Form LP-8 Natural Grass Sod Ballot

FORM APPROVED OMB NO. 0581-NEW

United States Department of Agriculture
Agricultural Marketing Service
OFFICIAL REFERENDUM BALLOT

I. ELIGIBLITY
I have been engaged in the production and sale of natural grass sod products
in the United States during the period [INSERT DATE] through [INSERT
DATE, and am currently a natural grass sod producer.

Natural Grass Sod Promotion, Research, and
Information Order

YES 

To be counted, completed ballots must be received by the
U.S. Department of Agriculture on [INSERT DATE] by
4:30 p.m. Eastern Time.
NOTE: Only one vote will be counted for each eligible natural grass
sod producer. Incomplete ballots may be INVALID and may not be
counted in the referendum.

NO 

**USDA may request documentation to support the claim above.

II. VOTE
Instructions: Mark one box only.

Do you favor implementing the Natural Grass Sod
Promotion, Research, and Information Order?

YES 

NO 

III. CERTIFICATION AND SIGNATURE
ALL BALLOTS MUST BE SIGNED BELOW IN ORDER TO BE COUNTED.

I CERTIFY that I am the person authorized to cast this ballot and that the information contained
on this ballot is true, complete, and correct to the best of my knowledge and belief, and is made
in good faith. If this ballot is being cast on behalf of any group of individuals, partnership,
corporation, or other business entity engaged in the production and sale of natural grass sod
products, I also CERTIFY that I have the authority to cast this ballot.

____________________________

____________________________

____________________________

____________________________

____________________________

____________________________

SIGNATURE

PRINTED NAME
ENTITY NAME

LP-8 (Expiration Date XX/XX/XXXX)

DATE

TELEPHONE NUBMER

TAX ID/EMPLOYER ID#

IV. MAILING
Return ballot in the enclosed, postage-paid envelope.
See reverse for burden/non-discrimination statement

Note: The making of any false statement or representation on this form, knowing it to be false, is a violation of Title 18, section 1001 United States Code, which provides for
the penalty of a fine of $10,000 or imprisonment of not more than 5 years, or both.
The following statements are made in accordance with the Privacy Act of 1974 (5 U.S.C. §522a) and the Paperwork Reduction Act of 1995, as amended. The authority for
requesting this information to be supplied on this form is from the applicable commodity legislation for research and promotion programs. Furnishing the requested
information is necessary for the administration of this program. Submission of Tax Identification Number (TIN) or importer identification number is mandatory and will be
used to determine affiliation or entity identity.
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-NEW. The time required to complete this information
collection is estimated to average 15 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.