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UNITED STATES DISTRICT COURT DISTRICT OF MASSACHUSETTS INSTRUCTIONS AND OTHER INFORMATION FOR COMPLETING FORM FOR CONSENT OR REFUSAL OF MAGISTRATE JUDGE JURISDICTION I. AUTHORITY The Court has entered a General Order (07-4), dated December 4, 2007 authorizing the assignment of civil cases to the Magistrate Judges sitting in Boston. That Order may be found on the Court's web page at www.mad.uscourts.gov II. PROCESS As the party initiating the civil action, you are responsible for serving the Court's General Order of December 4, 2007 and the consent form on all opposing parties. You are also responsible for contacting these attorneys or parties to inquire as to their consent or refusal to proceed before the Magistrate Judge. The document does not need to have a handwritten signature from each attorney or party. If the consent is unanimous you may enter an electronic signature on the consent form for each attorney or party in this style: `/s/ John Smith' (see the Court's CM/ECF Administrative Procedures for further information on electronic signatures). You may use multiple sheets if additional space is needed. The consent form is also available on the Court's web page. An example of a completed form is attached to these instructions. Should any party not consent, you should electronically file the form, after completing just the bottom part of the form. NOTE: The Court is not to be made aware of which party or parties did not consent to the Magistrate Judge's jurisdiction. The consent or refusal is to be filed electronically in the Court's CM/ECF system, using one of these items, found under the `Other Documents' menu: `Consent to Jurisdiction by US Magistrate Judge,' or `Refusal of Consent to Proceed Before a US Magistrate Judge.' III. CONSENT AND FURTHER PROCEEDINGS Should all parties consent to the Magistrate Judge's jurisdiction, the case will continue before the Magistrate Judge as any other civil case, including bench or jury trial, and the entry of final judgment, with direct review by the First Circuit Court of Appeals if any appeal is filed. See 28 U.S.C. § 636(c).

IV.

REFUSAL OF CONSENT Should any party not consent to the Magistrate Judge's jurisdiction, you are responsible for completing the lower portion of the consent/refusal form and electronically filing it with the Court through its CM/ECF system. While consent to the assignment of the case to the Magistrate Judge is entirely voluntary, and no adverse substantive consequences of any kind will redound to an attorney or party refusing to consent, submission of the executed form, memorializing consent or refusal to consent to final assignment to the Magistrate Judge, is mandatory. Should any party not consent to the Magistrate Judge's jurisdiction, or should the parties fail to submit the document at all, the courtroom deputy clerk will transmit the case file to the Clerk to have the case randomly assigned to a District Judge of this Court. If the District Judge issues an Order of Reference of any matter in this case to a Magistrate Judge, the matter will be transmitted to the previously assigned Magistrate Judge

V.

ADDITIONAL PARTIES Counsel or pro se parties filing a pleading that adds additional parties to the civil action are responsible for serving the General Order and the consent form with that pleading, and then filing the consent form.

UNITED STATES DISTRICT COURT DISTRICT OF MASSACHUSETTS ABC TRUCKING COMPANY Plaintiff v. MARY ALICE JONES Defendant NOTICE This case has been assigned to Magistrate Judge ___________________ for all purposes. Please read the attached General Order for further information regarding this assignment. Plaintiff, or defendant if the case is initiated by a Notice of Removal, is responsible for submitting this form to the Court advising that all parties consent to the Magistrate Judge's jurisdiction, or indicating that the consent is not unanimous. One document is to be filed. While consent to the assignment of the case to the Magistrate Judge is entirely voluntary, and no adverse substantive consequences of any kind will redound to an attorney or party refusing consent, submission of this executed form, memorializing consent or refusal to the final assignment to the Magistrate Judge is mandatory. This document is to be electronically filed with the Court within thirty days after the date of service on the last party. CONSENT TO PROCEED BEFORE A U.S. MAGISTRATE JUDGE (To Be Completed Only If All Parties Consent) In accordance with 28 U.S.C. § 636(c) and Rule 73(b) of the Federal Rules of Civil Procedure, the undersigned pro se party or counsel of record consent to have the above named Magistrate Judge conduct all further proceedings in this case, including bench or jury trial, and order the entry of final judgment, with direct review by the First Circuit Court of Appeals if any appeal is filed. Party Represented ABC Trucking Company Mary Alice Jones Civil Action No. 08-10356

