Free Complaint - District Court of Delaware - Delaware

Case 1:05-cv-00792-Gl\/IS Document 1-3 Filed 11/15/2005 Page 1 of 1
AO rom as Recemr gow. 9/04)
United States District Court for the District of Delaware
Civil Action No. ii I l ii 2
ACKNOWLEDGM ENT
OF RECEIPT FOR AO FORM 85
NOTICE OFA VAILABILITY OFA
UNITED STA TES MAGISTRATE JUDGE
T O EXERCISE J URISDI CTI ON
I HEREBY ACKNOWLEDGE RECEIPT OF \3 COPIES OF AO FORM 85.
( I Lil igl Q5 Q lgiil/lllgggligg
_ (Date forms issued) (Signature of Patty or their Representative)
3;.: 2(Printed name of Party or their Representative) `
Note; Comgleted receigt will be tiled in the Civil Action