UNITED STATES DISTRICT COURT
XXXXXX DISTRICT OF XXXXXX
Plaintiff,
vs.
F Docket No. XXXX
Defendant.
CONSENT TO JURISDICTION BY A UNITED STATES MAGISTRATE JUDGE
In accordance with the provisions of Title 28, U.S.C. § 636(c), the undersigned party or parties to the above-captioned civil matter hereby voluntarily consent to have a United States magistrate judge conduct any and all further proceedings in the case, including trial, and order the entry of a final judgment.
Date Signature
Note: Return this form to the Clerk of the Court if you consent to jurisdiction by a magistrate judge. Do not send a copy of this form to any district judge or magistrate judge.