EXAMPLE of
- - OR - Signature /s/ Phyllis Q. Harrison /s/ George S. Britt

Date 1/15/08 1/16/08

(If additional space is needed, additional forms may be attached)

REFUSAL TO CONSENT TO PROCEED BEFORE A U.S. MAGISTRATE JUDGE (To Be Completed If Any Party Declines to Consent - Please DO NOT Identify the Party) In accordance with General Order 07-4 , dated December 4, 2007, the parties advise the Court that at least one party does not consent to the Magistrate Judge's jurisdiction. The case will be randomly assigned to a U.S. District Judge for further proceedings. If you elect to have the case proceed before a U.S. District Judge, the above named Magistrate Judge shall continue to be assigned to this case to hear matters referred by the District Judge, in accordance with 28 U.S.C. § 636(b) and Rule 72 of the Federal Rules of Civil Procedure. Dated: ____________________________ ___________________________________________ Plaintiff or Removing Party (through counsel, if appropriate) ___________________________________________ ___________________________________________ ___________________________________________

CONSENT
BBO # Address:

UNITED STATES DISTRICT COURT DISTRICT OF MASSACHUSETTS ABC TRUCKING COMPANY Plaintiff v. MARY ALICE JONES Defendant NOTICE This case has been assigned to Magistrate Judge ___________________ for all purposes. Please read the attached General Order for further information regarding this assignment. Plaintiff, or defendant if the case is initiated by a Notice of Removal, is responsible for submitting this form to the Court advising that all parties consent to the Magistrate Judge's jurisdiction, or indicating that the consent is not unanimous. One document is to be filed. While consent to the assignment of the case to the Magistrate Judge is entirely voluntary, and no adverse substantive consequences of any kind will redound to an attorney or party refusing consent, submission of this executed form, memorializing consent or refusal to the final assignment to the Magistrate Judge is mandatory. This document is to be electronically filed with the Court within thirty days after the date of service on the last party. CONSENT TO PROCEED BEFORE A U.S. MAGISTRATE JUDGE (To Be Completed Only If All Parties Consent) In accordance with 28 U.S.C. § 636(c) and Rule 73(b) of the Federal Rules of Civil Procedure, the undersigned pro se party or counsel of record consent to have the above named Magistrate Judge conduct all further proceedings in this case, including bench or jury trial, and order the entry of final judgment, with direct review by the First Circuit Court of Appeals if any appeal is filed. Party Represented Civil Action No. 08-10356

EXAMPLE of
- - OR - Signature

Date

(If additional space is needed, additional forms may be attached)

REFUSAL TO CONSENT TO PROCEED BEFORE A U.S. MAGISTRATE JUDGE (To Be Completed If Any Party Declines to Consent - Please DO NOT Identify the Party) In accordance with General Order 07-4, dated December 4 , 2007, the parties advise the Court that at least one party does not consent to the Magistrate Judge's jurisdiction. The case will be randomly assigned to a U.S. District Judge for further proceedings. If you elect to have the case proceed before a U.S. District Judge, the above named Magistrate Judge shall continue to be assigned to this case to hear matters referred by the District Judge, in accordance with 28 U.S.C. § 636(b) and Rule 72 of the Federal Rules of Civil Procedure. Dated: 1/15/08 /s/ Phyllis Q. Harrison Plaintiff or Removing Party (through counsel, if appropriate) BBO # Address: 123456 9004 Main Street Cambridge, MA 02138

REFUSAL