Free Complaint - District Court of Delaware - Delaware

Case 1:05—cv—00916-TNO Document 1-3 Filed 12/29/2005 Page 1 of 1
A0 Form 85 RECEIPT gmav. 9/04)
United States District Court for the District of Delaware
Civil Action No. _ _ _ _
ACKNOWLEDGMENT
OF RECEIPT FOR AO FORM 85
NOTICE OF A VAILABILI TY OF A
UNITED STATESMAGISTRATE JUDGE ,
T O EXERCISE J URISDI CTI ON
`
I HEREBY ACKNOWLEDGE RECEIPT OF 6 COPIES OF AO FORM 85.
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_ K (Date forms issued) (Signature of Party or their Representative)
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‘ _‘ ;A(Printed name of Party or their Repre entative) `
Note: Comgleted receigt will be tiled in the Civil Action