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OMB No. 0581-0178 

GROWER BALLOT 

Marketing Order No. 955 - Vidalia Onions Grown in Georgia 

20___ ELECTION 

Ballot No. ________________ 

These elections are for nominees to fill (4) seats and (4) alternate seats on the Vidalia Onion Committee. 

Please indicate your votes by placing an “X” on the line next to the names of your selected candidates. 

You may vote for up to eight individuals (including any write-ins). Ballots with more than eight votes 

will be voided. All candidates listed below are eligible to serve. 

Name__________________________ 

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WRITE IN CANDIDATES MAY BE LISTED BELOW 

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid 

OMB control number. The valid OMB control number for the information collection is 0581-0178. The time required to complete this 

information collection is estimated to average 5 minutes, including the time for reviewing instructions, searching existing data sources, gathering 

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. 

(Exp. 3/31/2024) Destroy previous editions.