AVO-OPB Avocados Producer Ballot

OMB No. 0581-0093

HASS AVOCADO BOARD 20XX OFFICIAL PRODUCER BALLOT

PLEASE FOLLOW THESE FOUR STEPS (See reverse side for further information):

1. Determine your voting eligibility

2. Sign your ballot (required)

3. Check the appropriate voting boxes

4. Return ballot by MONTH xx, 20xx, in order for it to be counted 

Hass Avocado Board (HAB) has engaged an independent Certified Public Accounting (CPA) Firm to conduct the nomination process to arrive at two names for each open seat. The names of those receiving the highest number of votes for the available seats will be submitted to the U.S. Secretary of Agriculture (Secretary). The Secretary will make the final decision on who will be appointed to fill the open seats. For information, call HAB xxx-xxx-xxxx.

VOTER ELIGIBILITY, CERTIFICATION, AND VOTING INSTRUCTIONS

STEP 1: In order to be eligible to vote, you must currently meet the definition of a Hass avocado producer: Under the Hass Avocado Promotion, Research, and Information Order, 7 CFR Part 1219, a PRODUCER is defined as: Any person who is engaged in the business of producing Hass avocados in the United States for commercial use, who owns, or shares the ownership and risk of loss, of such Hass avocados.

If you DO NOT meet the criteria, check the box to the right, print and sign your name, and return your ballot without completing it.

Print Name: ______________________________ Signature: ____________________________ Date: ______________

Company Name: ________________________________________ Phone: _______________________________

STEP 2: If you are an eligible Hass producer, complete the certification and voting sections below.

Certification Statement I hereby CERTIFY that I am a producer of Hass avocados in the United States. If this ballot is being cast on behalf of any group of individuals, partnership, corporation, or other business entity engaged in importing Hass avocados, I also CERTIFY that I have the authority to cast this ballot.: ___________________________________ ____________________________________ ________________ Signature Title Date
Print First and Last Name:
Company name:			Phone:

UNSIGNED BALLOTS ARE INVALID AND WILL NOT BE COUNTED

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STEP 3: Vote for no more than X producer nominees (including write-ins) by placing a check ( ) in the left column next to your preference. If you vote for more than X producer nominees, your ballot will be disqualified. If you wish to vote for a producer whose name is not on the ballot, you may write the name of the person on the write-in line and check the appropriate space. The term of office is for a 3-year term (November 1, 20xx, to October 31, 20xx). Candidate information forms are included in this package.

Vote 	PRODUCER NOMINEES		Vote 	PRODUCER NOMINEES
				Write-in optional
				Write-in optional
				Write-in optional

STEP 4: Mail this ballot to (CPA firm) in the return envelope provided Ballots postmarked after xx/xx/20xx will not be counted.

(Name of CPA firm)

Street Address

City, State, Zip

ADDITIONAL VOTING INSTRUCTIONS

The making of any false statement or representation on this form, knowing it to be false, is a violation of Title 18, §1001 United States Code, which provides for the penalty of a fine of $10,000, imprisonment of not more than 5 years, or both.

Voters who are eligible as both a producer and an importer must declare in writing prior to voting whether they will be voting as a producer or an importer. Please complete the form included in your packet and fax to HAB at xxx-xxx-xxxx.

Please cast your ballot for the nominees, OR WRITE IN THE PRODUCER NAME(S) OF YOUR CHOICE. If you choose to write in a candidate name, you must include their full name and contact information. Each Hass avocado producer is entitled to submit one ballot. If more than one ballot is submitted by the same producer, that producer’s ballot will not be counted. An unsigned ballot or incomplete Certification Statement will disqualify the ballot.

Signed ballots must be returned to (CPA firm) in the enclosed, prepaid, self-addressed envelope. Ballots must be received no later than close of business on xx/xx/20xx. Ballots postmarked after xx/xx/20xx will not be counted.

If you have any questions regarding the ballot, please contact HAB at xxx-xxx-xxxx.

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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, 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.

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IMPORTANT NOTICE

Voters who are eligible as both a producer and an importer must declare in writing prior to voting whether they will be voting as a producer or an importer.

If you represent both Producer and Importer, please complete the following and fax to HAB at xxx-xxx-xxxx.

I will be voting as: (check one)

• PRODUCER

• IMPORTER

Name: ____________________________________

Signature: _________________________________

If proper protocol is not followed, your vote could be disqualified.

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