SC-161 905-Citrus Grown in FL. Cooperative Association Producer

REPRODUCE LOCALLY. Include form number and date on all reproductions. OMB No. 0581-0189

UNITED STATES DEPARTMENT OF AGRICULTURE

AGRICULTURAL MARKETING SERVICE

SPECIALTY CROPS PROGRAM

COOPERATIVE ASSOCIATION PRODUCER BALLOT

ON THE CONTINUANCE OF MARKETING ORDER NO. 905, REGULATING

ORANGES, GRAPEFRUIT, TANGERINES AND TANGELOS GROWN IN FLORIDA

I hereby certify that I have been authorized¹ by the

_____________________________________________________________________________________

(Name of Cooperative)

_____________________________________________________________________________________

(Address of Cooperative)

to furnish the following information and to cast this Ballot on behalf of such cooperative association. There are ________ members of this cooperative who, during the period _______________, 20___ through _____________, 20___ produced for shipment to the fresh market the following number of boxes (1-3/5 bushel equivalents) of citrus grown in Florida:

	Boxes of Oranges		Boxes of Tangerines
	Boxes of Grapefruit		Boxes of Tangelos

A list showing names of our producers and the volume shipped by each is attached.

A "YES" vote means you favor continuance of Marketing Order No. 905 regulating the handling of Oranges, Grapefruit, Tangerines, and Tangelos Grown in Florida.

A "NO" vote means you do not favor continuance of Marketing Order for No. 905 regulating the handling of Oranges, Grapefruit, Tangerines, and Tangelos Grown in Florida.

Do you favor the continuance of Marketing Order No. 905, regulating the handling of Oranges, Grapefruit, Tangerines, and Tangelos Grown in Florida?

 YES  NO

	By
Name of Cooperative		Signature of Authorized Agent
		Title
Affix corporate seal; if none, so state
		Date

¹ Prepare certified copy of the Resolution authorizing the casting of this Ballot.

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 OMB 0581-0189. The time required to complete this information collection is estimated to average 2 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.

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.

SC-161 (Exp. X/XXXX) Destroy previous editions.