THIS FORM MUST BE FILED IN PAPER FORMAT AND CANNOT BE FILED ELECTRONICALLY
IMPORTANT: RETURN THIS FORM TO THE CLERK'S OFFICE PROMPTLY, BUT NOT LATER THAN TWENTY DAYS AFTER YOUR APPEARANCE, ANSWER OR RESPONSIVE PLEADING UNITED STATES DISTRICT COURT EASTERN DISTRICT OF MISSOURI EASTERN DIVISION ) ) ) ) ) ) ) ) ) )
Reset
Plaintiff(s),
vs.
Case No.
Defendant(s),
CONSENT TO JURISDICTION BY UNITED STATES MAGISTRATE JUDGE In accordance with the provisions of Title 28, U.S.C. Sec. 636(c)(1), the undersigned (party*) ) in the above-captioned civil matter hereby (counsel of record for voluntarily consents to have a United States Magistrate Judge conduct any and all further proceedings in the case, including trial and entry of a final judgement, with direct review by the Eighth Circuit Court of Appeals if an appeal is filed. Date: Signature Print Name:
DISTRICT JUDGE OPTION Pursuant to Title 28, U.S.C. Sec. 636(c)(2), the undersigned (party*) (counsel of record for ) in the above-captioned civil matter hereby acknowledges the availability of a United States Magistrate Judge but elects to have this case randomly assigned to a United States District Judge. Date: Signature Print Name:
CERTIFICATE OF SERVICE I hereby certify that a true copy of the foregoing Consent was served (by mail) (by hand delivery) on all parties of record in this cause, this day of , 20 .
Signature
Corporations may execute only by counsel