Form LS-86 Lamb Promotion, Research, and Information Order Referend

FORM APPROVED. OMB NO. 0581-0227

REPRODUCELOCALLY.Include form number and date on all reproductions.
UNITED STATES DEPARTMENT OF AGRICULTURE
AGRICULTURAL MARKETING SERVICE

LAMB PROMOTION, RESEARCH, AND
INFORMATION ORDER REFERENDUM
NOTE: For the purpose of this referendum, "Lamb" means ovine animals of any age, including ewes and rams.
Please Complete Sections A. B. C. and D
Section A:

Do you favor the continuation of the Lamb Promotion, Research, and Information Order?
Yes

D

No

D
Enter Number of Lambs

Section B: Type(s) of Production
ProducerlSeedstock
-Total number of domestic lambs owned and produced during calendar year 20
Feeder
-Total number oflambs owned and fed during calendar year 20
First Handler (packer)
-Total number of lambs slaughtered during calendar year 20
Total:
Section C: Name and Address
Name of person or Other Entity Represented: (Print)
Address: (Street, P.O. Box, or Route No.)
State:

City:

Section D: Certification

Statement

Zip Code:

and Signature

I HEREBY CERTIFY that I am a person (any individual, group of individuals, partnership, corporation,
association, cooperative or any other legal entity) or authorized representative and have engaged rn the production,
feeding, or slaughtering of lambs sometime from
, through
. I am voting
only once in the same capacity registered.
I FURTHER CERTIFY that the supporting documentation that I am providing along with this form and the
volume of production voted is true, complete, and correct.
FAILURE TO PROVIDE supporting documentation showing that the person voting was engaged in the
production,feeding, or slaughtering of lambsfrom
, through
, enter
number of lambs, complete the ballot in its entirety, or provide a signature will invalidate this ballot.

'Signature

me

Date

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 0581-0227.
The time required to complete this information collection is estimated to average 2 minutes per response, including the time for reviewing
instructions, seatehing existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.
The U.S. Department of Agriculture (USDA) prohibits discrimination
in all its programs and activities on the basis of race, color, national origin, age, disability, and where applicable, sex, marital status, familial status, parental status, religion, sexual orientation, genetic information,
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of program informaffon (Braille, large print, audiotape, etc.) should contact USDA's TARGET Center at (202) 720-2600 (voice and TOO). To file a complaint of discrimination,
write to USDA,
Director,

LS-86

Office of Civil Rights,

1400 Independence

Avenue,

S. w., Washington,

D. C. 20250-9410,

or call (800) 795-3272

(voice) or (202) 720-6382

(TOO). USDA is an equal opportunity

provider and employer.