FV-136B Cooperatives Certificate of Resolution (Hazelnuts)

OMB No. 0581-0178

REPRODUCE LOCALLY. Include fonn munber and date on all reproductions

COOPERATIVE'S CERTIFICATE OF RESOLUTION
At a duly convened meeting of the Board of Directors of
Name of Cooperative Association

held at

on the -

of

, 20-,

the followingresolution

was adopted:

who is

RESOLVED, that we authorize
Authorized agent's name

Title

of the cooperative association, to cast the attached cooperative

association referendum bal/ot for the membership of the aforesaid organization.

CERTIFICATION
I,

, Secretary of

do hereby certify this is a true and correct copy of a resolution adopted at the above-named meeting as said
resolution appears in the minutes thereof
IN WITNESS WHEREOF, I have hereunto set my hand and the seal of said Corporation this

(Corporate Seal:
if none, so state)

_

day of

Signature

Address of Firm

City, State, and Zip Code

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 nwnber. The valid OMB control nwnber 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
instructions, searching 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, political
beliefs, reprisal, or because all or part of an individual's income is derived ftom any public assistance program (Not all prohibited bases apply to
all programs.) Persons with disabilities who require alternative means for communication of program information (Braille, large print, audiotape,
etc.) should contact USDA's TARGET Center at (202) 720-2600 (voice and TDD).
To file a complaint of discrimination, write to USDA, Director, Office of Civil Rights, 1400 Independence Avenue, S.W., Washington, D.C.
20250-9410, or call (800) 795-3212 (voice) or (202) 720-6382 (TDD). USDA is an equal opportunity provider and employer.
FV-136B (12/06)