reverse side of this page. Also enclosed are:

1. Voting Instructions and Rules Governing Producer Eligibility to Vote;

2. News Release issued on the Referendum; and

3. Copy of the Referendum Order dated ________________, 20___.

The voting period for the referendum is ______________, 20___ through _____________, 20___. Please vote promptly because Ballots postmarked later than _______________, 20___, cannot be opened or counted. Each Ballot will be held in strict confidence.

_____________________________________

Referendum Agent

Phone: (503) 326-2724

PRODUCER REFERENDUM BALLOT

Marketing Order No. 946 – Irish Potatoes Grown in Washington

This referendum is being held to determine producer support for the federal marketing order regulating the handling of potatoes grown in certain designated counties in Idaho, and Malheur County, Oregon. The Secretary of Agriculture will consider termination of this order if less than two-thirds of those voting and less than two-thirds of the volume represented in the referendum favor continuance.

1. Do you favor continuance of Marketing Order No. 945, regulating the handling of potatoes grown in Washington?

 YES  NO

PRODUCER ELIGIBILITY STATEMENT

2. I hereby certify that I am currently a producer of potatoes within the production area. During the representative period _____________, 20___, through _____________, 20___, I produced for the fresh market ____________ hundredweight on __________ acres in ______________________________________________________ county(ies).

3. Name of Packing House(s) that Handled your Potatoes Hundredweight Affiliation

___________________________________________ ________________ _____________________

___________________________________________ ________________ _____________________

___________________________________________ ________________ _____________________

4. Producer’s Name __________________________________________ Telephone ___________________

Name of Business __________________________________________________________________________

Mailing Address ____________________________________________________________________________

5. If this Ballot is cast by an officer or employee of a partnership, LLC, corporation, association or other business unit, my signature below further certifies that I am duly authorized to vote on behalf of the producing entity name on this Ballot and that I will submit evidence of such authority at the request of an Agent of the Secretary.

Partnership LLC Corporation Association Other ____________________________

______________________________________ ____________________________________

Signature* Title

__________________________________________________________________________________

If Partnership or Joint Venture, list name(s).

6. I hereby certify that the information I provided on this Ballot is accurate and correct to the best of my knowledge.

_____________________________________________ ___________________________________________

Signature* Title

*Your signature certifies that you have the authority to take such action and will submit supplementary evidence of such authority at the request of an agent of the Secretary of Agriculture. The information provided in this Ballot is required to determine voter eligibility and vote of potato producers.

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 20 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.

WASHINGTON STATE POTATO BALLOT

UNITED STATES DEPARTMENT OF AGRICULTURE

Agricultural Marketing Service

Fruit and Vegetable Program

Northwest Marketing Field Office

1220 SW 3^rd Avenue, Suite 305

Portland, OR 97204

Referendum Agent

USDA-AMS-F&V-NWMFO

1220 SW 3^rd AVENUE, SUITE 305

PORTLAND, OR 97204

FOLD HERE, TAPE AT THE TOP, AND MAIL PROMPTLY 

WASHINGTON STATE

POTATO BALLOT

VOTING INSTRUCTIONS AND RULES

GOVERNING PRODUCER ELIGIBILITY TO VOTE

I. VOTING PERIOD: _______________, 20___ through _______________, 20___

II. REPRESENTATIVE PERIOD: _______________, 20___ through _______________, 20___

III. PRODUCTION AREA: State of Washington

IV. PERSONS ELIGIBLE TO VOTE: Any person who is currently a fresh market potato producer in the production area and produced such potatoes during the representative period ________________, 20___ through ________________, 20___ is entitled to cast one Ballot. Each separate business unit, partnership, LLC, family enterprise, corporation, association, estate, or firm is entitled to one vote.

“Producer” means any individual, partnership, LLC, corporation, association, institution, estate, or other business unit who:

• Owns and farms land resulting in ownership of the potatoes produced thereon;

• Rents and farms land resulting in ownership of all or a portion of the potatoes produced thereon; or

• Owns land from which, as rental for such land, ownership is obtained of a portion of the potatoes produced thereon. (A lien holder, cash landlord, or person having only a financial interest in the potato crop is not eligible to vote.)

V. HOW TO VOTE:

1. Indicate your vote by placing an “X” in the appropriate box.

2. Certify your potato production by listing the volume in hundredweight that you produced, the number of acres in production, and the county or counties in which such potatoes were produced during the representative period ______________, 20___ through ______________, 20___. If you are renting on a share-crop basis, you should show only that part of the crop represented by your share.

3. List the names of packing houses that handled your potatoes, the hundredweight, and affiliation (co-op or independent).

4. Print or type your name, phone number, business name, and address.

5. Proxy voting is not authorized. If Ballot is cast by an officer or employee of a partnership, LLC, corporation, association or other business unit, check box to indicate your business designation, and sign to indicate authority to vote. If partnership or joint venture, list names of partners.

6. Sign below the certification. Incomplete or unsigned Ballots cannot be counted. Fold your Ballot so the Referendum Agent’s address is displayed, seal with tape and mail to Referendum Agent, USDA-AMS-FV-NWMFO, 1220 SW 3^rd AVENUE SUITE 305, PORTLAND OR 97205. For further information, please call (503) 326-2724.

Ballots must be postmarked by ________________________, 20___ to be valid.

FV-39 (Rev. 01/2014. Destroy previous editions.)