Free Complaint - District Court of Delaware - Delaware

Case 1:05-cv—00918-SLR Document 1-3 Filed 12/29/2005 Page 1 of 1
AO FORM 85 RECEIPT SREV. 9/04)
United States District Court for the District of Delaware
Civil Action No.
ACKNOWLED GMENT
OF RECEIPT FOR AO FORIVI 85
NOTICE OFA VAILABILITY OFA
UNITED STATESMAGISTRATE JUDGE
T O EXERCISE J URISDI C T I ON
I HEREBY ACKNOWLEDGE RECEIPT OF COPIES OF AO FORM 85.
DEI} 2 9 ZEUE . I/. `
_ (Date forms issued) (Signature of Party ortheir Representative)
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I T__:Vf/Printed name of Party or their Representative) '
Note: Corngleted receigt will be tiled in the Civil Action