Case 1:05-cv-0019iAJ Document 1-3 Filed O4/ O5 Page 1 of 1
AO rom as mzctanw (nav. om;
United States District Court for the District of Delaware
( L T Q 2;:
Civil Action N0.
ACKNOWLEDGMENT
OF RECEIPT FOR AO FORM 85
NOTICE OF A VAILABILI TY OF A
UNITED STATES MAGISTRATE JUDGE
TO EXERCISE J URISDICT ION
I I-IEREBY ACKNOWLEDGE RECEIPT OF COPIES OF AO FORM 85.
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(Date forms issued) (Signattiie of Party or their Representative)
I is . I / i I
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(Printed name of Party or their Representative)
Note: Comgleted receigt will be filed in the Civil Action