Case 1:05-cv—00923-SLR Document 1-4 Filed 12/30/2005 Page 1 cf 1
AO Perm as rzacairr gruzv. 9/04)
United States District Ceurt fer the District of Delaware
_ _ _ Ct .;§- Q 2
) Civil Action N0. __
O ACKNOWLED GMENT ‘
OF RECEIPT FOR AO FORM 85
NOTICE OFA VAILABILITY OFA
UNITED STA TES MAGISTRATE JUDGE
T O EXERCISE J URISDI CTI ON
I HEREBY ACKNOWLEDGE RECEIPT OF Q COPIES OF AO FORJVI 85.
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_ n (Date forms issued) l (Signature et; Party er their Representative)
S )\'I(}OQ.. \"{()t°\A Pl
‘ ri"-(PI`iI1t€·d name cf Party er their Representative) I
Note: Curngleted receigt will be tiled in the Civil Action A