Case 1:05-cv-00424-SLR Document 1-3 Filed 06/23/2005 Page 1 of 1
AO FORM 85 RECEIPT 9/O4!
United States District Coun for the District of Delaware
_ _ _ et tg fi
Civil Action No.
ACKNOWLEDGMENT
OF RECEIPT FOR AO FORM 85
NOTICE OFA VAILABILITY OFA
UNITED STATES MAGISTRATE JUDGE
TO EXERCISE J URIS DI C T I ON
I HEREBY ACKNOWLEDGE RECEIPT OF I COPIES OF AO FORM 85.
(Date ibrrns lisstiedj I (Signature of drty ort /1, epresentative)
ilgzgéfiq C Cj/I w
(Printed name of Patti r their Representative)
Note: Completed receipt will be tiled in the Civil Action