FV-136A Cooperative Association Referendum Ballot (Hazelnuts)

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

COOPERATIVE ASSOCIATION REFERENDUM BALLOT

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

Please read the attached VOTING INSTRUCTIONS AND RULES GOVERNING PRODUCER ELIGIBILITY TO VOTE before completing this Ballot.

This referendum is being held to determine producer support for Marketing Order No. 982 (Order), regulating the handling of hazelnuts grown in Oregon and Washington. The Secretary of Agriculture (Secretary) 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.

A. Do you favor continuance of Marketing Order No. 982, regulating the handling of hazelnuts grown in Oregon and Washington?

 YES  NO

COOPERATIVE ASSOCIATION ELIGIBILITY STATEMENT

B. Contact Name _________________________________ Phone Number _____________

Name of Cooperative Association __________________________________________________

Mailing Address ________________________________________________________________

City _______________________________ State _______________ Zip _________

What is the total tons of hazelnuts produced in the production area by the member producers of this cooperative association during the representative period from _____________, 20___ through ____________, 20___?
What is the total number of producers for which this cooperative association is casting this Ballot?

C. 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. The information provided in this Ballot is required to determine the voter eligibility and vote of hazelnut producers. Falsification of information on this government document may result in a fine or imprisonment, or both. (18 U.S.C. 1001)

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.

VOTING INSTRUCTIONS AND RULES GOVERNING

PRODUCER ELGIBILTY TO VOTE

1. VOTING PERIOD: ________________, 20___ through ________________, 20___

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

3. PRODUCTION AREA: States of Oregon and Washington

4. PERSONS ELIGIBLE TO VOTE: Any cooperative association engaged in the handling of hazelnuts grown in the production area during the representative period. Section 608c(12) of the Agricultural Marketing Agreement Act of 1937 provides, in part, that the Secretary of Agriculture shall consider the approval or disapproval by any cooperative association, bona fide engaged in the marketing of the commodity covered by the subject marketing order, as the approval or disapproval of the producers who are members of, stockholders in, or under contract with, such cooperative association. Cooperative associations are defined in the Capper-Volstead Act (7 U.S.C. §§ 291, 292). Each separate business unit, partnership, LLC, family enterprise, corporation, association, estate, or firm that is a member of the cooperative association 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 hazelnuts produced thereon;

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

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

5. HOW TO VOTE:

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

2. Print or type the information requested under the eligibility statement. All information must be provided to ensure the validity of the Ballot.

3. Sign below the certification. Incomplete or unsigned Ballots cannot be counted.

4. Attach to the Ballot a list of hazelnut producers in the production area who are currently members of, stockholders in, or under contract with the cooperative association named herein as of the date this Ballot is cast, and who produced hazelnuts for market during the representative period. For each such producer provide the following:

   1. Address (street and house number, rural route number, city, state, and zip code).

   2. Volume of hazelnuts produced for fresh market during the representative period in tons.

5. Attach to the Ballot a certified copy of the resolution of the Board of Directors authorizing the individual signing this Ballot to cast the Ballot on behalf of the cooperative association.

6. Mail the completed Ballot, producer list, and corporate resolution in the enclosed envelope and return to:

Referendum Agent

USDA-AMS-FV-NWMFO

1220 SW 3^rd AVENUE, SUITE 305

PORTLAND, OR 97204

For further information, please call (503) 326-2724. Ballots must be postmarked by _______________, 20___.

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