ABC-18 Almond Board of CA. - Ballot for Cooperative Handler Mem

Vegetable and Specialty Crops

ABC-18 Cooperative Handler Ballot 2-12-19

Vegetable and Specialty Crops (Voluntary)

OMB: 0581-0178

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OMB No. 0581-0178

Almonds.com • 1150 Ninth St, Ste 1500 • Modesto, CA 95354 USA • T: +1.209.549.8262 • F:+1.209.549.8267


BALLOT FOR COOPERATIVE HANDLER MEMBERS


We hereby vote for the following nominees as member and alternate member of the Almond Board of California to represent the cooperative group of handlers for the term of office beginning August 1, 20___.


COOPERATIVE - HANDLER


Member Name


Member Address


Member Email




Alternate Name


Alternate Address


Alternate Email



I hereby certify that this cooperative handled for its own account, __________________ pounds of almonds (kernel weight basis during the 20__-20__ crop year to December 31, 20__). This amount is line 11 of the Redetermination Report.


Name of Cooperative


Address


Signature


Title



Return to the Almond Board, 1150 9th Street, Suite 1500, Modesto, California, 95354, no later than _______, 20__.



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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.

ABC-18 (1/2019)

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