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

OMB No. 0581-0178

VOTING DEADLINE

__________, 20___

California Walnut Board

101 Parkshore Drive, Suite 250

Folsom, CA 95630

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

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	Vote
Write In:		Write In:
Write In:		Write In:

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 City State Zip

Authorized Signature Print Name

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.

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: program.intake@usda.gov. USDA is an equal opportunity provider, employer, and lender.

(Rev. 01/2017) Destroy previous editions.