Case 1:05-cv-00809—***—lV|PT Document 1-3 Filed 11/22/2005 Page 1 of 1
AO Form as Rncarpr (asv. 9/O4)
United States District Court for the District ofDe1aware
C Civil Action No. C fi ·— M 8 Oli Q
ACKNOWLED GMENT
OF RECEIPT FOR AO FORM 85
NOTICE OF A VAILABILI T Y OF A
UNITED STATESMAGISTRATE JUDGE
TO EXERCISE .I URISDI C T I ON
I HEREBY ACKNOWLEDGE RECEIPT OF Q COPIES OF AO FORM 85.
J I isevzzirts gl) gl
_ (Date forms issued) (Signature oi`Party or their Representative)
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Q- _· I ;_(Printed name of Party or their Representative)
Note: Comgleted receigt will be iiied in the Civil Action