No Form number Vidalia Onion Grower Election Ballot

OMB No. 0581-0178

GROWER BALLOT

Marketing Order No. 955 - Vidalia Onions Grown in Georgia

20___ ELECTION

Ballot No. ________________

These elections are for nominees to fill (4) seats and (4) alternate seats on the Vidalia Onion Committee. Please indicate your votes by placing an “X” on the line next to the names of your selected candidates. You may vote for up to eight individuals (including any write-ins). Ballots with more than eight votes will be voided. All candidates listed below are eligible to serve.

Name__________________________ Name__________________________

Name__________________________ Name__________________________

Name__________________________ Name__________________________

Name__________________________ Name__________________________

Name__________________________ Name__________________________

Name__________________________ Name__________________________

Name__________________________ Name__________________________

Name__________________________ Name__________________________

WRITE IN CANDIDATES MAY BE LISTED BELOW

_______________________________ _______________________________

_______________________________ _______________________________

_______________________________ _______________________________

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for the information collection is 0581-0178. The time required to complete this information collection is estimated to average 5 minutes, including the time for reviewing instructions, searching existing data sources, gathering 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.

(Exp. x/xxxx) Destroy previous editions.