Free Complaint - District Court of Delaware - Delaware

Case 1:05-cv-00645-SLR Document 1-4 Filed O9/O2/2005 Page 1 of 1
AO FORM B5 R.ECEll’TtREV. 9/04t
United States District Court for the District of Delaware
Civil Action No. _ ig mi p _
ACKN OW LEDGMENT
OF RECEIPT FOR AO FORM 85
NOTICE OFA VAILABILITY OFA
UNITED STATES MA GISTRATE JUDGE
T 0 EXERCISE J URISDI C T I ON
1 HEREBY ACKNOWLEDGE RECEIPT or il. COPIES OF AO FORM ss.
F A E O) i t A I A
(Date forms issued) (S nat r of Part -or their Representative)
up -·iPrinted name of Party or their Representative)
Note: Completed receipt will be filed in the Civil Action