Free Complaint - District Court of Delaware - Delaware

Case 1:05-cv-00393—Gl\/IS Document 1-4 Filed 06/14/2005 Page 1 of 1
AOFORM 85 R.ECEIP'l` [REV. 9/O4!
United States District Court ter the District ef Delaware
Civil Actien N0. _ D D D D TD D DD _____ DAD)
ACKNOWLEDGMENT
OF RECEIPT FOR AO FORM 85
NOTICE OF A VAILABILI TY OF A
UNITED STA TES MA GIS TRA TE JUDGE
TO EXERCISE J URISDI CTI ON
1 HEREBY ACKNOVVLEDGE RECEIPT OF ` COPIES er AO FORM ss.
` E ` , { ih
mz A
(Date forms issued) Si nsture •‘ any er their Representative)
· (Printed name ef Patty or their Representative)
Note: Completed receigt will be filed in the Civil Action