No Form number (984) Walnut Mktng. Bd. Ballot Independent Handler Membe

OMB No. 0581-0178

California Walnut Board
110 Woodmere Rd., Suite 250
Folsom, CA 95630
Tel: (916) 932-7070; Fax: (916) 932-7071

VOTING DEADLINE
__________, 20___

BALLOT
ELECTION OF DISTRICT ___ HANDLER MEMBERS AND ALTERNATES
VOTING INSTRUCTIONS
In accordance with the provisions of Section 984.37 of Marketing Order No. 984, as amended, I hereby vote for the
following members and alternates as representatives of District ___ handlers of walnuts of the California Walnut
Board for the two-year term beginning September 1, 20___.
Walnut handlers may vote for two members and two alternates. Mark an “X” opposite your choice if your wish to
vote for the candidates listed. Write-in lines are provided if you wish to nominate qualified walnut handlers who are
not shown on the ballot. Please type or print clearly the handler’s name and address in the space provided. Vote for
only two names in each column.
Your ballot will be invalidated if you vote for more than two persons for each position.
DISTRICT ___ HANDLER NOMINEES
Member

Vote

Alternate Member

Write In:

Write In:

Write In:

Write In:

Vote

CERTIFICATION OF ELIGIBILITY
I hereby certify that I am currently a qualified handler of walnuts and operated as such a handler during the 20______
marketing year.
Legal Name of Voting Entity
Address
Authorized Signature

City

State

Zip

Print Name

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collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 05810178. The time required to complete this information collection is estimated to average 5 minutes per response, including the time for reviewing
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(Exp. 4/30/2027) Destroy previous editions.

OMB No. 0581-0178

BACKGROUND INFORMATION
In the event one handler does not handle 35% or more of the crop:
§ 984.35(a)(1) Two handler members from District 1; and
§ 984.35(a)(2) Two handler members from District 2.
In the event one handler handles 35% or more of the crop:
§ 984.35(b)(3) Two handler members to represent handlers that do not handle 35% or more of the crop.
Districts:
District 1: Consists of the counties in the State that lie north of a line drawn on the southern boundaries of
San Mateo, Alameda, San Joaquin, Calaveras and Alpine counties.
District 2: Consists of all other counties in the State south of the boundary line set forth in the definition of
District 1.

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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(Exp. 4/30/2027) Destroy previous editions.