Form SC-53 Cranberries Producer Ballott (rev.)

REPRODUCE LOCALLY. Include form number and date on all reproductions. OMB No. 0581-0189

USE TAPE – DO NOT STAPLE

ag code 0237

united states department of agriculture

Agricultural Marketing Service

SPECIALTY CROPS Program

Marketing Order AND AGREEMENT DIVISION

1400 INDEPENDENCE AVE., S.W.

Room 1406 - South Building

WASHINGTON, DC 20250-0237

Official Business

Penalty for Private Use $300 No Postage Stamp Necessary

Postage Has Been Prepaid By:

Referendum Agent

Southeast Marketing Field Office

1124-1^st Street South

Winter Haven, FL 33880

BALLOT

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 OMB 0581-0189. 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.

U.S. DEPARTMENT OF AGRICULTURE AGRICULTURAL MARKETING SERVICE OFFICIAL PRODUCER BALLOT CRANBERRY MARKETING ORDER NO. 929

INSTRUCTIONS: Complete the Ballot and Certification. Fold on the dotted line with the address displayed, and return. Information you enter on this Ballot will be kept strictly confidential. In order to be counted, your Ballot must be signed and postmarked by ________________, 20___.

Please read all questions and answer those that apply to you. This Referendum is for the purpose of determining whether growers favor continuance of Marketing Order No. 929.

Do you favor continuance of Marketing Order No. 929 regulating the handling of cranberries grown in the States of Massachusetts, Rhode Island, Connecticut, New Jersey, Wisconsin, Michigan, Minnesota, Oregon, Washington, and Long Island in the State of New York?

YES, I favor continuance of Marketing Order No. 929.

NO, I do not favor continuance of Marketing Order No. 929.

CERTIFICATION STATEMENT

I hereby certify that I am a producer and produced cranberries within the defined production area during the 20___ crop year (September 1, 20___ through August 31, 20___). (If you did not harvest cranberries from your acreage during 20___ because of crop failure or non-bearing acreage, write “NONE” in the space provided for number of barrels below).

________________ from ___________________ in _____________________________

(barrels) (approx. acreage) (State)

Name		Address
Signature
		Date

NOTE: If you are renting on a share crop basis, you should report only that part of the crop represented by your share.

If you marketed any of the above cranberries through a cooperative marketing association, please list the cooperative’s name.

NOTE: If the vote is cast on behalf of a corporate, estate, or producer, my signature certifies that I have the authority to take such action. (IN SUCH CASE, SHOW NAME OF SUCH CORPORATION, ESTATE, OR PRODUCER AND YOUR TITLE BELOW).

Name of corporation, estate, or producer

Title

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, AD-3027, 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.

SC-53 (Rev. 9/2016. Destroy previous editions.)