Case 1 :06-cv-00013-SLR Document 1-4 Filed 01/06/2006 Page 1 of 1
AO FORM S5 RECEIPT SREV. 9/O4!
I United States District Court for the District of Delaware
Civil Action No.
ACKNOWLED GMENT
OF RECEIPT FOR AO FORM 85
NOTICE OF A VAILABILI T Y OF A
UNITED STATES.MAGISTRATE JUDGE
T O EXERCISE J URISDI C T I ON
I HEREBY ACKNOWLEDGE RECEIPT OF l COPIES OF AO FORM 85.
pal Q s ana /U§%,Q,`
_ (Date forms issued) (Signature of Party or t eir Representative)
O))—i M/lj /l/H;//QB
f ::V__;_(Printed name of Party or their Representative) '
Note: Completed receipt will be tiled in the Civil Action