Case 1:05-cv—00796-SLR Document 1-3 Filed 11/17/2005 Page 1 of 1
AO FORM 85 RECEIPT EREV. 9/042
United States District Court for the District of Delaware
I Civil Action No. O 1; T 7 ___-
ACKNOWLEDGMENT
OF RECEIPT FOR AO FORM 85
NOTICE OF A VAILABILITY OFA
UNITED STATESMAGISTRA TE JUDGE
TO EXER CISE J URISDI CT I ON
I HEREBY ACKNOWLEDGE RECEIPT OF Li COPIES OF AO FORM 85.
l NUV17?-GUS I
_ (Date forms issued) Signature of Party or their Repre ntative)
.iii E { E, rxlawéagca
"’ ;[Printed name of Party or their Rep sentative)
Note: Cornpleted recei t will be tiled in the Civil Action