Ballot - CA Walnut Board - Handler, Members & Alternates

California Walnut Board OMB No. 0581-0178

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VOTING DEADLINE

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01 Parkshore Drive, Suite 250

Folsom, CA 95630

Tel: (916) 932-7070 Fax: (916) 932-7071

BALLOT

CALIFORNIA WALNUT BOARD

ELECTION OF [DISTRICT 1 / DISTRICT 2 / OR DELETE] 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 1 / District 2 / or delete] handlers of walnuts of the California Walnut Board for the two-year term beginning September 1, _______.

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 1 / DISTRICT 2 / OR DELETE] HANDLER NOMINEES

Member	Vote	Alternate Member	Vote
Write In:		Write In:
Write In:		Write In:

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CERTIFICATION OF ELIGIBILITY

I hereby certify that I am currently a qualified handler of walnuts and operated as such a handler during the _________________ marketing year.

Legal Name of Voting Entity

Address City State Zip

Authorized Signature Print Name

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.

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 0581-0178. 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 from 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) 795-3272 (voice) or (202) 720-6382 (TDD). USDA is an equal opportunity provider and employer.

Rev. 04/09