Case 1:05-cv-00345-SLR Document 1-12 Filed 05/27/2005 Page 1 of 1
AO FORM 85 ECEHYF IREV. 9/04)
United States District Court for the District of Delaware
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ACKNOWLEDGMENT
OF RECEIPT FOR AO FORM 85
NOTICE OFAVAILABILITY OFA
UNITED STATES MAGISTRATE JUDGE
T O EXERCISE J URISDI C T I ON
I HEREBY ACKNOWLEDGE RECEIPT OF COPIES OF AO FORM 85.
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(D te forms issued) l (Signature ot` Party or thei eprr l entative)
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(Printed name of Party or their Representative)
Note: Completed receipt will be tiled in the Civil Action