Free Complaint - District Court of Delaware - Delaware

l Case 1:05-cv-00636—G|\/IS Document 1-4 Filed 08/30/2005 Page 1 of 1
V
i AO 1=0RM ss RECEIPT (REV. 9/042
t United States District Ccurt for the District 0f Delaware
civu Action NO. 0 5 C (° 3 6
ACKNOWLED GMENT
OF RECEIPT FOR AO FORM 85
NOTICE OF A VAILABILITY OF A
UNITED STA TES MA GISTRA TE JUDGE
TO EXERCISE J URISDI CTI ON
I HEREBY ACKNOWLEDGE RECEIPT OF l COPIES OF AO FORM 85.
_ (Date Forms issued) (Signature of Party or their Re ntative)
‘ ____ ‘i(Printed name of Party or their Re esentative) A
Note: Comgleted receigt will be filed in the Civil Action