MAN-BAL Mangos Domestic Producer Nomination Ballot

OMB No. 0581-0093

NATIONAL MANGO BOARD (7 CFR 1206)
DOMESTIC PRODUCER NOMINATION BALLOT
The nominees listed on this ballot are seeking a seat on the National Mango Board (NMB). As a
domestic producer, you are asked to vote for xxx candidates. The individual receiving the highest
vote total will be considered the first-choice of the industry for the vacant position and the next one
will be considered the second-choice for the position. Please mark your selection and completely
fill in the information requested.
Mail this ballot in time for it to be received by NMB on or before
Submissions received after this date will not be counted.

XX, 20XX.

NATIONAL MANGO BOARD
Street
City, State Zip Code
Please select XXX names from the list of nominees:



XXX



XXX



XXX



XXX
Certification Statement:

I certify that I produced Mangos at the location listed below during the twelve-month period of
January 1, 20XX through December 31, 20XX.
(Please type or print)

Company/Business Name:________________________________________________________
Name: _______________________________________________________________________
Title: _________________________________________________________________________
Address: ______________________________________________________________________
City: ______________________________________ State: ____________Zip code: __________
Signature: __________________________________ Date: ___________________

DIVERSITY STATEMENT
The National Mango Board (NMB) encourages industry members without regard to race, color,
national origin, sex, religion, age, disability, political beliefs, sexual orientation, size of
business/operation, and marital or family status or other basis protected by U.S. law to participate
in NMB activities and seek a position on the NMB.
(Continued on Back Page)

MAN-BAL (Rev. 03/17) Destroy previous editions.
(Domestic Producer)

OMB No. 0581-0093

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 0581-0093. The time required to complete this information
collection is estimated to average 15 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.
In accordance with Federal civil rights law and U.S. Department of Agriculture (USDA) civil rights regulations
and policies, the USDA, its Agencies, offices, and employees, and institutions participating in or administering
USDA programs are prohibited from discriminating based on race, color, national origin, religion, sex, gender
identity (including gender expression), sexual orientation, disability, age, marital status, family/parental status,
income derived from a public assistance program, political beliefs, or reprisal or retaliation for prior civil rights
activity, in any program or activity conducted or funded by USDA (not all bases apply to all programs).
Remedies and complaint filing deadlines vary by program or incident.
Persons with disabilities who require alternative means of communication for program information (e.g.,
Braille, large print, audiotape, American Sign Language, etc.) should contact the responsible Agency or
USDA’s TARGET Center at (202) 720-2600 (voice and TTY) or contact USDA through the Federal Relay
Service at (800) 877-8339. Additionally, program information may be made available in languages other than
English.
To file a program discrimination complaint, complete the USDA Program Discrimination Complaint Form, AD3027, found online at http://www.ascr.usda.gov/complaint_filing_cust.html and at any USDA office or write a
letter addressed to USDA and provide in the letter all of the information requested in the form. To request a
copy of the complaint form, call (866) 632-9992. Submit your completed form or letter to USDA by: 1) mail:
U.S. Department of Agriculture Office of the Assistant Secretary for Civil Rights 1400 Independence Avenue,
SW Washington, D.C. 20250-9410; 2) fax: (202) 690-7442; or 3) email: [email protected].
USDA is an equal opportunity provider, employer, and lender.

MAN-BAL (Rev. 03/17) Destroy previous editions.
(Domestic Producer)