REPRODUCE LOCALLY. Include form number and date on all reproductions. OMB No. 0581-0178

SC-136A (Rev. 5/2017) Destroy previous editions.

VOTING INSTRUCTIONS AND RULES GOVERNING 

PRODUCER ELGIBILTY TO VOTE

I. VOTING PERIOD: ________________, 20___ through ________________, 20___

II. REPRESENTATIVE PERIOD: _______________, 20___ through _______________, 20___

III. PRODUCTION AREA: States of Oregon and Washington

IV. PERSONS ELIGIBLE TO VOTE: Any cooperative association engaged in the handling of hazelnuts 

grown in the production area during the representative period. Section 608c(12) of the Agricultural 

Marketing Agreement Act of 1937 provides, in part, that the Secretary of Agriculture shall consider the 

approval or disapproval by any cooperative association, bona fide engaged in the marketing of the 

commodity covered by the subject marketing order, as the approval or disapproval of the producers who are 

members of, stockholders in, or under contract with, such cooperative association. Cooperative 

associations are defined in the Capper-Volstead Act (7 U.S.C. §§ 291, 292). Each separate business unit, 

partnership, LLC, family enterprise, corporation, association, estate, or firm that is a member of the 

cooperative association is entitled to one vote. 

“Producer” means any individual, partnership, LLC, corporation, association, institution, estate, or other 

business unit who:

• Owns and farms land resulting in ownership of the hazelnuts produced thereon;

• Rents and farms land resulting in ownership of all or a portion of the hazelnuts produced thereon; 

or

• Owns land from which, as rental for such land, ownership is obtained of a portion of the hazelnuts 

produced thereon. (A lien holder, cash landlord, or person having only a financial interest in the 

hazelnut crop is not eligible to vote.)

V. HOW TO VOTE:

A. Indicate your vote by placing an “X” in the appropriate box.

B. Print or type the information requested under the eligibility statement. All information must be provided to 

ensure the validity of the Ballot. 

C. Sign below the certification. Incomplete or unsigned Ballots cannot be counted. 

D. Attach to the Ballot a list of hazelnut producers in the production area who are currently members of, 

stockholders in, or under contract with the cooperative association named herein as of the date this Ballot is 

cast, and who produced hazelnuts for market during the representative period. For each such producer 

provide the following:

a. Address (street and house number, rural route number, city, state, and zip code).

b. Volume of hazelnuts produced for fresh market during the representative period in tons.

E. Attach to the Ballot a certified copy of the resolution of the Board of Directors authorizing the individual 

signing this Ballot to cast the Ballot on behalf of the cooperative association.

F. Mail the completed Ballot, producer list, and corporate resolution in the enclosed envelope and return to:

Referendum Agent

USDA-AMS-SCP-NWMFO

1220 SW 3rd AVENUE, ROOM 308

PORTLAND, OR 97204

For further information, please call (503) 326-2724. Ballots must be postmarked by _______________, 20___.

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 20 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. 
REPRODUCE LOCALLY. Include form number and date on all reproductions. OMB No. 0581-0178

SC-136A (Rev. 5/2017) Destroy previous editions.

COOPERATIVE ASSOCIATION REFERENDUM BALLOT

Marketing Order No. 982: Hazelnuts Grown in Oregon and Washington

Please read the attached VOTING INSTRUCTIONS AND RULES GOVERNING PRODUCER ELIGIBILITY TO 

VOTE before completing this Ballot. 

This referendum is being held to determine producer support for Marketing Order No. 982 (Order), 

regulating the handling of hazelnuts grown in Oregon and Washington. The Secretary of Agriculture 

(Secretary) will consider termination of this Order if less than two-thirds of those voting and less than 

two-thirds of the volume represented in the referendum favor continuance. 

A. Do you favor continuance of Marketing Order No. 982, regulating the handling of hazelnuts 

grown in Oregon and Washington?

 YES  NO

COOPERATIVE ASSOCIATION ELIGIBILITY STATEMENT

B. Contact Name _________________________________ Phone Number _____________

Name of Cooperative Association __________________________________________________

Mailing Address ________________________________________________________________

City _______________________________ State _______________ Zip _________

What is the total tons of hazelnuts produced in the production area by the 

member producers of this cooperative association during the representative 

period from _____________, 20___ through ____________, 20___?

What is the total number of producers for which this cooperative 

association is casting this Ballot?

C. I hereby certify that the information I provided on this Ballot is accurate and correct to the 

best of my knowledge.

______________________________________ ________________________________

Signature* Title

*Your signature certifies that you have the authority to take such action and will submit supplementary evidence of 

such authority at the request of an agent of the Secretary. The information provided in this Ballot is required to 

determine the voter eligibility and vote of hazelnut producers. Falsification of information on this government 

document may result in a fine or imprisonment, or both. (18 U.S.C. 1001)

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.